Abstract: Assessment of Vitamin D deficiency and COVID-19 diagnosis in patients with breast or
prostate cancer using Electronic Medical Records
Aaron Galaznik, MD MBA1 | Emelly Rusli, MPH1 | Vicki Wing, MS1 | Rahul Jain, PhD1 | Sheila Diamond, MS CGC1 | David Fajgenbaum, MD MBA MSc FCPP2
1 Medidata Acorn AI, a Dassault Systèmes company, New York, NY, 10014 | 2 Castleman Disease Collaborative Network and the University of Pennsylvania, Philadelphia, PA, 19104
RESULTS
BACKGROUND
BACKGROUND
•
•
While patients with cancer are known to be at increased risk
of infection in part due to the immunocompromising nature of
cancer treatments, recent data indicate a particularly high
risk for COVID-19 infection and poor outcomes. 1
•
Our study suggests
potentially vulnerable
populations, such as breast
and prostate cancer
patients, may have an
elevated risk of
COVID-19 infection if
vitamin D deficient.
Vitamin D deficiency has been previously reported in two
leading causes of cancer deaths: breast and prostate. 4
•
In this study, we performed a retrospective cohort analysis on
nationally representative electronic medical records (EMR) to
assess whether vitamin D deficiency affects risk of COVID19 among these patients.
Vitamin D may play an important role in COVID-19. A recent
study demonstrated vitamin D deficiency may increase risk of
COVID-19 infection, and a small randomized controlled trial
in Spain reported significant improvement in mortality among
hospitalized patients treated with calcifediol. 2,3
METHODS
Figure 1. Study Timeline
•
A total of 16,287 breast cancer and 14,919 prostate cancer patients were included in the study. (Figure 2)
Table 1. Patient Demographic and Clinical Characteristics
Breast Cancer
TOTAL (N = 16,287)
Patient Characteristics
N/Mean
%/SD
N/Mean
%/SD
68.9
11.3
73.6
8.5
<70 years (n, %)
7,962
48.9%
4,625
31.0%
70-79 years (n, %)
5,368
33.0%
6,499
43.6%
80+ years (n, %)
2,957
18.2%
3,795
25.4%
16,287
100.0%
0
0.0%
0
13,805
2,102
305
16
49
10
0.0%
84.8%
12.9%
1.9%
0.1%
0.3%
0.1%
14,919
12,390
2,405
89
12
22
1
100.0%
83.1%
16.1%
0.6%
0.1%
0.1%
0.0%
2,384
14.6%
1,318
8.8%
1.1
1.5
1.4
1.7
Congestive heart failure (n, %)
1,075
6.60%
1,483
9.94%
Obesity (n, %)
5,036
30.9%
4,627
31.0%
Diabetes mellitus (n, %)
3,327
20.4%
3,897
26.1%
356
2.2%
303
2.0%
1,730
10.6%
2,371
15.9%
Age (Mean, SD)
Sex (n, %)
Female
Male
White
Race (n, %)
Black
Asian
Native Hawaiian/Pacific Islander
American Indian or Alaska Native
Missing
Vitamin D deficient (n, %)
Comorbid
Conditions
Quan Charlson Comorbidity Index (Mean, SD)
Liver disease (n, %)
Figure 2. Patient Attrition
Patient with ≥ 1 encounter
between 3/1/2018 and
3/1/2019, and after 3/1/2020
(index date)
Age ≥ 18 and non-missing sex
and race
n = 1,630,384 (52.8%)
•
•
•
Patients with breast (female) or prostate (male) cancer
were identified between 3/1/2018 and 3/1/2020 from
Healthjump EMR data provided pro-bono by the COVID-19
Research Database.5
Logistic regressions, adjusted for baseline demographic
and clinical characteristics assessed in the 12 months prior
to 3/1/2020, were conducted to estimate the effect of
•
•
The average age was 68.9 years in the breast cancer cohort
and 73.6 years in the prostate cancer cohort.
(Table 1)
•
Approximately 15% of the breast cancer cohort and 9% of
the prostate cancer cohort had vitamin D deficiency.
•
The most common comorbid conditions were obesity
(approximately a third..
{ 'indexed': { 'date-parts': [[2021, 12, 16]],
'date-time': '2021-12-16T01:13:47Z',
'timestamp': 1639617227727},
'reference-count': 0,
'publisher': 'American Society of Clinical Oncology (ASCO)',
'issue': '15_suppl',
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'abstract': '<jats:p> 6589 </jats:p><jats:p> Background: While patients with cancer are known to be at '
'increased risk of infection in part due to the immunocompromising nature of cancer '
'treatments, recent data indicate a particularly high risk for COVID-19 infection and poor '
'outcomes (Wang et\xa0al., 2020). A recent study (Meltzer et\xa0al., 2020) demonstrated '
'Vitamin D deficiency may increase risk of COVID-19 infection, and a small randomized '
'controlled trial in Spain reported significant improvement in mortality among hospitalized '
'patients treated with calcifediol. Vitamin D deficiency has been reported in two leading '
'causes of cancer deaths: breast and prostate. In this study, we performed a retrospective '
'cohort analysis on nationally representative electronic medical records (EMR) to assess '
'whether Vitamin D deficiency affects risk of COVID-19 among these patients. Methods: Patients '
'with breast (female) or prostate (male) cancer were identified between 3/1/2018 and 3/1/2020 '
'from EMR data provided pro-bono by the COVID-19 Research Database ( '
'covid19researchdatabase.org ). Patients with an ICD-10 code for Vitamin D deficiency or < '
'20ng/mL 20(OH)D laboratory result within 12 months prior to 3/1/2020 were classified as '
'Vitamin D deficient. COVID-19 diagnosis was defined using ICD-10 codes and laboratory results '
'for COVID-19 at any time after 3/1/2020. Logistic regressions, adjusting for baseline '
'demographic and clinical characteristics, were conducted to estimate the effect of Vitamin D '
'deficiency on COVID-19 incidence in each cancer cohort. Results: A total of 16,287 breast '
'cancer and 14,919 prostate cancer patients were included in the study. The average age was '
'68.9 years in the breast cancer cohort and 73.6 years in the prostate cancer cohort. The '
'breast cancer cohort consisted of 85% Whites, 13% Black or African Americans, and less than '
'5% of other races. A similar race distribution was observed in the prostate cancer cohort. '
'Unadjusted analysis showed the risk of COVID-19 was higher among Vitamin D deficient patients '
'compared to non-deficient patients in both cohorts (breast: OR = 1.60 [95% C.I.: 1.15, 2.20]; '
'prostate: OR = 1.59 [95% C.I.: 1.08, 2.33]). Similar findings were observed when assessed in '
'subgroups of patients with newly diagnosed cancer in the dataset, as well as after adjusting '
'for baseline characteristics. Conclusions: Our study suggests breast and prostate cancer '
'patients may have an elevated risk of COVID-19 infection if Vitamin D deficient. These '
'results support findings by Meltzer et\xa0al., 2020 demonstrating a relationship between '
'Vitamin D deficiency and COVID-19 infection. While a randomized clinical trial is warranted '
'to confirm the role for Vitamin D supplementation in preventing COVID-19, our study '
'underscores the importance of monitoring Vitamin D levels across and within cancer '
'populations, particularly in the midst of the global COVID-19 pandemic. </jats:p>',
'DOI': '10.1200/jco.2021.39.15_suppl.6589',
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'title': [ 'Assessment of vitamin D deficiency and COVID-19 diagnosis in patients with breast or prostate '
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'container-title': ['Journal of Clinical Oncology'],
'original-title': [],
'language': 'en',
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'date-time': '2021-06-03T17:38:14Z',
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