The Association Between Air Pollution and Lung Function in Sarcoidosis and Implications for Health Disparities

Ali M Mustafa; Kevin J Psoter; Kirsten Koehler; Nancy Lin; Meredith McCormack; Edward Chen; Robert A Wise; Michelle Sharp

doi:10.1016/j.chest.2024.08.049

The Association Between Air Pollution and Lung Function in Sarcoidosis and Implications for Health Disparities

Chest. 2024 Sep 17:S0012-3692(24)05152-3. doi: 10.1016/j.chest.2024.08.049. Online ahead of print.

Authors

Ali M Mustafa¹, Kevin J Psoter², Kirsten Koehler³, Nancy Lin⁴, Meredith McCormack⁴, Edward Chen⁴, Robert A Wise⁴, Michelle Sharp⁴

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Electronic address: amustaf7@jh.edu.
² Division of General Pediatrics, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD.
³ Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
⁴ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD.

PMID: 39299388
DOI: 10.1016/j.chest.2024.08.049

Abstract

Background: Sarcoidosis is a granulomatous disease with varying courses of disease progression. Environmental exposures are thought to be contributors to disease onset. Exposure to air pollutants such as fine particulate matter (PM_2.5) and nitrogen dioxide (NO₂) have been identified as contributors to health disparities in lung diseases; little is known about these environmental exposures' associations with disease outcomes in sarcoidosis.

Research question: Is higher exposure to PM_2.5 and NO₂ associated with worse lung function in sarcoidosis?

Study design and methods: We conducted a retrospective, cross-sectional study of individuals with pulmonary sarcoidosis seen from 2005 to 2015. Home addresses at the year of enrollment were geocoded, and exposure to PM_2.5 and NO₂ was modeled using high-resolution 1 km × 1 km annual surface exposure data during the year of enrollment. Racial and sex differences in exposure were determined. Multivariable linear regression models were used to examine the associations between PM_2.5 and NO₂ and the pulmonary function test (PFT) measures FVC, FEV₁, and Dlco.

Results: Among the 415 individuals in the analysis, Black individuals had significantly higher exposure to PM_2.5 and NO₂ compared with non-Hispanic White individuals, 12.2 μg/m³ (SD 2.4) vs 11 μg/m³ (SD 2.2) and 6.3 ppb (SD 1.9) vs 5.0 ppb (SD 2.0), respectively. Every 1 μg/m³ higher exposure to PM_2.5 was associated with 1.12% lower Dlco% predicted (95% CI, -1.83 to -0.41; P < .05). Every 1 ppb higher exposure to NO₂ was associated with 1.04% lower Dlco% predicted (95% CI, -1.91 to -0.18; P < .05) in fully adjusted models. There were no significant associations between these pollutants and either FVC or FEV₁% predicted.

Interpretation: Higher exposure to PM_2.5 and NO₂ was associated with worse Dlco% predicted. Black individuals with sarcoidosis were exposed to higher PM_2.5 and NO₂ than non-Hispanic White individuals. Air pollution exposure may be a contributor to reported health disparities in sarcoidosis.

Keywords: air pollution; health disparities; pulmonary function tests; sarcoidosis.