A Current Assessment of Rurally Linked Exposures
as Potential Risk Factors for Sarcoidosis
DANIEL K. KAJDASZ, PhD, DANIEL T. LACKLAND, DrPH,
LAWRENCE C. MOHR, JR., MD, AND MARC A. JUDSON, MD
Elsevier Science Inc. All rights reserved.
Ann Epidemiol2001;11:111-117. 02001
PURPOSE: To identify and quantify the risk of developing sarcoidosis associated with specific rural exposures previously recognized as potential risk factors for this disease.
METHODS: A matched case-control design was carried out,
with a 2-to-l ratio of controls to cases. Case exposure histories
were determine from a detailed questionnaire collecting self-reported
information covering the period from birth through disease development
and comparing that to exposure exposure histories for the corresponding
period in age-, race, and gender .matched controls Identified
using Random Digit Dial Survey
Methodology
CONCLUSIONS: The results of this study provide further support for the hypothesis that behaiviors associated with rural living play some role in the development of sarcoidosis. This study further suggests that exposures involving the handling or burning of wood for home heating may, in part, explain this rural association.
KEY WORDS: Case-Control Studies, Environmental Exposure, Epidemiology, Sarcoidosis.
INTRODUCTION
Sarcoidosis is a systemic granulomatous reticulosis of unknown
etiology that may involve any tissue or organ system, but most
often effects the lungs, lymph nodes, skin, eyes, and liver.
(l). Since this disorder was first documented 100 years ago, knowledge
of the clinical and epidemiological aspects of the disease has
progressed dramatically. However,
The etiology(s) of sarcoidosis remains unknown. A variety of environmental,
occupationa1,infectious, and genetic risk factors have been studied
over the last 50 years, but no sillgle eXPOSUre haS been foUnd
which consistencly ""d completely explains the distribution
of sarcoidosis (2-4). Epidemiological studieS Of Sarcoidosis in
the US have consistently documented an increased risk for sarcoidosis
i,
the Southeast and rural areas of the US (5-13). It i,,,
known if a single risk factor is responsible f,, both of these
Address reprint requeSlS to: Daniel Lackland, DrPH, Department
of Biometry and Epidemiology, Medical University of South Carolina,
R,tledge Tower llZ5, Charleston, SC 29425
DENVER -- April 24, 1997 -- "Sarcoidosis is a result of
an unknown
environmental agent," says Lee Newman, M.D., a National Jewish
Medical and
Research Center physician. "Sarcoidosis is a mystery disease.
There's
probably more than one cause."
Dr. Newman's "Medical Progress" report in the April
24 edition of the New
England Journal of Medicine outlines what the medical community
has learned
about the disease during the past 10 years and the best ways to
treat it.
Sarcoidosis -- the most common type of interstitial lung disease
-- attacks
the entire body, focusing on the lungs, eyes, skin and organs.
It is
characterized by inflamed, microscopic growths called granulomas,
most often
found in the lungs. Sarcoidosis can cause redness in the eyes,
shortness of
breath, bumps on the skin, fatigue, fever and general pain caused
by
exposure to light. Oral corticosteroids are used to treat sarcoidosis.
About 3 percent of African-American women risk getting the
disease sometime
during their adult lives. It typically affects people between
the ages of
20-40. The disease is slightly less common in African-American
men, and
Caucasian women and men. In the United States, 30 people in every
100,000,
in all ethnic groups, have sarcoidosis.
"Sarcoidosis shows up in every medical practice in the
country," says Dr.
Newman, director of the National Jewish Division of Environmental
and
Occupational Health Sciences.
Sarcoidosis apparently isn't contagious, but researchers believe
shared
environmental exposure, such as living in the same house or town,
or working
in the same building, may lead to the disease. For example, sarcoidosis
is
more common in health care workers, especially nurses, and in
rural areas.
"It tends to run in families," says Dr. Newman, who
has treated people with
sarcoidosis for more than 15 years. "If there's one person
in a family with
sarcoidosis, then there is as much as a 16 percent chance another
family
member will contract the disease."
Health care providers have learned:
-- About 50 percent of people need little or no treatment because
sarcoidosis eventually passes on its own;
-- Less than 5 percent of people with sarcoidosis die;
-- It occurs when the body's immune system overreacts to an unknown
agent;
-- It "masquerades" as other diseases, such as hepatitis,
dermatitis,
arthritis, tuberculosis and asthma;
-- About 50 percent of patients have at least some permanent organ
damage;
-- New ways of treating the disease are being developed that focus
on
controlling the immune system's over-reaction;
-- National Jewish is one of ten medical centers funded by the
National
Institutes of Health to conduct a study examining the causes of
this mystery
disease.
For more information about sarcoidosis, call LUNG LINE, (800) 222-LUNG.
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