SARCOIDOSIS IN CORONERS AUTOPSIES - A CRITICAL-EVALUATION OF DIAGNOSIS AND PREVALENCE FROM CUYAHOGA COUNTY, OHIO

Background and nim of the work: During a histologic study of sarcoidos is in tissues made available from the Cuyahoga County Coroner's autops y files, the prevalence of this disorder seemed much greater than gene rally reported. Aims were to evaluate this impression and if confirmed , to explore underlying reasons, including reliability of diagnoses an d possible overestimates as well as possible associations with particu lar population subgroups. Methods: Cases were retrieved by computer se arch of diagnoses coded over the past 7 years. Extent of organ involve ment was documented and relevant microscope slides reviewed, with cons ideration of diagnostic criteria generally proposed. Clinical informat ion, occupational risk and evidence for illicit drug use were evaluate d. Acceptable cases were categorized by gender, race and age. Crude an d standardized prevalences were calculated and related to 1990 US Cens us figures for the County. Results: On review of 9324 adult autopsies performed for medico-legal reasons, 31 were judged to have sarcoidosis . Standardized prevalence was 320 +/- 72/10(5). Among population subgr oups statistically significant differences were not established. Howev er, crude prevalences suggested that females, blacks and younger perso ns were more likely to have sarcoidosis than males, whites and older s ubjects, with ratios of 1.6 to 1, 4.7 to 1; and 2.5 to I, respectively . Overall prevalence was some 10 times greater than indicated from Sta te-wide death certificates. Conclusions: Sarcoidosis as found in cases autopsied at the Coroner's Office, Cuyahoga County, is much more prev alent than generally reported. It is an under-appreciated cause of sud den unexpected death. Young black females appear to be most affected, and worthy of further investigation.