Abstract Background Sarcoidosis disproportionately affects U.S. Veterans, potentially due to military-related exposures. We investigated whether estimated exposure to inorganic dust during service is associated with an increased sarcoidosis risk. Methods We conducted a retrospective nested case-control study of Veterans enrolled in the Veterans Health Administration (VHA) who received VHA- or Medicare-covered care between 2002 and 2022. Sarcoidosis cases were identified from electronic health records and matched to five control subjects using propensity scores, with incidence density sampling by calendar year. We linked military occupational codes (MOCs) to a job exposure matrix (JEM) to estimate inorganic dust exposure. Multivariable conditional logistic regression adjusted for demographics, geography, rurality, and service branch. We calculated the Attributable Fraction among the exposed. Secondary analyses examined latency from service separation to diagnosis. Two sensitivity analyses assessed exposure misclassification. Results Of over 16 million Veterans evaluated, 3,019,636 had at least one MOC; 5,855 incident cases and 29,275 controls were analyzed. Inorganic dust exposure was associated with an increased risk of sarcoidosis (conditional odds ratio cOR= 1.08; 95% confidence interval CI: 1.003-1.170), with an Attributable Fraction of 7.6%. Associations were stronger with a modified JEM score (cOR= 1.15; 95% CI: 1.05-1.27) and when restricted to post-9/11 Veterans (cOR= 1.25; 95% CI: 1.07-1.47). Latency analyses showed the highest risk for sarcoidosis was 2-5 years post-service (cOR= 2.10; 95% CI: 1.20-3.58). Conclusion Inorganic dust exposure during military service represents an occupational and environmental risk for sarcoidosis among Veterans, carrying important implications for prevention and surveillance This abstract is funded by: NHLBI and VA Airborne Hazards and Burn Pits Center of Excellence
Seedahmed et al. (Fri,) studied this question.