Introduction: Significant health disparities exist in sarcoidosis with low-income individuals having increased morbidity and mortality compared to higher income counterparts. However, income is dynamic and may not reflect the differing financial burdens of patients. 

Objectives: To measure financial strain in patients with sarcoidosis and to examine whether this instrument’s scale may be more sensitive to differentiate clinical outcomes than income.

Materials and Methods: We conducted a cross-sectional study that included adults ≥ 18 years of age with biopsy proven sarcoidosis, pulmonary involvement, and prescribed oral sarcoidosis treatment were recruited from the Johns Hopkins Sarcoidosis Clinic. Financial strain was collected at baseline using the National Academy of Medicine one-item questionnaire. Health-related quality of life (HRQoL) was assessed using the St. George’s Respiratory Questionnaire (SGRQ) and King’s Sarcoidosis Questionnaire (KSQ). Multivariable linear, logistic, and ordinal regression were used to evaluate the association between financial strain and HRQoL, 6-minute walk distance, health-care utilization, and subjective dyspnea, as appropriate. 

Results: 130 participants were included; the median age of participants was 58 years, 55% were female, 49% were Black. Approximately 20% (n=26) reported experiencing financial strain of any level. Financial strain was reported among all income levels and was significantly associated with worse HRQoL, higher odds of emergency room visits, and lower 6-minute walk distance after adjusting for disease severity covariates (Table 1). Financial strain was associated with higher odds of worse dyspnea (OR 3.64, 95% CI 1.45-9.15, p-value=0.006). Income was not significantly associated with clinical outcomes.

Conclusions: Financial strain was prevalent among all income levels and was associated with clinical outcomes while income was not. Given inherent limitations of income, financial strain, as assessed through a one-item measure, may be a more useful and appropriate measure for clinical epidemiologic studies. Future studies are needed to assess the determinants of financial strain and mitigating factors to minimize the impact on clinical outcomes.