AN EPIDEMIOLOGIC ANALYSIS OF SARCOIDOSIS IN NC

ECU Author/Contributor (non-ECU co-authors, if there are any, appear on document)

David Wambui (Creator)

Institution

East Carolina University (ECU )

Web Site: http://www.ecu.edu/lib/

Abstract: Sarcoidosis is a rare, complex inflammatory chronic condition that commonly affects the lymphatic system and the lungs. The clinical course of sarcoidosis can vary from acute to progressively chronic conditions including organ dysfunction, other comorbidities and even death. The etiology of sarcoidosis remains largely unknown and there is no cure. Risk factors includes being African American or black race, low socio-economic status, unhealthy lifestyle behavior, and a history of environmental/occupational exposures to antigens. In the U.S., the mortality rate of sarcoidosis is 10 to 11 times higher among African Americans compared to whites. North Carolina (NC) ranks fourth in the nation with the highest sarcoidosis mortality rates. Despite these facts, little published research is available, and no studies have explored the epidemiology of sarcoidosis mortality of NC using a population-based approach. Sarcoidosis in NC is an important public health concern that needs to be further investigated. The overarching aims of this project were to examine sarcoidosis mortality using an applied, public health practice approach. The primary objectives of this study were multifaceted, including, 1) synthesizing relevant literature to examine the relationship between increased risk of physician diagnosed sarcoidosis and exposures to respirable particles\; 2) detecting spatial clusters or hotspots of sarcoidosis deaths\; 3) evaluating sarcoidosis mortality risk factors and their spatial-temporal distribution in NC\; 4) determining common demographic and clinical characteristics among sarcoidosis patients in the East Carolina University Sarcoidosis Patients Registry (ECUSaR)\; and 5) developing information brochure for ECUSaR .Systematic review and meta-analysis were used to synthesize literature and examine the association between exposure to respirable particles and physician diagnosed sarcoidosis. Spatial distributions of sarcoidosis mortality risk factors, County-level analysis of sarcoidosis mortality clustering, and outlier analysis were performed. To assess the factors associated with observed spatial temporal mortality patterns, a multivariate linear regression model with region, percent of Africa Americans, percent of people working in nature, percent of obese adults and average annual ambient PM2.5 as predictor variables was conducted. Descriptive statistics were conducted to explore sociodemographic and clinical characteristics of sarcoidosis patients in ECUSaR. Although the pooled risk estimated from meta-analysis showed an increase in risk among those exposed to respirable particles compared to the unexposed (odds ratio (OR)=2.18, 95% confidence interval (CI) =0.79 - 5.79), the estimated risk was not statistically significant. Eastern NC had higher sarcoidosis mortality rate (1.16 per 100,000) compared to Piedmont (0.49 per 100,000) and Western (0.32 per 100,000) regions. Statistically significant sarcoidosis mortality clusters were detected in Eastern NC with p-value <0.001 for Global Moran's I. Similarly, associated sociodemographic (percent of African Americans, p-value <0.001, percent of obese adults, p-value <0.001) and environmental (percent working in nature, p-value <0.001) sarcoidosis risk factors were more prevalent in Eastern NC compared to Piedmont and Western regions. Region and percent of African American population were statistically significant predictors of sarcoidosis mortality. Results from the ECUSaR registry identified that most patients were of African American (85.4%) decent, and females accounted for 67.5% of all patients. Body mass index (BMI) was higher among females than males (median =33, Q1 (25th percentile) = 27.6 and Q3 (75th percentile) = 39.1 and median =29, Q1= 24.6 and Q3 = 32.2, respectively). Approximately 42% of patients had restricted lung function which was indicative of majority of patients (>95 %) presenting with pulmonary sarcoidosis. This dissertation advances the field of public health by describing the epidemiology of sarcoidosis mortality, associated risk factors, demographic, spatial, temporal, and clinical characteristics of sarcoidosis in NC. Evidently, Eastern NC region disproportionately bears the largest sarcoidosis mortality burden in the state. This disproportionality could be explained by the prevalence of associated sociodemographic and environmental risk factors in the region. More robust studies that are directed towards uncovering and explaining the patterns that this study has identified may help understand better and develop strategies to minimize sarcoidosis burden in the region.

Additional Information

Publication

Dissertation

Language: English

Date: 2023

Subjects

Epidemiology;North Carolina;Mortality;Spatial Distribution;Pulmonary Sarcoidosis;East Carolina University Sarcoidosis Patients Registry

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