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Hospitalizations in sarcoidosis: a cohort study of a universal health care population

Fidler LM, Gershon A, Fisher JH, Stanbrook MB, To T, Balter M. Ann Am Thorac Soc. 2021; Apr 8 [Epub ahead of print]. DOI:

Rationale — Population-based analyses of hospitalization rates from countries with universal health care systems are lacking for patients with sarcoidosis.

Objectives — We aimed to evaluate the long-term trends in hospitalization rates and risk factors for hospitalization in patients with sarcoidosis in Ontario, Canada.

Methods — We performed a cohort study using health administrative data from Ontario, Canada between 1996 and 2015. Sarcoidosis patients were identified by ≥ 2 physician visits using International Classification of Diseases codes. All-cause and sarcoidosis-related hospitalization rates were age- and sex-standardized. Hospitalization rates between groups were analyzed using Cochran-Armitage and Breslow-Day tests. Associations between patient characteristics and hospitalization rates were evaluated using multivariable Poisson regression.

Results — In total, 18,550 individuals with sarcoidosis experienced 33,516 all-cause and 1,725 sarcoidosis-related hospitalizations. Adjusted all-cause hospitalization rates decreased from 206.4 to 152.1 per 1000 cases between 1996 and 2015 (26% decrease, p<0.001). The largest decrease in all-cause hospitalization occurred in patients 18-25 years old (67% decrease, p<0.001). Adjusted sarcoidosis-related hospitalization rates decreased from 21.8 to 4.2 per 1000 cases between 1996 and 2015 (80% decrease, p<0.001). The decrease in sarcoidosis-related hospitalizations was largest in women compared with men (87% vs. 72%, p=0.004) and in those 26-35 years old (91% reduction, p<0.001). Lower income [RR 1.16 (1.10-1.23), p<0.001)] and rural residence [RR 1.16 (1.08-1.24), p<0.001] were associated with increased all-cause hospitalizations.

Conclusions — Hospitalization rates in sarcoidosis patients have decreased over the past 20 years, most substantially in patients of younger age. Important differences in the risk of hospitalization exists based on gender, socioeconomic and geographic factors in patients with sarcoidosis.