Research Paper Title

Relationship to Deployment on Sarcoidosis Staging and Severity in Military Personnel.

Background

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 hyper-reactivity are well established, data on other chronic pulmonary diseases such as sarcoidosis have not been defined.

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 Defence Medical Surveillance System and compared between Army and non-Army 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 post-deployment. 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 post-deployment 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 Defence medical data, estimated pulmonary sarcoidosis rates were lower among ever-deployed personnel, relative to non-deployed personnel.

Conclusions

Based on this analysis of Army sarcoidosis patients, there was no difference in the rates of sarcoidosis diagnosis in deployed and non-deployed soldiers. Spirometry values, total lung capacity, and radiographic staging did not show significant differences between deployment groups.

Reference

Forbes, D.A., Anderson, J.T., Hamilton, J.A,. Rawlins, F.A., Tinkelpaugh, C., Abraham, J.H. & Morris, M.J. (2020) Relationship to Deployment on Sarcoidosis Staging and Severity in Military Personnel. Military Medicine. doi: 10.1093/milmed/usz407. Online ahead of print.