Age, comorbidity, race and gender differences in referral to a pulmonologist among patients with sarcoidosis at a large academic medical center

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BACKGROUND: Prior work has reported differences in the prevalence of sarcoidosis as well as patient outcomes based on race, gender, and socioeconomic status. We investigated whether sociodemographic factors were associated with referral to pulmonary medicine at a large academic center for patients with an incident international classification of diseases (ICD) diagnosis of sarcoidosis. METHODS: We conducted a single-center retrospective study examining the associations between sociodemographic factors and time to pulmonary medicine referral in patients with an incident ICD diagnosis of sarcoidosis between October 31, 2011, and October 30, 2021. In our center, referral to pulmonary medicine for sarcoidosis is equivalent to referral to the sarcoidosis clinic. Additional outcomes were associations between pulmonology referral and receiving a pulmonary function test (PFT), electrocardiogram (EKG), or computed tomography scan of the chest (CT-chest). RESULTS: We identified 1,017 patients with an incident ICD diagnosis of sarcoidosis. Only 276 (27%) were referred to pulmonary medicine within 1 year of diagnosis. In a Cox proportional hazards model incorporating race, gender, area deprivation index (ADI), age, and tobacco use, Black males (HR = 0.57; 95% = CI 0.38, 0.86) and White females (HR = 0.62; 95% CI = 0.45, 0.85) were less likely to be referred to pulmonary medicine compared to White males. ADI was not associated with time to referral while increasing age (HR = 0.97, 95% = CI 0.96, 0.98) was associated with a decreased likelihood of referral. In a sensitivity analysis incorporating the Charlson Comorbidity Index (CCI), increasing CCI was associated with decreased likelihood of referral (HR = 0.88, 95% = CI 0.80, 0.96). Patients referred to pulmonary medicine were more likely to have received a PFT, EKG, and CT-chest within 1 year of diagnosis. CONCLUSION: In our cohort of patients with an incident ICD diagnosis of sarcoidosis, Black males, White females, older adults, and adults with more comorbidities were less likely to be referred to pulmonary medicine. Referrals were associated with receiving recommended screening tests for cardiopulmonary disease. Given that pulmonary medicine manages the sarcoidosis clinic at our institution, our findings highlight the importance of considering the impact of sociodemographic factors on referral to a sarcoidosis specialist.

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