Elsevier

Clinics in Chest Medicine

Volume 18, Issue 4, 1 December 1997, Pages 681-694
Clinics in Chest Medicine

GLOBAL EPIDEMIOLOGY OF SARCOIDOSIS: What Story Do Prevalence and Incidence Tell Us?

https://doi.org/10.1016/S0272-5231(05)70412-3Get rights and content

Global epidemiologic studies of sarcoidosis were most actively made during the 1960s, partly stimulated by the pine pollen hypothesis proposed by Cummings.10 Since then, papers on the epidemiology of sarcoidosis appeared here and there in medical journals and proceedings of the international sarcoidosis conferences. * In this article, the recent informative papers are reviewed in the light of modern sarcoidology.

Section snippets

THE ROLE OF EPIDEMIOLOGY

Textbooks of clinical medicine often begin with “epidemiology” of the disease, by describing the distribution of patients' characteristics in terms of age, gender, race, and so on. As a result, many clinicians erroneously think the description of such distribution is a role only for epidemiology. The real role of epidemiology, however, is to search for the determinants of and ways to prevent the disease. There are two areas in epidemiology: One is the study of the distribution of disease

SCALES TO MEASURE FREQUENCIES OF SARCOIDOSIS39

Disease frequencies are measured by two scales in addition to death: (1) Incidence is the scale to measure only new cases that occur in a period of time (e.g., in 1996). The incidence rate is the number of new persons with a disease in a specified period divided by the number of a given population during that period. (2) Prevalence is the scale to measure all cases at hand, either newly or previously detected, at a specific point of time (e.g., January 1, 1996). The prevalence rate is the total

DIAGNOSTIC CRITERIA FOR THE EPIDEMIOLOGIC STUDY OF SARCOIDOSIS

The 1990 descriptive definition of sarcoidosis65 by the World Association of Sarcoidosis and Other Granulomatous Disorders is as follows: Sarcoidosis is a multisystem disorder of unknown cause(s). It commonly affects young and middle-age adults and frequently presents with bilateral hilar lymphadenopathy (BHL), pulmonary infiltration, and ocular and skin lesions. Liver, spleen, lymph nodes, salivary glands, heart, nervous system, muscles, bones, and other organs may also be involved. The

COLLECTION OF SARCOIDOSIS CASE INFORMATION

Symptomatic cases: Prevalence and incidence of symptomatic cases will be collected from hospital records.

Asymptomatic cases: Asymptomatic cases will be collected in two ways. One is the mass radiograph in which BHL is a clue; the other is incidental detection in association with medical examinations for other disease. Unless mass radiographs are conducted, the majority of cases would remain undetected.

The best incidence study of sarcoidosis therefore is based on the sarcoidosis registration

RECENT PREVALENCE AND INCIDENCE OF SARCOIDOSIS

The global prevalence and incidence studies of this disease have been reported in the proceedings of the international conferences on sarcoidosis8, 12, 15, 16, 32, 34, 40, 41, 43, 45, 51, 56, 57, 62 and elsewhere, as shown in Figure 1.37 In addition, recent prevalence and incidence data are described as reported in Scandinavian countries, the former German Democratic Republic, and Japan, because those countries have or had a similar mass-radiography system with a little racial mixture (Table 1).

WHAT THE EPIDEMIOLOGIC DATA TELL US

The data obtained from prevalence and incidence surveys may mirror overall character istics influenced by host and environmental (place, time) indicators, which are too closely interrelated to be studied separately without multivariate analysis. For the convenience of discussion, the following single indicators are observed.

A WORKING HYPOTHESIS OF THE CAUSE OF SARCOIDOSIS

In epidemiology, statistics are widely used for data analysis. Some laymen, who are so enthusiastic toward statistics, often have become P-value (probability) believers. Statistical methods cannot establish proof of a causal relationship in an association, however. Because epidemiology is not statistics, but medicine, an association must be judged by medical or biologic principles. When multiple comparisons are made between exposed and control groups, resulting in a 5% P level, for example, the

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      The prevalence rates range from 64 patients per 100,000 population in Sweden to 0,2 per 100,000 population in Portugal with in-between numbers observed in Denmark; (53 per 100,000); Germany (43), Ireland (40), Norway (27), The Netherlands (22), the United Kingdom (20), Switzerland (16), France (10), Hungary (5) and Spain (1,2). The prevalence for the Caucasian population of North America is 3 and for Afro-Americans 47 per 100,000 [8,9]. Sarcoidosis is found in all races affecting slightly more women than men.

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    Address reprint requests to Yutaka Hosoda, MD Institute of Radiation Epidemiology Radiation Effects Association Higashinakanol-41-4 Nakano Tokyo 164-0003 Japan

    *

    References8, 12, 15, 16, 32, 34, 40, 41, 43, 45, 51, 56, 57, 62

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