Occupational exposures and sarcoidosis: a rapid review of the evidence
Bibliographic record
Abstract
We write regarding a rapid review (RR) of sarcoidosis and occupational exposures published in Occupational Medicine on 22 May 2024 (2024, XX, 1–8). The authors of this article are affiliated with the Policy and Consultation Services Division, Workplace Safety and Insurance Board in Ontario, Canada. We are employed by or have an affiliation with Occupational Health Clinics for Ontario Workers, Inc. This article is of great interest to us as we have responsibility for the evaluation of workers in Ontario with known or suspected occupational disease, including workers with sarcoidosis. The purpose of our letter is to bring attention to potential shortcomings of the RR that may adversely impact scientific thinking about sarcoidosis and occupational aetiology and, in turn, the care and compensation of individuals at risk for or diagnosed with sarcoidosis. We have two major concerns. First, the authors do not adequately explain or provide a clear rationale for why they chose to conduct a RR versus a more comprehensive systematic review (SR), particularly since the RR was conducted in part to provide basis for ‘occupational disease policy development’ [1]. Tricco et al., whom they cite, advise that ‘Further research on rapid reviews is warranted’ and suggest a prospective study comparing results of RRs and those of SRs of the same subject [2]. To our knowledge, such a prospective study has not been carried out. Second, this RR is limited in scope. The following are excluded from consideration: cross-sectional studies, case series and case reports. So too are studies of sarcoidosis in first responders exposed to World Trade Center dust. Each can provide valuable information about sarcoidosis. Our case series of sarcoidosis in Ontario hard rock miners is an example; it is unique in its inclusion of semi-quantitative silica exposure data [3]. In August 2023, a paper by Huntley et al. entitled ‘Airborne occupational exposures associated with pulmonary sarcoidosis: a systematic review and meta-analysis’ was published [4]. This SR/meta-analysis (MA) is broader in scope than the RR and its findings are notably different. The MA reveals statistically significant associations between sarcoidosis and occupational exposures to silica (six studies), pesticides (three studies) and mould or mildew (two studies). Risk estimates were significantly elevated for five other agents in single case–control studies. The RR reveals statistically significant associations for silica (two studies). The authors of the RR conclude only that their RR suggests ‘a developing body of research’ supporting an association between occupational exposure to silica and sarcoidosis [1]. Huntley et al. conclude that given the number of antigens positively associated with sarcoidosis in their study, ‘… the onset [of sarcoidosis] is far more likely the result of a complex genetic-environmental-immunological interaction’ [4]. We agree and we suggest that the use of RR methodology for developing occupational disease policy for rare diseases such as sarcoidosis be held in abeyance until equivalency with SRs has been shown.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.004 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".