Sarcoidosis is found throughout the world, affecting all races, all ages, and males as well as females, with a predilection for adults less than 40 years of age. The incidence of sarcoidosis peaks at the age of 20 to 25; in Scandinavian countries and Japan, a second peak is noted in women over 50 years of age. Women have a slightly higher rate of disease than men, 6.3 per 100,000 person-years for women and 5.9 per 100,000 person-years in men in the United States (31). Among the world population, Swedes, Danes, and African Americans have the highest prevalence of sarcoidosis. Analyses of clinical disease expression in various ethnic and racial groups reveal heterogeneity in disease presentation and severity. African Americans show greater severity of disease than Caucasian Americans. Certain manifestations are more common in specific ethnic groups: chronic uveitis in African Americans, erythema nodosum in Europeans, cardiac disease in Japan, and lupus pernio in Puerto Ricans. Mortality is secondary to respiratory failure, except in Japan, where myocardial disease is the most frequent cause of sarcoid-related death. The overall mortality due to sarcoidosis is 1% to 5%. Clusters of disease have been described in some studies, suggesting person-to-person transmission or shared environmental exposure; however, these etiologic hypotheses remain unproven. Sarcoidosis occurs more commonly in nonsmokers than in smokers (30).
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