Mortality among African American women with sarcoidosis: data from the Black Women's Health Study.

BACKGROUND: Sarcoidosis is a chronic systemic granulomatous disease of unknown etiology that disproportionately affects black females.  Few studies have specifically addressed causes of death in this population. OBJECTIVES: To assess rates and causes of death among women with sarcoidosis in a prospective cohort study of U.S. black women. DESIGN: The Black Women's Health Study is a follow-up study of 59,000 U.S. black women aged 21-69 (median age 38) at entry in 1995.  Data on demographic and lifestyle factors and medical conditions, including sarcoidosis, were obtained through biennial questionnaires.  Deaths and causes of death from 1995 through 2009 among study subjects were identified from National Death Index data. We assessed mortality rates among women with and without a history of sarcoidosis.  Poisson regression models were used to estimate age-adjusted mortality rates. Cox proportional-hazards models were used to estimate hazard ratios for mortality and 95% confidence intervals. RESULTS: A total of 121 deaths occurred among 1,192 women with a history of sarcoidosis and 2813 deaths among women without sarcoidosis.  Mortality was greater at every age among women with sarcoidosis and the overall multivariable-adjusted hazard ratio was 2.44 (95% CI 2.03-2.93, p<0.0001). Of the deaths among women with sarcoidosis, 24.7% were directly attributable to sarcoidosis. CONCLUSIONS: In the Black Women's Health Study, women with sarcoidosis were more than twice as likely to die as women without the disease, with many of the deaths directly attributable to sarcoidosis.  Sarcoidosis is an important cause of premature death among black women with the disease.

Fine-mapping in African-American women confirms the importance of the 10p12 locus to sarcoidosis.

Sarcoidosis is a chronic granulomatous disease with a wide spectrum of symptoms. Genome-wide association studies in European populations have reported significant associations between sarcoidosis and single-nucleotide polymorphisms (SNPs) located in the intergenic region between the C10ORF67 and OTUD1 genes on chromosome 10p12, and the ANXA11 gene (chromosome 10q22). We carried out fine-mapping at 10p12 and 10q22 to assess associations of genetic variants in these regions with sarcoidosis risk in African-American women, based on 486 sarcoidosis cases and 943 age- and geography-matched controls in a nested case-control study within the Black Women's Health Study. There were no significant associations with variants of the ANXA11 gene (P=0.17). Haplotypic analyses of the C10ORF67-OTUD1 intergenic region revealed a strong inverse association of the variants rs1398024 and rs11013452 with sarcoidosis (odds ratio=0.52; P=0.01). Both SNPs are located inside an ∼300 kb low recombination region of chromosome 10p12, suggesting that both SNPs are tagging the same causal variant. Our top SNP (rs11013452) is located inside a smaller linkage disequilibrium block in HapMap YRI, further narrowing the position of the causal SNP to a region of ~8 kb on chromosome 10p12. The present findings confirm the potential importance of the 10p12 locus in the etiology of sarcoidosis.

Hypertension and risk of uterine leiomyomata in US black women.

BACKGROUND: Previous studies have found a positive association between hypertension and risk of hysterectomy-confirmed uterine leiomyomata (UL). The association of hypertension with UL confirmed by ultrasound or other surgery is less clear. METHODS: The present study evaluated the association of hypertension with UL incidence according to confirmation method (hysterectomy, other surgery or ultrasound) in the Black Women's Health Study, 1997-2007. We collected prospective data every 2 years on physician-diagnosed hypertension and UL in 22 530 premenopausal women. Validation sub-studies confirmed 99 and 96% of hypertension and UL self-reported diagnoses, respectively. Cox regression was used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for the association of hypertension and UL, adjusting for potential confounders. RESULTS: During 172 162 person-years of follow-up, there were 6447 incident cases of UL confirmed by ultrasound (n = 5111), hysterectomy (n = 670) or other surgery (n = 666). Treated hypertension was associated with UL confirmed by hysterectomy (IRR = 1.32, 95% CI: 1.06, 1.63), but it was not associated with UL confirmed by ultrasound (IRR = 1.05, 95% CI: 0.96, 1.16) or other surgery (IRR = 1.13, 95% CI: 0.88, 1.46). CONCLUSIONS: Treated hypertension was associated with UL confirmed by hysterectomy, but not UL confirmed by other methods (other surgery or ultrasound). These data suggest it is premature to conclude that hypertension is related to an increased risk of UL. Additional studies are needed to assess whether the association with hysterectomy-confirmed UL can be explained by other sources of bias, such as patient or physician preferences for specific types of medical care.

Recent mammography use among African-American women.

OBJECTIVE: The incidence of breast cancer in Black women is lower, but their mortality rate is higher, compared to White women. Lower rates of mammography use among Black women in the past may have resulted in later diagnosis of breast cancer, leading to shorter survival periods and higher mortality rates. We assessed recent mammography use in a large national study, the Black Women's Health Study. DESIGN: In 1995, 27,632 US Black women aged 40-69 years completed mailed questionnaires, which included questions on mammography use. RESULTS: Seventy-three percent of women aged 40-49, and 82% of those aged 50-69, reported having had a mammogram within the previous three years. Use was greater among women with higher levels of education, and among those who had cystic breast disease or a mother or sister with breast cancer. CONCLUSIONS: The high rate of recent mammography use among participants in the Black Women's Health Study agrees with national data. If breast cancer mortality rates in Black women continue to exceed those in White women, despite the lower incidence among Black women, reasons other than differential mammography use must be sought.