Relationship to Deployment on Sarcoidosis Staging and Severity in Military Personnel

Abstract

Introduction Ongoing studies are investigating the potential link between deployment to Operation Iraqi Freedom and Operation Enduring Freedom and relationship to increases in pulmonary disease. While increases in certain diseases such as asthma and airway hyperreactivity are well established, data on other chronic pulmonary diseases such as sarcoidosis have not been defined. Material and Methods A retrospective chart review was conducted of all active duty military personnel diagnosed with sarcoidosis from 2005 to 2010. Deployment dates and locations were obtained through the Armed Forces Health Surveillance Branch. Electronic medical records were reviewed to determine the following parameters: dates of diagnosis, temporal relationship of diagnosis and deployment, symptoms (pre- and/or post-deployment), spirometry, diffusing capacity, radiographic staging, and treatment course. Pulmonary sarcoidosis incidence rates were estimated using International Classification of Diseases (ICD-9) coded medical encounter data from the Defense Medical Surveillance System and compared between Army and nonArmy personnel, as well as between ever-deployed and never-deployed personnel. Results A cohort of 478 Army soldiers was identified with sarcoidosis based on ICD-9 codes and individual review of the medical records. The cohort was 80% male. 38.7% of soldiers with sarcoidosis never deployed. 11.7% were diagnosed prior to deployment, and 50.2% were diagnosed postdeployment. The diagnosis of sarcoidosis was established with a tissue diagnosis in 68% of the deployed cohort. Overall differences in spirometry were not identified. Obstructed spirometry was similar in all deployment groups (never, pre, and post) at 9.2%, 15.8% and 8.7%, respectively. Restrictive patterns based on total lung capacity (<70%) were similar at 9.2%, 12.5%, and 11.0%, respectively. Radiographic staging showed a similar distribution in the populations with the never/pre versus postdeployment groups having Stage 0 = 2.3 versus 3.5%, Stage I = 43.8 versus 41.6%, Stage II = 33.1 versus 41.0%, Stage III = 15.1 versus 12.1%, and Stage IV = 2.2 versus 1.7%, respectively. During 2005–2010, the estimated incidence rate of pulmonary sarcoidosis was low among active duty Army personnel (16.5 cases/100,000 person-years), and no trend in annual rates was observed, p = 0.89. Based on overall Department of Defense medical data, estimated pulmonary sarcoidosis rates were lower among ever-deployed personnel, relative to nondeployed personnel. Conclusion Based on this analysis of Army sarcoidosis patients, there was no difference in the rates of sarcoidosis diagnosis in deployed and nondeployed soldiers. Spirometry values, total lung capacity, and radiographic staging did not show significant differences between deployment groups.

Factors associated with a diagnosis of sarcoidosis among US veterans of Iraq and Afghanistan

“…Supporting this conclusion, Forbes and colleagues examined sarcoidosis incidence rates among active-duty Army personnel from 2005 to 2010 and reported no difference between those deployed to Southwest Asia compared to those who were never deployed, suggesting that in-theater exposures may not meaningfully increase the risk of developing sarcoidosis 24 . Of note, the association between Navy service and lower odds of sarcoidosis is consistent with a recent study of Military Health System data showing that the Navy accounted for the lowest proportion of sarcoidosis cases compared to the other service branches over 2004–2013 25 .…”

Sarcoidosis in Post–9/11 Military Veterans

“…Still, the higher prevalence of sarcoidosis in active-duty military personnel suggests similar shared exposures in this group. 16 Presumptive In addition to the prior locations.…”

Sarcoidosis in U.S. Military Veterans: Can Lessons from Those Who Have Served Shape the Future of Sarcoidosis?

“…Risk factors other than the deployed environment may play a role. One study conducted in active-duty Army soldiers failed to detect a difference in rates of sarcoidosis diagnosis in deployed versus nondeployed personnel ( 14 ). Follow-up studies that drill down to the specific external environmental exposures, internal atmosphere of work areas, and associated duties are needed to shed light on actionable risk-factor modification for military service members.…”