Sarcoidosis in Iceland: a nationwide study of epidemiology, clinical picture and environmental exposure.

BACKGROUND: This nationwide study aimed to elucidate the incidence and clinical characteristics of tissue-verified sarcoidosis in Iceland. A secondary aim was to analyse sex differences and identify possible environmental factors contributing to the pathological process. MATERIALS AND METHODS: This is a descriptive study covering 36 years (January 1, 1981 through December 31, 2016). Histopathological reports and electronic hospital discharge registries were reviewed in context for granulomas and/or sarcoidosis. National data were used for comparison regarding smoking habits and occupation, adjusted for age, sex and year of diagnosis. The data were stored in FileMaker and calculations were made by extracting data from this database to the statistical software package R. RESULTS: A total of 418 patients (54% females) were diagnosed with tissue-verified sarcoidosis. The incidence rate was 4.15/100 000/year, similar among females and males. The mean age at diagnosis was higher among females (53.0±14.2 years) than males (48.2±13.8 years). Fatigue was the most frequent single symptom (49.7%), but when all respiratory symptoms were grouped, they were the most frequent symptoms (60%). No significant difference was found between smoking status and sarcoidosis. Possible hazardous exposure in the workplace was reported by 19.4% of the cases. CONCLUSION: The incidence of sarcoidosis in Iceland was higher than in an Asian population where the same inclusion criteria were applied. The clinical picture diverges partly from that in the Asian population but resembles that among other Caucasians. Fatigue and respiratory symptoms were predominant. The biphasic pattern of age at disease debut seen elsewhere among females was not evident in Iceland.

[Prevalence of COPD in Iceland--the BOLD study]. / Hversu algeng er langvinn lungnateppa?--Islensk faraldsfraedirannsókn.

OBJECTIVE: To investigate the prevalence of chronic obstructive pulmonary disease (COPD) in Iceland and possible risk factors. MATERIALS AND METHODS: This Icelandic survey is a part of an international study (www.BOLDCOPD.org). The target population consisted of a simple random sample taken among all non-institutionalized Icelanders 40 years and older living in Reykjavik and adjacent suburbs (n=938). Participants were subjected to a structured interview based on questionnaires on respiratory diseases, symptoms, life style and possible risk factors. They also underwent a spirometry that was repeated after inhalation of a bronchodilating agent. COPD stage I, or higher, was defined according to the GOLD staging (www.goldcopd.org) based on chronic airflow limitation (FEV1/FVC 70%) persisting after inhaled bronchodilator. RESULTS: Full participation was by 755 (80.5%). Altogether 18.0 % of the participants fulfilled criteria for COPD, GOLD stage I or higher and 9.0 % for GOLD stage II or higher. There were proportionally more young females (40-49 years) than males diagnosed with COPD GOLD stage I or higher (8.1% compared to 4.8%), even though there was no difference in total prevalence between males and females. The prevalence of COPD increased with increasing age and the amount of tobacco smoked. Only a part of those fulfilling criteria for COPD had been diagnosed by doctors. CONCLUSION: Our results show a high prevalence of COPD among Icelanders 40 years and older when internationally accepted criteria and methods are used. These results are useful for heath authorities when planning and giving priority in our future health care system.

[Sarcoidosis in Iceland 1981-2003]. / Sarklíki á Islandi 1981-2003.

OBJECTIVE: To investigate the incidence of sarcoidosis in Iceland, its clinical manifestations and potential environmental influences. MATERIALS AND METHODS: All histopathological diagnoses of non-necrotizing granulomas generated in Iceland during the period 1981-2003 were reviewed with respect to a diagnosis of sarcoidosis. Further, patients were identified by searching hospital discharge diagnoses at the University Hospital in Reykjavik and the Regional Hospital in Northern Iceland. Only histologically verified cases were included. RESULTS: A total of 235 patients were found with histopathologically proven sarcoidosis. Limited to patients verified by tissue diagnosis, the annual incidence of sarcoidosis is 3,84/100.000/year. The incidence was found to be 2,8/100,000/year during the first half of the investigation period and 5,0/100,000/year during the second. This rate is lower than in other Nordic countries. There were 122 women and 113 men. The mean age at diagnosis was 50,8 years for women and 47,5 for men. The mean age at diagnosis was higher in Iceland than elsewhere. Clinically, respiratory symptoms predominated. Ocular symptoms and erythema nodosum are rare, and life-threatening cardiovascular and neurological manifestations are distinctly unusual. CONCLUSION: The low incidence is undoubtedly due to the strict inclusion criteria in the present study, i.e. only those with a tissue diagnosis were included. We have no explanation as to the higher age at diagnosis in Iceland than elsewhere. Registration of possible environmental factors and clinical evaluation may be improved.