Exploring gender and ethnic disparities in sarcoidosis: insights from the British Thoracic Society UK Interstitial Lung Disease Registry

Introduction
Sex and ethnicity influence sarcoidosis internationally, but UK data are limited. We analysed the British Thoracic Society Interstitial Lung Disease Registry to assess whether gender or ethnic differences affect presentation and management of pulmonary sarcoidosis in the UK.
Methods
A retrospective study included adults with confirmed pulmonary sarcoidosis recorded between January 2013 and December 2024. Demographics, symptoms, comorbidities, investigations, radiology, treatment and Index of Multiple Deprivation were extracted. Group comparisons used χ², t-tests or Mann-Whitney U tests; multivariable logistic regression identified factors associated with immunosuppressive initiation.
Results
Among 1071 patients, 55.5% were male; median age 54 years (SD 13). Ethnicity was documented in 918 (85.7%): 55.4% white, 14.2% non-white (black, South Asian, mixed).Gender: Women presented older than men (56 vs 52 years; p=0.002) and reported more fatigue, higher erythrocyte sedimentation rate and prior tuberculosis. Men had more lymphopenia, elevated ACE and arrhythmia. Lung function and CT patterns were similar, but methotrexate use was higher in men (4.9% vs 2.3%; p=0.017).Non-white patients presented younger (52 vs 54 years; p<0.001) with greater symptom burden (breathlessness 46% vs 33%; cough 44% vs 27%) and more comorbidities (hypertension, diabetes, tuberculosis). Physiology was comparable, but CT nodularity (54% vs 36%) and abnormal liver tests (16% vs 9%) were more frequent, and mycophenolate was prescribed more often (3.7% vs 0.3%; p=0.036).In multivariable analysis, male sex (OR 2.34), non-white ethnicity (OR 3.20), breathlessness (OR 2.05) and lower forced vital capacity (OR 0.97 per % predicted) were independently associated with immunosuppressive treatment (all p≤0.031).
Conclusions
In this UK cohort, treatment decisions were more influenced by sex and ethnicity than by lung function or imaging. Male and non-white patients received immunosuppression more frequently, suggesting possible biological, socioeconomic or practice-related differences.