# Unequal Burdens: Exploring Racial Differences in Sarcoidosis-Related Deaths Due to Pulmonary Hypertension Versus Fibrosis in the United States (1999-2023)

## TL;DR

Black Americans with sarcoidosis are more likely to die from pulmonary hypertension than white Americans, who are more likely to die from pulmonary fibrosis, highlighting racial disparities in disease outcomes.

## Contribution

This study reveals racial differences in sarcoidosis-related mortality causes, specifically pulmonary hypertension and fibrosis, in the U.S. from 1999 to 2023.

## Key findings

- Pulmonary deaths with sarcoidosis increased from 1999 to 2023, with a notable rise from 2018 to 2020.
- Black individuals, especially women, are more likely to die from pulmonary hypertension compared to white individuals, who are more likely to die from pulmonary fibrosis.

## Abstract

Introduction

Sarcoidosis disproportionately affects Black Americans, who report a higher incidence (17.8 per 100,000) compared to White Americans (8.1 per 100,000) and also experience greater disease severity, leading to an overall worse prognosis. Despite these trends, racial differences in cause-specific mortality among patients with sarcoidosis remain unexplored. In light of this, we aimed to assess longitudinal trends in mortality rates attributed to pulmonary causes of death among individuals with comorbid sarcoidosis.

Methods

We conducted a retrospective repeated cross-sectional study to determine the cause of death attributed to pulmonary deaths with comorbid sarcoidosis in the United States from 1999 to 2023. The data were obtained from the Centers for Disease Control and Prevention’s Wide Ranging Online Data for Epidemiologic Research (CDC WONDER) database, which includes the underlying and contributing causes of death from all death certificates in the United States.

Results

Of the 24,156 pulmonary deaths with comorbid sarcoidosis identified, 61.1% were women, and nearly 50% were aged 55-74 years. The age-adjusted mortality rate (AAMR) increased from 2.7 (95% confidence interval (CI): 2.5-3.0) per million in 1999 to 4.8 (95% CI: 4.5-5.1) in 2023. The annual percentage change (APC) was +1.1% (95% CI: 0.85-1.35) from 2001 to 2018, with a marked rise from 2018 to 2020 (APC: +10.36%, 95% CI: 4.50-16.54). Pulmonary fibrosis (PF) and pulmonary hypertension (PH) constituted 70% of pulmonary deaths with sarcoidosis. When stratified by race, Black individuals are more likely to die from PH (37.3%), with a greater burden in Black women (40.5%). In contrast, White individuals most commonly died from pulmonary fibrosis (PF) (52.8%).

Conclusions

Pulmonary deaths in sarcoidosis have increased over the past two decades, with racial disparities evident in underlying phenotypes. Black individuals, especially Black women, are more likely to die from PH, while White individuals disproportionately die from fibrosis. These findings highlight the importance of phenotype-specific screening strategies and equity-focused clinical interventions.