Impact of Race, Gender, and Socioeconomics on Cardiac Sarcoidosis Management

Abstract

Approximately one quarter of sarcoidosis patients have cardiac involvement which is the second most common cause of mortality in sarcoidosis patients. Among pulmonary sarcoidosis patients, symptoms and access to care have been shown to vary by race. These metrics have not been in examined in a cardiac sarcoidosis (CS) population. Leveraging a racially diverse, urban CS registry at Temple University Hospital, we assessed socioeconomics and potential disparities in disease management and resource allocation. METHODS: Using our electronic medical record, we performed a retrospective review of consecutive CS patients receiving care at our hospital between January 2014 and September 2019. Patient demographics, socioeconomics characteristics, CS related interventions and outcomes were collected. Comparisons were made among race (white vs non-white), gender (male vs female), and household income (low vs medium/high income). Patient's home ZIP codes were collected as a surrogate for socioeconomic status. Using US census data in 2019, ZIP codes were used to categorize patients based on median annual household income into either low income (<$45,000) or medium/high income group (>$45,000). Outcomes were defined as arrhythmia burden (defined by any atrial tachycardia, non-sustained ventricular tachycardia, or sustained ventricular tachycardia found in intra-cardiac device interrogation), intra-cardiac device placement, and use of steroids and immunomodulators. RESULTS: We identified 49 CS patients, of which 49% were non-white (23 black, 1 Hispanic), 57% were male (n¼28), with a mean age of 56AE13 years. Whites were more likely to live in a higher income ZIP codes (82% white vs 33% non-white patients, p<0.0001). When comparing among race (white vs non-white), gender (male vs female), or income by ZIP code (low vs medium/ high income), there is no statistical significant difference in medical comorbidities (hypertension, hyperlipidemia, diabetes, coronary artery disease, obstructive sleep apnea). Arrhythmia burden and intra-cardiac device placements were similar among comparison groups. There was no difference in steroid use among race (84% white vs 83% non-white, p¼0.95), gender (71% female vs 78% male, p¼0.57), and income (79% low income vs 70% medium/high income, p¼0.45). Similarly, there was no difference in immunomodulator use among race (36% white vs 50% black, p¼0.32), gender (52% female vs 56% male, p¼0.74), and income (48% low income vs 35% medium/high income, p¼0.36). CONCLUSIONS: When comparing CS patients by race, gender, or income by ZIP code, there was no difference in medical comorbidities, prevalence of arrhythmic events, presence of intra-cardiac devices, or steroid or immunomodulator use. CLINICAL IMPLICATIONS: This revelation is promising but needs further examination by collaboration between CS registries and large prospective studies.