Income and Other Contributors to Poor Outcomes in US Sarcoidosis Patients.

Abstract

RATIONALE\nSocioeconomic factors are associated with worse disease severity at presentation in sarcoidosis, but the relative importance of socioeconomic variables on morbidity and disease burden has not been fully elucidated.\n\n\nOBJECTIVES\nTo determine the association between income and sarcoidosis outcomes after controlling for socioeconomic and disease-related factors.\n\n\nMETHODS\nUsing the Sarcoidosis Advanced Registry for Cures (SARC) database, we analyzed data from 2318 United States sarcoidosis patients to determine the effect of income and other variables on outcomes. We divided comorbidities arising after diagnosis into those likely related to steroid use and those likely related to sarcoidosis. We assessed the development of health-related, functional and socioeconomic outcomes following the diagnosis of sarcoidosis.\n\n\nMEASUREMENTS AND MAIN RESULTS\nIn multivariate analysis, low income patients had significantly higher rates of new sarcoidosis related comorbidities [<$35,000 OR 2.4 (1.7-3.3), $35,000-$85,000 OR 1.4 (1.1-1.9), >$85,000 (REF)], new steroid related comorbidities [<$35,000 OR 1.3 (0.9-2.0), $35,000-$85,000 OR 1.5 (1.1-2.1), >$85,000 (REF)], had lower health-related quality of life as assessed by the Sarcoidosis Health Questionnaire (p<0.001) and experienced more impact on family finances [<$35,000 OR 7.9 (4.9-12.7), $35,000-$85,000 OR 2.7 (1.9-3.9), >$85,000 (REF)]. The use of supplemental oxygen, need for assistive devices, and job loss were more common in lower income patients. Development of comorbidities after diagnosis of sarcoidosis occurred in 63% of patients and were strong independent predictors of poor outcomes. In random forest modeling, income was consistently a leading predictor of outcome.\n\n\nCONCLUSIONS\nThese results suggest the burden from sarcoidosis preferentially impacts the economically disadvantaged.