Related Experiment Video
Updated: Jan 18, 2026

Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
Published on: June 16, 2020
Delays in Referral to Multidisciplinary Care for Black Individuals With Sarcoidosis
Kristen R Mathias1, Ofure Akhiwu1, Ali M Mustafa1
1Division of Rheumatology (K. R. M.), Johns Hopkins University, Baltimore, MD; the Division of Pulmonary & Critical Care (O. A.), Yale School of Medicine, New Haven, CT; the Divisions of Pulmonary & Critical Care Medicine (A. M. M., E. S. C., N. W. L., and M. S.), and Cardiology (N. A. G.), and Department of General Pediatrics (K. J. P.), Johns Hopkins University, Baltimore, MD; the Division of Pulmonary, Critical Care & Sleep Medicine (J. O.), The Ohio State University, Columbus, OH; and the Division of Pulmonary & Critical Care (C. A. B.), University of Virginia, Charlottesville, VA.
Background:
Sarcoidosis is a complex granulomatous disease that benefits from multidisciplinary subspecialty expertise. Inequitable access to care contributes to racial disparities in many diseases; however, to our knowledge, no studies have examined racial differences in referral times to Sarcoidosis Centers of Excellence.
Research Question:
Is there an association between race and time from sarcoidosis diagnosis to referral to an independently certified, peer-reviewed World Association of Sarcoidosis and Other Granulomatous Disorders Center of Excellence? Does a referral result in a change in sarcoidosis management?
Study Design And Methods:
We retrospectively reviewed all 2021 referrals to the Johns Hopkins Sarcoidosis Center of Excellence. Multivariable Cox regression evaluated the association between race and time to referral, adjusting for covariates of sex, ethnicity, referral type, referral provider, insurance provider, employment status, organ involvement, and sarcoidosis medications. Changes in sarcoidosis management including treatment changes, additional organ evaluation, and/or additional subspecialty expertise were ascertained 1 year after establishing care.
Results:
At total of 207 individuals were analyzed (40% Black, 55% White, and 5% Asian and other race). Black individuals experienced longer referral delay than White individuals, with a median of 9 vs 5 years, respectively (P < .05). In multivariable analysis, the hazard of referral for White individuals was higher than for Black individuals (hazard ratio, 2.04; 95% CI, 1.48-2.82; P < .001), independent of the covariates. Sarcoidosis management changed in 78% of individuals after referral.
Interpretation:
Black patients experienced significant delays in referral to a multidisciplinary subspecialty Sarcoidosis Center of Excellence compared with other racial groups. Recognition of referral delay may offer insight and opportunity to address disparities in clinical outcomes observed in Black individuals with sarcoidosis. Future multicenter studies must quantify the impact of care received through World Association of Sarcoidosis and Other Granulomatous Disorders Sarcoidosis Centers of Excellence, define patient phenotypes in need of urgent referral, and develop targeted patient and provider outreach.
Related Concept Videos
SBAR II: Application of SBAR
SBAR Report from a Nurse to a Health Care Provider
S: "Hello, Dr. Smith. This is Jane, RN, from the Med Surg unit. I am calling to tell you about Ms. White in Room 210, who is experiencing increased pain and redness at her incision site. Her recent...
Cardiomyopathy IV: Restrictive Cardiomyopathy
Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies
Medical History
Pulmonary Tuberculosis I
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...
Acute Coronary Syndrome IV: Interprofessional Care