Published ahead of print on September 3, 2004, doi:10.1164/rccm.200402-249OC
Am. J. Respir. Crit. Care Med., Volume 170, Number 12, December 2004, 1324-1330
A more recent version of this article appeared on December 15, 2004
Submitted on February 27, 2004
Accepted on August 26, 2004
A Case Control Etiologic Study of Sarcoidosis: Environmental and Occupational Risk Factors
Lee S Newman1*, Cecile S Rose1, Eddy A Bresnitz2, Milton D Rossman3, Juliana Barnard1, Margaret Frederick4, Michael L Terrin4, Steven E Weinberger5, David R Moller6, Geoffrey McLennan7, Gary Hunninghake7, Louis DePalo8, Robert P Baughman9, Michael C Iannuzzi8, Marc A Judson10, Genell L Knatterud4, Bruce W Thompson4, Alvin S Teirstein8, Henry Yeager, Jr.11, and Carol J Johns
1 National Jewish Medical and Research Center and University of Colorado Health Sciences Center, Denver, CO, USA,
2 New Jersey Department of Health and Senior Programs, Trenton, NJ, USA,
3 University of Pennsylvania and Medical College of Pennsylvania-Hahnemann University Medical Centers, Philadelphia, PA, USA,
4 Clinical Trials and Surveys Corporation, Baltimore, MD, USA,
5 Beth Israel Deaconess Medical Center, Boston, MA, USA,
6 Johns Hopkins University School of Medicine, Baltimore, MD, USA,
7 University of Iowa College of Medicine, Iowa City, IA, USA,
8 Mount Sinai Medical Center, New York, NY, USA,
9 University of Cincinnati Medical Center, Cincinnati, OH, USA,
10 University of South Carolina, Charleston, SC, USA,
11 Georgetown University Medical Center, Washington, DC, USA
* To whom correspondence should be addressed. 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 sarcoidosis patients and an equal number of age-, race-, and gender-matched controls. Interviewers administered questionnaires containing questions regarding occupational and non-occupational 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]; and 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 controls (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: sarcoidosis,granulomas,environment,occupation, etiology
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