Rather than a single disease entity, sarcoidosis may be a constellation of “sarcoidoses” with a characteristic pattern of organ involvement and clinic course, depending upon the triggering exposure and underlying epidemiologic factors such as race. This review examines the racial disparities inherent to sarcoidosis disease course and mortality and discusses factors that may be responsible for these findings. In the United States, black patients with sarcoidosis experience more severe pulmonary disease, more multiorgan involvement, and an overall worse prognosis with higher rates of hospitalization and mortality. Beyond inherent genotype, ascertainment and access to medical care, physician implicit bias, and patient perceived discrimination likely play a role. Moving forward, epidemiologic concepts can be used to formulate strategies for control, treatment, and even prevention of disease in black Americans at risk for developing life-altering or life-threatening sarcoidosis phenotypes. Identification and rectification of modifiable risk factors such as socioeconomic status, lack of insurance, and financial barriers to care as well as the incorporation of implicit bias training for physician will likely lead to improvement in discordant outcomes.

结节病不是单一的疾病实体，它可能是一系列“结节病”，具有器官受累和临床病程的特征模式，具体取决于触发暴露和潜在的流行病学因素（例如种族）。本综述探讨了结节病病程和死亡率所固有的种族差异，并讨论了可能导致这些结果的因素。在美国，患有结节病的黑人患者患有更严重的肺部疾病，更多的多器官受累，总体预后更差，住院率和死亡率更高。除了固有的基因型之外，确定和获得医疗护理的机会、医生隐性偏见和患者感知到的歧视也可能发挥作用。展望未来，流行病学概念可用于制定控制、治疗甚至预防美国黑人疾病的策略，这些美国黑人有可能出现改变生活或危及生命的结节病表型。识别和纠正可改变的风险因素，例如社会经济地位、缺乏保险和护理的财务障碍，以及对医生进行隐性偏见培训，可能会改善不一致的结果。