A57-19 Combat Deployment and Risk of New-onset Sarcoidosis Among U.S. Veterans

Rationale

Sarcoidosis disproportionately affects U.S. military Veterans. Its incidence, prevalence, and mortality are higher and rising among Veterans and vary by branch of service, suggesting a role for prior military exposures. Objectives: To investigate whether deployment to combat zones during military service is associated with increased risk of sarcoidosis.

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. We identified sarcoidosis cases from electronic health records and matched each case to five controls by age and sex using propensity scores, using incidence density sampling by calendar year. A combat veteran was defined by the presence of a combat flag or Purple Heart designation in any data source. Deployment with combat experience status was classified using a validated algorithm into combat deployment Veterans versus non-combat deployment/no deployment. Multivariable conditional logistic regression adjusted for race, ethnicity, geography, rurality, tobacco use, military service duration, and service branch. We additionally estimated the attributable fraction among Veterans with combat deployment.

Results

Among >12 million Veterans evaluated, 26,707 incident cases and 133,535 controls were analyzed; 36,335 Veterans had at least one combat deployment. Combat deployment was associated with increased risk of sarcoidosis incidence (conditional odds ratio [cOR], 1.20; 95% confidence interval [CI], 1.16-1.23); the attributable fraction was 16.7% [95% CI, 14.02%-19.3%]. Other risk factors included Black race, Northeast, South, and Midwest residence, ever tobacco use, and serving in the Air Force, and a lower risk among Hispanic Veterans.

Conclusion

Combat deployment was associated with an increased risk of sarcoidosis among Veterans, supporting the need for long-term post-deployment surveillance and prevention under the Honoring Our Promise to Address Comprehensive Toxics (PACT) Act and further investigation into exposure-specific mechanisms.

This abstract is funded by: NHLBI and VA Airborne Hazards and Burn Pits Center of Excellence