Annals of the American Thoracic Society

Rationale: United States veterans represent an important population to study sarcoidosis. Their unique history of environmental exposures, wide geographic distribution, and long-term enrollment in a single integrated healthcare system provides an unparalleled opportunity to understand the incidence, prevalence, and risk factors for sarcoidosis.

Objectives: To determine the epidemiology, patient characteristics, geographic distribution, and associated risk factors of sarcoidosis among U.S. veterans.

Methods: We used data from the Veterans Health Administration (VHA) electronic health record system between 2003 and 2019 to evaluate the annual incidence, prevalence, and geographic distribution of sarcoidosis (defined using the International Classification of Diseases codes). We used multivariate logistic regression to examine patient characteristics associated with sarcoidosis incidence.

Results: Among more than 13 million veterans who received care through or paid for by the VHA, 23,747 (0.20%) incident diagnoses of sarcoidosis were identified. Compared with selected VHA control subjects using propensity score matching, veterans with sarcoidosis were more likely to be female (13.5% vs. 9.0%), of Black race (52.2% vs. 17.0%), and ever–tobacco users (74.2% vs. 64.5%). There was an increase in the annual incidence of sarcoidosis between 2004 and 2019 (from 38 to 52 cases/100,000 person-years) and the annual prevalence between 2003 and 2019 (from 79 to 141 cases/100,000 persons). In a multivariate logistic regression model, Black race (odds ratio [OR], 4.49; 95% confidence interval [CI], 4.33–4.65), female sex (OR, 1.64; 95% CI, 1.56–1.73), living in the Northeast compared with the western region (OR, 1.57; 95% CI, 1.48–1.67), history of tobacco use (OR, 1.36; 95% CI, 1.31–1.41), and serving in the Army, Air Force, or multiple branches compared with the Navy (OR, 1.08; 95% CI, 1.03–1.13; OR, 1.10; 95% CI, 1.04–1.17; OR, 1.27; 95% CI, 1.16–1.39, respectively) were significantly associated with incident sarcoidosis (P < 0.0001).

Conclusions: The incidence and prevalence of sarcoidosis are higher among veterans than in the general population. Alongside traditionally recognized risk factors such as Black race and female sex, we found that a history of tobacco use within the Veterans Affairs population and serving in the Army, Air Force, or multiple service branches were associated with increased sarcoidosis risk.

Correspondence and requests for reprints should be addressed to Mohamed I. Seedahmed, M.D., M.P.H., Division of Pulmonary, Critical Care, Allergy and Immunology, and Sleep, Department of Medicine, University of California San Francisco, Helen Diller Medical Center, 513 Parnassus Avenue, HSE 1314, Box 0111, San Francisco, CA 94143. E-mail: .

Supported by funds from the National Center for Advancing Translational Science, National Institutes of Health, through the University of California San Francisco (UCSF) - Clinical Research Informatics Postdoctoral (CRISP) Fellowship Award UCSF-CTSI grant TL1-5TL1TR001871-05 (M.I.S.); UCSF Research Resource Allocation Program (RAP) grant (M.I.S.); California Tobacco-related Disease Research Program grant T29IR0715 (M.A.); and Flight Attendant Medical Research Institute grant CIA190001 (M.A.). This work is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author Contributions: All authors have read and approved the final manuscript. Conceived and designed the study research: M.I.S., C.E.M., M.A.W., L.L.K., and M.A. Worked on the methods: M.I.S., A.D.B., J.C., M.T.A., Y.L., C.E.M., M.A.W., L.L.K., and M.A. Analyzed and interpreted data: M.I.S., A.D.B., J.C., M.T.A., Y.L., C.E.M., M.A.W., L.L.K., and M.A. Writing – original draft: M.I.S. Writing – review & editing: M.I.S., A.D.B., M.T.A., C.E.M., M.A.W., L.L.K., and M.A. Obtained funding: M.I.S., M.A., and M.A.W.

This article has a related editorial.

This article has a data supplement, which is accessible from this issue’s table of contents at

Author disclosures are available with the text of this article at

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Annals of the American Thoracic Society

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