Introduction: Environmental and occupational exposures have been associated with sarcoidosis risk and, in some cases, organ involvement, but associations remain incompletely understood.

Objectives: Determine associations between occupational and environmental exposures and sarcoidosis organ involvement.

Materials and Methods: We used a single-center sarcoidosis repository with prospectively collected clinical data and questionnaire-based occupational and environmental exposure assessment. Organ involvement and diagnosis was determined by treating sarcoidologists at the time of enrollment using the Genomic Research in Alpha-1 Antitrypsin Deficiency and Sarcoidosis organ assessment tool. A priori exposures of interest were based on existing literature. Outcomes included pulmonary-only, cardiac, extrapulmonary-only, and multisystemic involvement at enrollment. Chi-square test or Fisher's exact test was used to determine differences in outcomes across exposures, stratified by sex and race. Multivariable(MV) logistic regression was performed on associations significant at p<0.05 to adjust for age at diagnosis and smoking status.

Results: Univariate analysis(n=1245) identified associations between occupational radiation exposure(RAD) and pulmonary-only(p=0.023); exposure to children at work or home(CHILD) and extrapulmonary-only(p=0.038); middle or high school teaching(p=0.049) and RAD(p=0.023) and multisystemic; and military job(MILITARY)(p=0.001) and cardiac sarcoidosis. Stratification included: White Females(WF)(n=587), Black Females(BF)(n=60), White Males(WM)(n=518), and Black Males(BM)(n=51) and identified: in WF, MILITARY(p=0.04) and RAD(p=0.03) were associated with multisystemic; in BF, metal dust(p=0.049) and RAD(p=0.04) were associated with cardiac; in WM, CHILD was associated with extrapulmonary-only(p=0.04); in BM, agricultural employment(p=0.047) and wood/coal stove/fireplace in the home(WOOD)(p=0.01) were associated with pulmonary-only. WOOD was negatively associated with multisystemic(p=0.04) in BM, supporting the pulmonary-only association. WOOD in BM and RAD in WF remained significant after MV analysis(Table1).

Conclusions: In a retrospective analysis of a large, real-world sarcoidosis cohort, we found associations between wood or coal stoves/fireplaces and pulmonary-only sarcoidosis in black males and occupational radiation exposure and multisystemic involvement in white females. Continued efforts to understand the role of exposures and possible opportunities for risk mitigation are needed.