Impact of Standard of Living on the 2-year course in sarcoidosis

Sarcoidosis is a granulomatous disease of uncertain etiology, characterized by significant clinical and epidemiological heterogeneity. Studies, mainly from the United-States, suggest a negative impact of low socio-economic status on sarcoidosis. We hypothesize that a low standard of living would have a negative impact on the 2-year course of sarcoidosis. Patients with thoracic sarcoidosis were selected from the consultation register of Avicenne pulmonary department. Their standard of living, calculated as household disposable income per consumption unit, was assessed on the median standard of living in a 200 x 200 m square provided by the French National Institute of Statistics and Economic Studies, according to their residential address. Patients were categorized into "modest" or "affluent" standard of living groups depending on whether their annual standard of living was estimated to be below or above 19,598 euros/year. A poor disease course at 2 years was defined by a "symptomatic under treatment in the last year" or "worsening under treatment in the last year" status according to the clinical outcome status (COS) classification. Multivariate logistic regression assessed associations between poor disease course and modest standard of living. 224 patients were included, of whom 54% were men. The median age at diagnosis was 44.5 years. Over a quarter of patients (26.6%, n=60) had a poor disease course at 2 years. After adjustment for age, sex, smoking status and geographical origin, modest standard of living remained significantly associated with a poor disease course (OR: 3.09, CI95%: 1.55-6.34, p= 0.002). <bold>In conclusion</bold>, a modest standard of living emerges as an independent prognostic factor in sarcoidosis.