Vitamin D Deficiency and Comorbidities as Risk Factors of COVID-19 Infection: A Systematic Review and Meta-analysis
Pinki Mishra, Rizwana Parveen, Ram Bajpai, Nidhi Agarwal
Journal of Preventive Medicine and Public Health, doi:10.3961/jpmph.21.640
Objectives: Extensive evidence links low vitamin D status and comorbidities with coronavirus disease 2019 outcomes, but the results of published studies are contradictory. Therefore, we investigated the association of lower levels of vitamin D and comorbidities with the risk of COVID-19 infection.
Methods: We searched MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov for articles published until August 20, 2021. Sixteen eligible studies were identified (386 631 patients, of whom 181 114 were male). We included observational cohort and case-control studies that evaluated serum levels of vitamin D in COVID-19-positive and COVID-19-negative patients. Mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Results: Significantly lower vitamin D levels were found in COVID-19-positive patients (MD, -1.70; 95% CI, -2.74 to -0.66; p=0.001), but with variation by study design (case-control: -4.04; 95% CI, -5.98 to -2.10; p<0.001; cohort: -0.39; 95% CI, -1.62 to 0.84; p=0.538). This relationship was more prominent in female patients (MD, -2.18; 95% CI, -4.08 to -0.28; p=0.024) than in male patients (MD, -1.74; 95% CI, -3.79 to 0.31; p=0.096). Male patients showed higher odds of having low vitamin D levels (odds ratio [OR], 2.09; 95% CI, 1.38 to 3.17; p<0.001) than female patients (OR, 1.17; 95% CI, 0.74 to 1.86; p=0.477). Comorbidities showed inconsistent, but generally nonsignificant, associations with COVID-19 infection. Conclusions: Low serum vitamin-D levels were significantly associated with the risk of COVID-19 infection. This relationship was stronger in female than in male COVID-19 patients. Limited evidence was found for the relationships between comorbidities and COVID-19 infection, warranting large population-based studies to clarify these associations.
CONFLICT OF INTEREST The authors have no conflicts of interest associated with the material presented in this paper.
FUNDING None.
AUTHOR CONTRIBUTIONS Conceptualization: Mishra P, Parveen R. Data curation: Mishra P, Parveen R. Formal analysis: Mishra P, Bajpai R. Funding acquisition: None. Methodology: Mishra P, Bajpai R. Project administration: Agarwal N, Mishra P. Visualization: Mishra P, Parveen R. Writing -original draft: Mishra P, Parveen R, Agarwal N, Bajpai R. Writing -review & editing: Bajpai R, Agarwal N.
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'abstract': '<jats:p>Objectives: Extensive evidence links low vitamin D status and comorbidities with '
'coronavirus disease 2019 (COVID-19) outcomes, but the results of published studies are '
'contradictory. Therefore, we investigated the association of lower levels of vitamin D and '
'comorbidities with the risk of COVID-19 infection.Methods: We searched MEDLINE (via PubMed), '
'Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov for articles published '
'until August 20, 2021. Sixteen eligible studies were identified (386 631 patients, of whom '
'181 114 were male). We included observational cohort and case-control studies that evaluated '
'serum levels of vitamin D in COVID-19-positive and COVID-19-negative patients. Mean '
'differences (MDs) with 95% confidence intervals (CIs) were calculated.Results: Significantly '
'lower vitamin D levels were found in COVID-19-positive patients (MD, -1.70; 95% CI, -2.74 to '
'-0.66; p=0.001), but with variation by study design (case-control: -4.04; 95% CI, -5.98 to '
'-2.10; p<0.001; cohort: -0.39; 95% CI, -1.62 to 0.84; p=0.538). This relationship was more '
'prominent in female patients (MD, -2.18; 95% CI, -4.08 to -0.28; p=0.024) than in male '
'patients (MD, -1.74; 95% CI, -3.79 to 0.31; p=0.096). Male patients showed higher odds of '
'having low vitamin D levels (odds ratio [OR], 2.09; 95% CI, 1.38 to 3.17; p<0.001) than '
'female patients (OR, 1.17; 95% CI, 0.74 to 1.86; p=0.477). Comorbidities showed inconsistent, '
'but generally non-significant, associations with COVID-19 infection.Conclusions: Low serum '
'vitamin-D levels were significantly associated with the risk of COVID-19 infection. This '
'relationship was stronger in female than in male COVID-19 patients. Limited evidence was '
'found for the relationships between comorbidities and COVID-19 infection, warranting large '
'population-based studies to clarify these associations.</jats:p>',
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'resource': {'primary': {'URL': 'http://jpmph.org/journal/view.php?doi=10.3961/jpmph.21.640'}},
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