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A Case Control Etiologic Study of Sarcoidosis

Environmental and Occupational Risk Factors

Lee S. Newman, Cecile S. Rose, Eddy A. Bresnitz, Milton D. Rossman, Juliana Barnard, Margaret Frederick, Michael L. Terrin, Steven E. Weinberger, David R. Moller, Geoffrey McLennan, Gary Hunninghake, Louis DePalo, Robert P. Baughman, Michael C. Iannuzzi, Marc A. Judson, Genell L. Knatterud, Bruce W. Thompson, Alvin S. Teirstein, Henry Yeager, Jr., Carol J. Johns, David L. Rabin, Benjamin A. Rybicki and Reuben Cherniack the ACCESS Research Group^*

National Jewish Medical and Research Center and University of Colorado Health Sciences Center, Denver, Colorado; New Jersey Department of Health and Senior Programs, Trenton, New Jersey; University of Pennsylvania and Medical College of Pennsylvania-Hahnemann University Medical Centers, Philadelphia, Pennsylvania; Clinical Trials and Surveys Corp., and Johns Hopkins University School of Medicine, Baltimore, Maryland; Beth Israel Deaconess Medical Center, Boston, Massachusetts; University of Iowa College of Medicine, Iowa City, Iowa; Mount Sinai Medical Center, New York, New York; University of Cincinnati Medical Center, Cincinnati, Ohio; University of South Carolina, Charleston, South Carolina; Georgetown University Medical Center, Washington, DC; and Case Western Reserve University-Henry Ford Health Sciences Center, Detroit, Michigan

Correspondence and requests for reprints should be addressed to Lee S. Newman, M.D., M.A., Division of Environmental and Occupational Health Sciences, National Jewish Medical and Research Center, 1400 Jackson St., Room G212, Denver, CO 80206. E-mail: newmanL{at}njc.org

Past research suggests that environmental factors may be associated with sarcoidosis risk. We conducted a case control study to test a priori hypotheses that environmental and occupational exposures are associated with sarcoidosis. Ten centers recruited 706 newly diagnosed patients with sarcoidosis and an equal number of age-, race-, and sex-matched control subjects. Interviewers administered questionnaires containing questions regarding occupational and nonoccupational exposures that we assessed in univariable and multivariable analyses. We observed positive associations between sarcoidosis and specific occupations (e.g., agricultural employment, odds ratio [OR] 1.46, confidence interval [CI] 1.13–1.89), exposures (e.g., insecticides at work, OR 1.52, CI 1.14–2.04, and work environments with mold/mildew exposures [environments with possible exposures to microbial bioaerosols], OR 1.61, CI 1.13–2.31). A history of ever smoking cigarettes was less frequent among cases than control subjects (OR 0.62, CI 0.50–0.77). In multivariable modeling, we observed elevated ORs for work in areas with musty odors (OR 1.62, CI 1.24–2.11) and with occupational exposure to insecticides (OR 1.61, CI 1.13–2.28), and a decreased OR related to ever smoking cigarettes (OR 0.65, CI 0.51–0.82). The study did not identify a single, predominant cause of sarcoidosis. We identified several exposures associated with sarcoidosis risk, including insecticides, agricultural employment, and microbial bioaerosols.

Key Words: environment • etiology • granuloma • occupation • risk factors • sarcoidosis

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