Delays in Referral to Multidisciplinary Care for Black Individuals With SarcoidosisTake-Home Points

Kristen R. Mathias, MD; Ofure Akhiwu, MD; Ali M. Mustafa, MD; Kevin J. Psoter, PhD; Edward S. Chen, MD; Nisha A. Gilotra, MD; Nancy W. Lin, MD; John Odackal, MD; Catherine A. Bonham, MD; Michelle Sharp, MD

CHEST Pulmonary (Jun 2025)

Delays in Referral to Multidisciplinary Care for Black Individuals With SarcoidosisTake-Home Points

Kristen R. Mathias, MD,
Ofure Akhiwu, MD,
Ali M. Mustafa, MD,
Kevin J. Psoter, PhD,
Edward S. Chen, MD,
Nisha A. Gilotra, MD,
Nancy W. Lin, MD,
John Odackal, MD,
Catherine A. Bonham, MD,
Michelle Sharp, MD

Affiliations

Kristen R. Mathias, MD: Division of Rheumatology, Johns Hopkins University, Baltimore, MD
Ofure Akhiwu, MD: Division of Pulmonary & Critical Care, Yale School of Medicine, New Haven, CT
Ali M. Mustafa, MD: Divisions of Pulmonary & Critical Care Medicine, Johns Hopkins University, Baltimore, MD
Kevin J. Psoter, PhD: Department of General Pediatrics, Johns Hopkins University, Baltimore, MD
Edward S. Chen, MD: Divisions of Pulmonary & Critical Care Medicine, Johns Hopkins University, Baltimore, MD
Nisha A. Gilotra, MD: Cardiology, Johns Hopkins University, Baltimore, MD
Nancy W. Lin, MD: Divisions of Pulmonary & Critical Care Medicine, Johns Hopkins University, Baltimore, MD
John Odackal, MD: Division of Pulmonary, Critical Care & Sleep Medicine, The Ohio State University, Columbus, OH
Catherine A. Bonham, MD: Division of Pulmonary & Critical Care, University of Virginia, Charlottesville, VA
Michelle Sharp, MD: Divisions of Pulmonary & Critical Care Medicine, Johns Hopkins University, Baltimore, MD; CORRESPONDENCE TO: Michelle Sharp, MD

Journal volume & issue: Vol. 3, no. 2
p. 100125

Abstract

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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.

Published in CHEST Pulmonary

ISSN: 2949-7892 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the respiratory system
Website: https://www.sciencedirect.com/journal/chest-pulmonary

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