Abstract
This multicentre, international, prospective cohort study evaluated whether patients with pulmonary sarcoidosis living in neighbourhoods with greater material and social disadvantage experience worse clinical outcomes. The area deprivation index (ADI) and the Canadian Index of Multiple Deprivation (CIMD) evaluate neighbourhood-level disadvantage in the U.S. and Canada, with higher scores reflecting greater disadvantage. Multivariable linear regression evaluated associations of disadvantage with baseline forced vital capacity (FVC) or diffusion capacity for carbon monoxide (DLCO); linear mixed effects models for associations with rate of FVC or DLCO decline; and competing hazards models were used for survival analyses in the U.S. cohort, evaluating competing outcomes of death or lung transplantation. Adjustments were made for age at diagnosis, sex, race, and smoking history. We included 477 U.S. and 122 Canadian patients with sarcoidosis. Higher disadvantage was not associated with survival or baseline FVC. The highest disadvantage quartile was associated with lower baseline DLCO in the U.S. cohort (β=−6.80, 95%CI −13.16 to −0.44, p=0.04), with similar findings in the Canadian cohort (β=−7.47, 95%CI −20.28 to 5.33, p=0.25); with more rapid decline in FVC and DLCO in the U.S. cohort (FVC β=−0.40, 95%CI −0.70 to −0.11, p=0.007; DLCO β=−0.59, 95%CI −0.95 to −0.23, p=0.001); and with more rapid FVC decline in the Canadian cohort (FVC β=−0.80, 95%CI −1.37 to −0.24, p=0.003). Patients with sarcoidosis living in high disadvantage neighbourhoods experience worse baseline lung function and more rapid lung function decline, highlighting the need for better understanding of how neighbourhood-level factors impact individual patient outcomes.
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- Received July 18, 2022.
- Accepted August 18, 2022.
- Copyright ©The authors 2022
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