To the Editor:
In support of their belief that sarcoidosis mortality is higher in African-Americans than Caucasians, Luisetti et al. 1 cited the Gideon and Mannino study 2 which reported a US sarcoidosis mortality ratio, African-American: Caucasian, of 14:1. The incidence rate ratio 3 has been estimated at 13:1. Thus, the differential mortality is attributable to a difference in case rate, not to a difference in case-fatality rate. Regarding differences in ethnic severity: Reisner 4 reported that, in a New York City health clinic in which 79% of the patients with intrathoracic sarcoidosis were African-American, they constituted only 66% of those experiencing an adverse course (defined as radiographic or clinical deterioration). We found no discernible difference in outcome by stage between African-Americans and Caucasians in a US health maintenance organization 5.
In summary, the proposition that African-Americans with sarcoidosis experience a more unfavourable outcome than do Caucasians is open to question.
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