Chest
Volume 140, Issue 5, November 2011, Pages 1261-1266
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Original Research
Pulmonary Vascular Disease
Increased Risk of Pulmonary Embolism Among US Decedents With Sarcoidosis From 1988 to 2007

https://doi.org/10.1378/chest.11-0324Get rights and content

Background

A recently published report from the United Kingdom suggested an association between sarcoidosis and pulmonary embolism (PE). We sought to examine whether this association was present among US decedents with sarcoidosis.

Methods

We used data from the National Center for Health Statistics to investigate the association between sarcoidosis and PE among US decedents from 1988 to 2007.

Results

From 1988 to 2007, there were 46,450,489 deaths in the United States and 23,679 decedents with sarcoidosis mentioned on their death certificates. Among these, 602 (2.54%) had PE mentioned on their death certificates, compared with only 1.13% of the background population (P < .0001 for comparison). The association between sarcoidosis and PE was significant regardless of gender (OR, 2.07; 95% CI, 1.80-2.39; P < .0001 for men and OR, 1.76; 95% CI, 1.59-1.96; P ≤ .0001 for women) or race (OR, 1.57; 95% CI, 1.41-1.76; P < .0001 for blacks and OR, 1.87; 95% CI, 1.63-2.14; P < .0001 for whites). Among decedents with sarcoidosis, there was no difference in risk of PE between men and women (2.30% vs 2.54%, χ2 = 1.32, P = .25) or between blacks and whites (2.60% vs 2.23%, χ2 = 3.09, P = .08). The association between sarcoidosis and PE held regardless of age.

Conclusions

Using death certificate data from 1988 to 2007, we detected an association between sarcoidosis and PE regardless of gender, race, or age. Further investigation is needed to decipher the mechanisms of this apparent association.

Section snippets

Materials and Methods

Briefly, we used multiple cause-of-death files, compiled and manipulated annually by the National Center for Health Statistics, that were derived from all US death certificates from 1988 to 2007. The National Center for Health Statistics applies computer algorithms to the death certificate data to produce a standardized “record axis.” The record axis includes up to 20 associated causes of death, including the underlying cause of death. A full description of the methods has been published

Results

From 1988 to 2007, there were 46,450,489 deaths in the United States, and 23,679 multiple cause-of-death records contained a diagnostic code for sarcoidosis. Table 1 shows that among decedents with sarcoidosis, 602 (2.54%) had PE mentioned on their death certificates, compared with only 1.13% of the background population (P < .0001 for comparison). The association between sarcoidosis and PE was significant regardless of gender (women: OR, 1.76; 95% CI; 1.59-1.96, P ≤ .0001 and men: OR, 2.07;

Discussion

We analyzed > 46 million records of US decedents from 1988 to 2007 and found that the risk of PE among the 23,679 people coded with sarcoidosis was more than twofold greater than the risk of PE in the background population, regardless of gender, race, or age. Among decedents with sarcoidosis, the risk of PE was independent of gender or race; men were just as likely as women to have PE, and whites were equally as likely as blacks to have PE. Any decedent with sarcoidosis, except those 45 to 55

Conclusions

In the United States from 1988 to 2007, > 2.5% of the 23,679 decedents with sarcoidosis had PE, more than twice the percentage observed in the background population. This increased risk of PE was present for both genders, blacks and whites, and for every age group. Among sarcoidosis decedents, men were equally as likely as women, and blacks were equally as likely as whites, to develop PE. What is driving the risk of PE in sarcoidosis requires further exploration; meanwhile, PE should be

Acknowledgments

Author contributions: Dr Swigris: contributed to the conception and design of the study, analysis and interpretation of the data, and drafting of the manuscript for important intellectual content.

Dr Olson: contributed to the conception and design of the study, analysis and interpretation of the data, and drafting of the manuscript for important intellectual content.

Dr Huie: contributed to the conception and design of the study, analysis and interpretation of the data, and drafting of the

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  • Cited by (0)

    Funding/Support: Dr Swigris is supported in part by a Career Development Award from the NIH [K23 HL092227].

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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