Screening for exposure to beryllium among US Veterans with a diagnosis of sarcoidosis, 2002-2020

Abstract: Inhalation of beryllium (Be) causes chronic Be disease (CBD), a granulomatous lung disease that without specific testing is indistinguishable from sarcoidosis. Veterans exposed to embedded shrapnel may be at risk for shrapnel-induced sensitization due to trace beryllium in armament-related aluminum. However, the frequency of testing for beryllium exposure among Veterans with sarcoidosis is unknown. We sought to determine the proportion of U.S. Veterans with sarcoidosis who had beryllium lymphocyte proliferation tests (BeLPT) ordered between 2002 and 2020. We also examined factors, such as exposure to embedded shrapnel, associated with BeLPT orders. We used data from the Veterans Health Administration (VHA) electronic health record (EHR) to identify BeLPT orders among patients diagnosed with sarcoidosis (defined using International Classification of Diseases (ICD)-9th or 10th revisions) between 2002 and 2020. Demographic and geographic data, branch of service, history of embedded shrapnel, and ICD-9 or -10 codes for CBD or pneumoconiosis were extracted from the EHR. We used multivariable logistic regression to identify factors associated with a BeLPT order, with results expressed as odds ratios (OR) with 95% confidence intervals (CI). Among 27,659 Veterans with a diagnosis of sarcoidosis, 129 (0.5%) had at least one BeLPT order, including 23 of 2227 (1%) patients with embedded shrapnel and 106 of 25,326 (0.4%) patients without embedded shrapnel (unadjusted OR 2.49, 1.59-3.92; p<.001). In a multivariable logistic regression analysis, blacks were less likely than whites to have a BeLPT order (OR 0.48, 95% CI 0.32-0.71; p<0.001), and the presence of embedded shrapnel was associated with 2-fold greater odds of having a BeLPT order (OR 2.15, 95% CI 1.32-3.35; p=0.001). No Veteran with sarcoidosis had a specific ICD code for CBD; 78 (0.3%) had an ICD-9 or 10 code for pneumoconiosis.Conclusions: Less than 1% of Veterans with sarcoidosis had a BeLPT ordered between 2002 and 2020. The odds of ordering a BeLPT assay to screen for CBD was lower in blacks (vs. whites) and higher among Veterans with a history of embedded shrapnel. BeLPT assays should be ordered more routinely for veterans with sarcoidosis diagnosis, especially when there is a history of embedded fragments.