Who Typically Gets Sarcoidosis? An Exploration of Risk Factors

September 21, 2025 •

4 min read

Studies indicate that sarcoidosis disproportionately affects certain populations, with African Americans facing higher prevalence and more severe disease. To understand who typically gets sarcoidosis, it is crucial to examine the complex interplay of genetic, environmental, and demographic risk factors.

Quick Summary

Sarcoidosis is an inflammatory condition that commonly affects young and middle-aged adults, though it can occur at any age. Higher rates are seen in African Americans and people of Northern European descent, with gender and environmental factors also influencing risk and disease presentation.

Key Points

Racial and Ethnic Disparities: Sarcoidosis disproportionately affects African Americans and people of Northern European (Scandinavian) descent, with African Americans typically experiencing more severe disease.
Age and Gender Trends: The disease most often begins between ages 20 and 40, though a later-life peak exists for women. While overall more common in women, men often present earlier.
Genetic and Familial Influence: A family history of sarcoidosis significantly increases risk, indicating a genetic predisposition that interacts with other factors to trigger the disease.
Environmental and Occupational Triggers: Exposure to certain dusts, chemicals (like silica), and infectious agents in occupations such as firefighting or metalworking is associated with higher risk.
Varied Disease Presentation: Clinical features and prognosis differ significantly across demographic groups, impacting which organs are affected and the disease's overall severity and duration.

Understanding Sarcoidosis: Demographics and Distribution

Sarcoidosis is a systemic disease characterized by the formation of tiny clumps of inflammatory cells, called granulomas, in various organs. While it can affect anyone, worldwide prevalence and disease characteristics vary significantly by geography, race, age, and sex. The precise cause remains unknown, but research points to a combination of genetic predisposition and environmental triggers.

The Influence of Race and Ethnicity

Race is one of the most significant predictors of sarcoidosis risk and disease course. In the United States, the disease is considerably more common among people of African descent compared to white individuals.

African Americans: This group has the highest incidence rates and often experiences more severe, chronic, and multi-organ involvement. Common manifestations include involvement of the skin, eyes, nervous system, and spleen, in addition to the lungs. The lifetime risk of developing sarcoidosis is estimated to be as high as 2% for African Americans.
Northern Europeans: High prevalence rates are also reported in Scandinavian countries like Sweden, Denmark, and Finland. In contrast, certain parts of Asia, including Japan and Eastern Asian countries, have lower incidence rates, though specific population groups can have unique clinical features.

Age and Sex Patterns

Age and sex also play key roles in shaping who gets sarcoidosis, though patterns can vary by ethnicity.

Age: Sarcoidosis most often begins in young adulthood, typically between the ages of 20 and 40. However, some studies have noted a second incidence peak, particularly among women over 50 years old. The disease is rare in young children.
Sex: Across many populations, sarcoidosis is slightly more common in women than in men. However, among African Americans, females develop the disease twice as often as males. Interestingly, men may have a higher incidence in the younger age group (20–45), while the incidence in women peaks later in life (50–65). Men also show a higher incidence of cardiac involvement than women.

The Genetic Factor: A Family Link

Evidence strongly suggests a genetic component to sarcoidosis. Familial clusters have been observed, indicating that having a first-degree relative with sarcoidosis increases one's risk. Research has identified specific gene variants, particularly within the Human Leukocyte Antigen (HLA) region, that are associated with susceptibility and specific disease phenotypes. The exact genetic links are complex and vary by ancestry.

The Environmental Connection

Environmental triggers are suspected to interact with genetic predispositions to cause sarcoidosis. Occupational and environmental exposures have been linked to the disease.

Occupational Exposures: Certain professions carry a higher risk due to exposure to dusts and chemicals. These include firefighters, metalworkers, construction workers, and agricultural workers. Examples of implicated substances include silica, wood dust, and metal particles.
Infectious Agents: Researchers have explored a potential link between sarcoidosis and certain infections. Microbes like mycobacteria (similar to those causing tuberculosis) and Propionibacterium acnes have been investigated as possible triggers, although a definitive link remains unclear.
Other Factors: Some studies suggest a potential role for exposure to mold, insecticides, and even wood-burning stoves. Factors like obesity may also increase risk by promoting a pro-inflammatory environment.

How Disease Presentation Varies

The demographic differences in sarcoidosis extend beyond prevalence to include the specific organs affected and the severity of the disease.

Severity: Black patients in the U.S. often experience more chronic, progressive, and severe forms of sarcoidosis compared to white patients.
Organ Involvement: African Americans are more prone to multi-organ involvement and more frequent manifestations in the skin, eyes, and nervous system. In contrast, people of Northern European descent with the acute form known as Löfgren's syndrome (characterized by erythema nodosum, joint pain, and enlarged lymph nodes) tend to have a better prognosis and higher rates of spontaneous remission. Japanese patients, while having lower overall incidence, show a higher tendency for cardiac involvement.

Demographics and Clinical Characteristics: A Comparison


Feature	Predominant Group(s)	Typical Age of Onset	Disease Trajectory	Common Organ Involvement
Incidence	African Americans, Northern Europeans (Scandinavians)	Bimodal peak (20s-40s, 50s-60s)	Variable, often resolves spontaneously	Lungs, lymph nodes, eyes, skin
Severity	African Americans often more severe and chronic	Varies widely by individual	Chronic vs. spontaneous resolution	Lungs, lymph nodes, skin, eyes, heart, nervous system
Gender	Overall more common in women; male-peak at younger age, female-peak at older age	Varies by ethnicity and individual	Varies	Lungs, lymph nodes (men more cardiac involvement)
Genetics	Familial predisposition, HLA genes	Any age	Influences risk and specific manifestations	Varies by specific gene polymorphisms
Environment	Occupations with dust/chemical exposure, specific geographical areas	Varies, can occur at any point after exposure	Potential trigger, but not always sole cause	Varies depending on exposure pathway

Conclusion: A Multifaceted Picture

Understanding who typically gets sarcoidosis is not a simple matter of identifying a single profile. It requires recognizing that the disease is a complex, multi-system disorder influenced by a combination of genetic vulnerabilities, environmental triggers, and demographic factors. High-risk groups include African Americans and people of Northern European descent, with African Americans often facing a more challenging disease course. The average age of onset is in young adulthood, though a second peak occurs later, particularly in women. Continued research into the genetic and environmental drivers is essential for developing targeted prevention strategies and therapies. For more information, the Foundation for Sarcoidosis Research is an excellent resource dedicated to improving patient care and finding a cure: https://www.stopsarcoidosis.org/.

Frequently Asked Questions

Racial and ethnic background are significant risk factors. In the United States, African Americans have a higher incidence rate and often a more severe disease course than white individuals.

Yes, statistics show that women are slightly more likely to develop sarcoidosis than men. However, men may have a peak incidence at a younger age (20-45), while women's incidence might peak later (50-65). Men also face a higher risk of cardiac involvement.

Sarcoidosis typically affects adults between 20 and 40 years old, which is the most common age range for diagnosis. A secondary peak of incidence is sometimes seen later in life, especially in women.

Yes, strong evidence suggests a genetic basis for sarcoidosis. The risk is significantly higher if a close family member has the disease. Research has linked several genes, particularly in the HLA region, to increased susceptibility.

Certain occupations involving exposure to specific environmental triggers, such as inorganic dusts (silica) and chemicals, have been linked to a higher risk. Examples include firefighting, construction, and metalworking.

Environmental factors are believed to interact with genetic predispositions. Exposure to things like mold, certain infectious agents, and various dusts or chemicals are considered potential triggers for the disease.

Yes. For example, African Americans often experience more aggressive, chronic disease affecting multiple organs. The acute form known as Löfgren's syndrome, which has a better prognosis, is more common in people of Northern European descent.