Association of Vitamin D Status and Other Clinical Characteristics With COVID-19 Test Results
MD David O Meltzer, PhD Thomas J Best, PhD Hui Zhang, PhD Tamara Vokes, MD Vineet Arora, MD, MPP Julian Solway
JAMA Network Open, doi:10.1001/jamanetworkopen.2020.19722
IMPORTANCE Vitamin D treatment has been found to decrease the incidence of viral respiratory tract infection, especially in patients with vitamin D deficiency. Whether vitamin D is associated with coronavirus disease 2019 (COVID-19) incidence is unknown. OBJECTIVE To examine whether the last vitamin D status before COVID-19 testing is associated with COVID-19 test results. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study at an urban academic medical center included patients with a 25-hydroxycholecalciferol or 1,25-dihydroxycholecalciferol level measured within 1 year before being tested for COVID-19 from March 3 to April 10, 2020. EXPOSURES Vitamin D deficiency was defined by the last measurement of 25-hydroxycholecalciferol less than 20 ng/mL or 1,25-dihydroxycholecalciferol less than 18 pg/mL before COVID-19 testing. Treatment changes were defined by changes in vitamin D type and dose between the date of the last vitamin D level measurement and the date of COVID-19 testing. Vitamin D deficiency and treatment changes were combined to categorize the most recent vitamin D status before COVID-19 testing as likely deficient (last level deficient and treatment not increased), likely sufficient (last level not deficient and treatment not decreased), and 2 groups with uncertain deficiency (last level deficient and treatment increased, and last level not deficient and treatment decreased). MAIN OUTCOMES AND MEASURES The outcome was a positive COVID-19 polymerase chain reaction test result. Multivariable analysis tested whether vitamin D status before COVID-19 testing was associated with testing positive for COVID-19, controlling for demographic and comorbidity indicators. RESULTS A total of 489 patients (mean [SD] age, 49.2 [18.4] years; 366 [75%] women; and 331 [68%] race other than White) had a vitamin D level measured in the year before COVID-19 testing. Vitamin D status before COVID-19 testing was categorized as likely deficient for 124 participants (25%), likely sufficient for 287 (59%), and uncertain for 78 (16%). Overall, 71 participants (15%) tested positive for COVID-19. In multivariate analysis, testing positive for COVID-19 was associated with increasing age up to age 50 years (relative risk, 1.06; 95% CI, 1.01-1.09; P = .02); non-White race (relative risk, 2.54; 95% CI, 1.26-5.12; P = .009), and likely deficient vitamin D status (relative risk, 1.77; 95% CI, 1.12-2.81; P = .02) compared with likely sufficient vitamin D status. Predicted COVID-19 rates in the deficient group were 21.6% (95% CI, 14.0%-29.2%) vs 12.2%(95% CI, 8.9%-15.4%) in the sufficient group. (continued) Key Points Question Is vitamin D status, reflecting vitamin D levels and treatment, associated with test results for coronavirus disease 2019 (COVID-19)? Findings In this cohort study of 489 patients who had a vitamin D level measured in the year before COVID-19 testing, the relative risk of testing positive for COVID-19 was 1.77 times greater for patients..
References
Cdc Covid-, Characteristics of health care personnel with COVID-19 -United States, MMWR Morb Mortal Wkly Rep,
doi:10.15585/mmwr.mm6915e6Diagnostics, cobas Elecsys Vitamin D total II assay
Diagnostics, cobas SARS-CoV-2 test (for the COVID-19 coronavirus)
Elliott, Binkley, Carnes, Fracture risks for women in long-term care: high prevalence of calcaneal osteoporosis and hypovitaminosis D, Pharmacotherapy,
doi:10.1592/phco.23.6.702.32182Frieden, Former, Chief Dr, Tom Frieden: coronavirus infection risk may be reduced by vitamin D. Fox News, Opinion
Garg, Kim, Whitaker, Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019: COVID-NET, 14 States, MMWR Morb Mortal Wkly Rep,
doi:10.15585/mmwr.mm6915e3Ginde, Sullivan, Mansbach, Camargo, Vitamin D insufficiency in pregnant and nonpregnant women of childbearing age in the United States, Am J Obstet Gynecol,
doi:10.1016/j.ajog.2009.11.036Gold, Wong, Szablewski, Characteristics and clinical outcomes of adult patients hospitalized with COVID-19 -Georgia, March 2020, MMWR Morb Mortal Wkly Rep,
doi:10.15585/mmwr.mm6918e1Grant, Lahore, Mcdonnell, Evidence that vitamin D supplementation could reduce risk of influenza and COVID-19 infections and deaths, Nutrients,
doi:10.3390/nu12040988Greger, Effect of Variations in Dietary Protein, Phosphorus, Electrolytes and Vitamin D on Calcium and Zinc Metabolism: Nutrient Interactions, Marcel Dekker
Holick, Binkley, Bischoff-Ferrari, Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline, J Clin Endocrinol Metab,
doi:10.1210/jc.2011-0385Hunt, Britons urged to take vitamin D while sheltering inside during the pandemic, Published
Huotari, Herzig, Vitamin D and living in northern latitudes-an endemic risk area for vitamin D deficiency, Int J Circumpolar Health,
doi:10.3402/ijch.v67i2-3.18258Li, Guan, Wu, Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia, N Engl J Med,
doi:10.1056/NEJMoa2001316Martineau, Jolliffe, Hooper, Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data, BMJ,
doi:10.1136/bmj.i6583Mcnutt, Wu, Xue, Hafner, Estimating the relative risk in cohort studies and clinical trials of common outcomes, Am J Epidemiol,
doi:10.1093/aje/kwg074Misra, Pacaud, Petryk, Collett-Solberg, Kappy, Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society. Vitamin D deficiency in children and its management: review of current knowledge and recommendations, Pediatrics,
doi:10.1542/peds.2007-1894Nakamura, Vitamin D insufficiency in Japanese populations: from the viewpoint of the prevention of osteoporosis, J Bone Miner Metab,
doi:10.1007/s00774-005-0637-0Pregibon, Data Analytic Methods for Generalized Linear Models
Ross, Dietary Reference Intakes for Calcium and Vitamin D
Sowah, Fan, Dennett, Hagtvedt, Straube, Vitamin D levels and deficiency with different occupations: a systematic review, BMC Public Health,
doi:10.1186/s12889-017-4436-zStokes, Zambrano, Anderson, Coronavirus disease 2019 case surveillance -United States, MMWR Morb Mortal Wkly Rep,
doi:10.15585/mmwr.mm6924e2Umhau, Casting sunlight on an epidemic: is vitamin D a critical host factor to prevent COVID-19? MedPage Today
Velthuis, Van Den Worm, Sims, Baric, Snijder et al., Zn(2+) inhibits coronavirus and arterivirus RNA polymerase activity in vitro and zinc ionophores block the replication of these viruses in cell culture, PLoS Pathog,
doi:10.1371/journal.ppat.1001176Viracor, Coronavirus (COVID-19) SARS-CoV-2 PCR
Zhang, Iwashyna, Christakis, The performance of different lookback periods and sources of information for Charlson comorbidity adjustment in Medicare claims, Med Care,
doi:10.1097/00005650-199911000-00005{ 'indexed': {'date-parts': [[2024, 4, 8]], 'date-time': '2024-04-08T12:41:22Z', 'timestamp': 1712580082301},
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'title': 'Association of Vitamin D Status and Other Clinical Characteristics With COVID-19 Test Results',
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'key': 'zoi200688r2',
'doi-asserted-by': 'publisher',
'first-page': '988',
'DOI': '10.3390/nu12040988',
'article-title': 'Evidence that vitamin D supplementation could reduce risk of influenza '
'and COVID-19 infections and deaths.',
'volume': '12',
'author': 'Grant',
'year': '2020',
'journal-title': 'Nutrients'},
{ 'key': 'zoi200688r3',
'doi-asserted-by': 'publisher',
'first-page': 'i6583',
'DOI': '10.1136/bmj.i6583',
'article-title': 'Vitamin D supplementation to prevent acute respiratory tract '
'infections: systematic review and meta-analysis of individual '
'participant data.',
'volume': '356',
'author': 'Martineau',
'year': '2017',
'journal-title': 'BMJ'},
{ 'issue': '1',
'key': 'zoi200688r4',
'doi-asserted-by': 'publisher',
'first-page': '48',
'DOI': '10.1016/j.nutres.2010.12.001',
'article-title': 'Prevalence and correlates of vitamin D deficiency in US adults.',
'volume': '31',
'author': 'Forrest',
'year': '2011',
'journal-title': 'Nutr Res'},
{ 'issue': '15',
'key': 'zoi200688r5',
'doi-asserted-by': 'publisher',
'first-page': '458',
'DOI': '10.15585/mmwr.mm6915e3',
'article-title': 'Hospitalization rates and characteristics of patients hospitalized with '
'laboratory-confirmed coronavirus disease 2019: COVID-NET, 14 States, '
'March 1–30, 2020.',
'volume': '69',
'author': 'Garg',
'year': '2020',
'journal-title': 'MMWR Morb Mortal Wkly Rep'},
{ 'issue': '15',
'key': 'zoi200688r9',
'doi-asserted-by': 'publisher',
'first-page': '477',
'DOI': '10.15585/mmwr.mm6915e6',
'article-title': 'Characteristics of health care personnel with COVID-19 - United States, '
'February 12-April 9, 2020.',
'volume': '69',
'author': 'CDC COVID-19 Response Team',
'year': '2020',
'journal-title': 'MMWR Morb Mortal Wkly Rep'},
{ 'issue': '2-3',
'key': 'zoi200688r10',
'doi-asserted-by': 'publisher',
'first-page': '164',
'DOI': '10.3402/ijch.v67i2-3.18258',
'article-title': 'Vitamin D and living in northern latitudes—an endemic risk area for '
'vitamin D deficiency.',
'volume': '67',
'author': 'Huotari',
'year': '2008',
'journal-title': 'Int J Circumpolar Health'},
{ 'issue': '6',
'key': 'zoi200688r11',
'doi-asserted-by': 'publisher',
'first-page': '702',
'DOI': '10.1592/phco.23.6.702.32182',
'article-title': 'Fracture risks for women in long-term care: high prevalence of '
'calcaneal osteoporosis and hypovitaminosis D.',
'volume': '23',
'author': 'Elliott',
'year': '2003',
'journal-title': 'Pharmacotherapy'},
{ 'issue': '1',
'key': 'zoi200688r12',
'doi-asserted-by': 'publisher',
'first-page': '519',
'DOI': '10.1186/s12889-017-4436-z',
'article-title': 'Vitamin D levels and deficiency with different occupations: a '
'systematic review.',
'volume': '17',
'author': 'Sowah',
'year': '2017',
'journal-title': 'BMC Public Health'},
{ 'issue': '13',
'key': 'zoi200688r13',
'doi-asserted-by': 'publisher',
'first-page': '1199',
'DOI': '10.1056/NEJMoa2001316',
'article-title': 'Early transmission dynamics in Wuhan, China, of novel '
'coronavirus-infected pneumonia.',
'volume': '382',
'author': 'Li',
'year': '2020',
'journal-title': 'N Engl J Med'},
{ 'issue': '5',
'key': 'zoi200688r15',
'doi-asserted-by': 'publisher',
'first-page': '436.e1',
'DOI': '10.1016/j.ajog.2009.11.036',
'article-title': 'Vitamin D insufficiency in pregnant and nonpregnant women of '
'childbearing age in the United States.',
'volume': '202',
'author': 'Ginde',
'year': '2010',
'journal-title': 'Am J Obstet Gynecol'},
{ 'issue': '2',
'key': 'zoi200688r16',
'doi-asserted-by': 'publisher',
'first-page': '398',
'DOI': '10.1542/peds.2007-1894',
'article-title': 'Vitamin D deficiency in children and its management: review of current '
'knowledge and recommendations.',
'volume': '122',
'author': 'Misra',
'year': '2008',
'journal-title': 'Pediatrics'},
{ 'issue': '1',
'key': 'zoi200688r17',
'doi-asserted-by': 'publisher',
'first-page': '1',
'DOI': '10.1007/s00774-005-0637-0',
'article-title': 'Vitamin D insufficiency in Japanese populations: from the viewpoint of '
'the prevention of osteoporosis.',
'volume': '24',
'author': 'Nakamura',
'year': '2006',
'journal-title': 'J Bone Miner Metab'},
{ 'issue': '7',
'key': 'zoi200688r27',
'doi-asserted-by': 'publisher',
'first-page': '1911',
'DOI': '10.1210/jc.2011-0385',
'article-title': 'Evaluation, treatment, and prevention of vitamin D deficiency: an '
'Endocrine Society clinical practice guideline.',
'volume': '96',
'author': 'Holick',
'year': '2011',
'journal-title': 'J Clin Endocrinol Metab'},
{ 'issue': '11',
'key': 'zoi200688r29',
'doi-asserted-by': 'publisher',
'first-page': '1128',
'DOI': '10.1097/00005650-199911000-00005',
'article-title': 'The performance of different lookback periods and sources of '
'information for Charlson comorbidity adjustment in Medicare claims.',
'volume': '37',
'author': 'Zhang',
'year': '1999',
'journal-title': 'Med Care'},
{ 'issue': '10',
'key': 'zoi200688r30',
'doi-asserted-by': 'publisher',
'first-page': '940',
'DOI': '10.1093/aje/kwg074',
'article-title': 'Estimating the relative risk in cohort studies and clinical trials of '
'common outcomes.',
'volume': '157',
'author': 'McNutt',
'year': '2003',
'journal-title': 'Am J Epidemiol'},
{ 'issue': '1',
'key': 'zoi200688r32',
'doi-asserted-by': 'publisher',
'first-page': '5',
'DOI': '10.1002/(ISSN)1521-4036',
'article-title': 'Parameter estimation and goodness-of-fit in log binomial regression.',
'volume': '48',
'author': 'Blizzard',
'year': '2006',
'journal-title': 'Biom J'},
{ 'issue': '4',
'key': 'zoi200688r33',
'doi-asserted-by': 'publisher',
'first-page': '561',
'DOI': '10.1016/j.dsx.2020.04.050',
'article-title': 'Vitamin D concentrations and COVID-19 infection in UK Biobank.',
'volume': '14',
'author': 'Hastie',
'year': '2020',
'journal-title': 'Diabetes Metab Syndr'},
{ 'issue': '24',
'key': 'zoi200688r35',
'doi-asserted-by': 'publisher',
'first-page': '759',
'DOI': '10.15585/mmwr.mm6924e2',
'article-title': 'Coronavirus disease 2019 case surveillance - United States, January '
'22-May 30, 2020.',
'volume': '69',
'author': 'Stokes',
'year': '2020',
'journal-title': 'MMWR Morb Mortal Wkly Rep'},
{ 'issue': '18',
'key': 'zoi200688r36',
'doi-asserted-by': 'publisher',
'first-page': '545',
'DOI': '10.15585/mmwr.mm6918e1',
'article-title': 'Characteristics and clinical outcomes of adult patients hospitalized '
'with COVID-19 - Georgia, March 2020.',
'volume': '69',
'author': 'Gold',
'year': '2020',
'journal-title': 'MMWR Morb Mortal Wkly Rep'},
{ 'issue': '11',
'key': 'zoi200688r37',
'doi-asserted-by': 'publisher',
'first-page': '1656',
'DOI': '10.3390/nu10111656',
'article-title': 'Vitamin D: nutrient, hormone, and immunomodulator.',
'volume': '10',
'author': 'Sassi',
'year': '2018',
'journal-title': 'Nutrients'},
{ 'issue': '11',
'key': 'zoi200688r39',
'doi-asserted-by': 'crossref',
'DOI': '10.1371/journal.ppat.1001176',
'article-title': 'Zn(2+) inhibits coronavirus and arterivirus RNA polymerase activity in '
'vitro and zinc ionophores block the replication of these viruses in '
'cell culture.',
'volume': '6',
'author': 'te Velthuis',
'year': '2010',
'journal-title': 'PLoS Pathog'},
{ 'key': 'zoi200688r40',
'first-page': '69',
'article-title': 'Vitamin D and inflammatory diseases.',
'volume': '7',
'author': 'Yin',
'year': '2014',
'journal-title': 'J Inflamm Res'},
{ 'issue': '22',
'key': 'zoi200688r41',
'doi-asserted-by': 'publisher',
'first-page': '5811',
'DOI': '10.3390/ijms20225811',
'article-title': 'Correlation of vitamin D with inflammatory cytokines, atherosclerotic '
'parameters, and lifestyle factors in the setting of heart failure: a '
'12-month follow-up study.',
'volume': '20',
'author': 'Roffe-Vazquez',
'year': '2019',
'journal-title': 'Int J Mol Sci'},
{ 'issue': '10229',
'key': 'zoi200688r42',
'doi-asserted-by': 'publisher',
'first-page': '1033',
'DOI': '10.1016/S0140-6736(20)30628-0',
'article-title': 'COVID-19: consider cytokine storm syndromes and immunosuppression.',
'volume': '395',
'author': 'Mehta',
'year': '2020',
'journal-title': 'Lancet'},
{ 'key': 'zoi200688r26',
'volume-title': 'Dietary Reference Intakes for Calcium and Vitamin D',
'author': 'Del Valle',
'year': '2011'},
{ 'key': 'zoi200688r34',
'volume-title': 'Dietary Reference Intakes for Calcium and Vitamin D',
'author': 'Institute of Medicine',
'year': '2011'},
{ 'key': 'zoi200688r38',
'first-page': '205',
'volume-title': 'Effect of Variations in Dietary Protein, Phosphorus, Electrolytes and '
'Vitamin D on Calcium and Zinc Metabolism: Nutrient Interactions',
'author': 'Greger',
'year': '1988'},
{ 'key': 'zoi200688r1',
'unstructured': 'COVID-19 corona virus pandemic. Worldometer. Updated August 12, 2020. '
'Accessed August 12, 2020. https://www.worldometers.info/coronavirus'},
{ 'key': 'zoi200688r6',
'unstructured': 'Umhau? JC. Casting sunlight on an epidemic: is vitamin D a critical host '
'factor to prevent COVID-19? MedPage Today. Published March 25, 2020. '
'Accessed April 13, 2020. '
'https://www.medpagetoday.com/infectiousdisease/covid19/85596?'},
{ 'key': 'zoi200688r7',
'unstructured': 'NCHS, National Vital Statistics System. Provisional death counts for '
'coronavirus disease (COVID-19). Centers for Disease Control and '
'Prevention. Updated August 12, 2020. Accessed August 12, 2020. '
'https://www.cdc.gov/nchs/nvss/vsrr/COVID19/index.htm'},
{ 'key': 'zoi200688r8',
'unstructured': 'National Center for Immunization and Respiratory Diseases (NCIRD), '
'Division of Viral Diseases. Preparing for COVID-19 in nursing homes. '
'Updated August 12, 2020. Accessed August 12, 2020. '
'https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html'},
{ 'key': 'zoi200688r14',
'unstructured': 'Cumulative number of patients diagnosed with coronavirus disease '
'(COVID-19) in Japan as of August 7, 2020. Statista. Accessed August 12, '
'2020. '
'https://www.statista.com/statistics/1096478/japan-confirmed-cases-of-coronavirus-by-state-of-health'},
{ 'key': 'zoi200688r18',
'unstructured': 'Hunt? K. Britons urged to take vitamin D while sheltering inside during '
'the pandemic. Published April 23, 2020. Accessed April 27, 2020. '
'https://www.cnn.com/2020/04/23/health/vitamin-d-uk-coronavirus-wellness/index.html'},
{ 'key': 'zoi200688r19',
'unstructured': 'Frieden? T. Former CDC Chief Dr. Tom Frieden: coronavirus infection risk '
'may be reduced by vitamin D. Fox News, Opinion. Published March 23, '
'2020. Accessed April 13, 2020. '
'https://www.foxnews.com/opinion/former-cdc-chief-tom-frieden-coronavirus-risk-may-be-reduced-with-vitamin-d'},
{ 'key': 'zoi200688r20',
'unstructured': 'Medical societies advise on vitamin D in midst of COVID-19. Medscape. '
'Published July 10, 2020. Accessed July 10, 2020. '
'https://www.medscape.com/viewarticle/933715'},
{ 'key': 'zoi200688r21',
'unstructured': 'National Center for Immunization and Respiratory Diseases (NCIRD), '
'Division of Viral Diseases. CDC diagnostic tests for COVID-19. Centers '
'for Disease Control and Prevention. Updated August 5, 2020. Accessed '
'August 12, 2020. '
'https://www.cdc.gov/coronavirus/2019-ncov/lab/testing.html'},
{ 'key': 'zoi200688r22',
'doi-asserted-by': 'crossref',
'unstructured': 'Viracor. Coronavirus (COVID-19) SARS-CoV-2 PCR. Accessed July 13, 2020. '
'https://www.viracor-eurofins.com/test-menu/8300-coronavirus-covid-19-sars-cov-2-rt-pcr/',
'DOI': '10.22627/2072-8107-2020-19-1-5-6'},
{ 'key': 'zoi200688r23',
'unstructured': 'Roche Diagnostics. cobas SARS-CoV-2 test (for the COVID-19 coronavirus). '
'Accessed July 13, 2020. '
'https://diagnostics.roche.com/us/en/products/params/cobas-sars-cov-2-test.html'},
{ 'key': 'zoi200688r24',
'unstructured': 'Roche Diagnostics. cobas Elecsys Vitamin D total II assay. Accessed July '
'15, 2020. '
'https://diagnostics.roche.com/se/sv/products/params/elecsys-vitamin-d-total-ii.html'},
{ 'key': 'zoi200688r25',
'unstructured': 'Mayo Clinic Laboratories. Test ID: DHVD: 1,25-dihydroxyvitamin D, serum. '
'Accessed July 15, 2020. '
'https://www.mayocliniclabs.com/test-catalog/Performance/8822'},
{ 'key': 'zoi200688r28',
'unstructured': 'Healthcare Cost and Utilization Project (HCUP). Elixhauser Comorbidity '
'Software for ICD-10-CM (beta version).Version 2020 v1. Accessed April 8, '
'2020. '
'https://www.hcup-us.ahrq.gov/toolssoftware/comorbidityicd10/comorbidity_icd10.jsp'},
{ 'key': 'zoi200688r31',
'unstructured': 'Pregibon? D. Data Analytic Methods for Generalized Linear Models. '
'Dissertation. University of Toronto; 1979; 43.'}],
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