Elevated Mortality Risk in the First Year Post-Diagnosis of Sarcoidosis: A Comprehensive Population-Based Cohort...

Background and Objectives: Sarcoidosis, marked by chronic inflammation and granuloma formation, shows a variable clinical course. While many patients have benign outcomes, others face chronic, life-threatening complications. Mortality studies in sarcoidosis show mixed results due to age, ethnicity, sex, and geography, highlighting the need for a comprehensive mortality risk analysis. This study compares mortality risks between sarcoidosis patients and controls, considering demographic and clinical factors, and performs subgroup analyses across different age groups and post-diagnosis periods. Materials and Methods: This is a retrospective cohort study that used Clalit Health Services' electronic database, including patients first diagnosed with sarcoidosis from 2000 to 2016 and age- and sex-matched controls at a 1:5 ratio. Hazard ratios (HR) for all-cause mortality were obtained using the Cox proportional hazard model, adjusted for sociodemographic and clinical variables. Results: Sarcoidosis patients showed higher mortality rates (17.7%) than controls (10.6%), with an adjusted HR of 1.79 (95% CI: 1.64-1.96, p < 0.001). Subgroup analysis revealed the HR for mortality decreased with age: HR for patients under 50 was 3.04 (95% CI: 2.20-4.21), and for those over 70, it was 1.8 (95% CI: 1.69-2.11). The HR was highest in the first year post-diagnosis. Key mortality predictors included age at diagnosis, male gender, and higher Charlson comorbidity index score. Conclusions: Sarcoidosis patients, particularly younger ones and those with higher comorbidity burdens, have elevated mortality risks compared to controls, with the highest HR in the first year post-diagnosis. These findings highlight the most vulnerable period of the disease.