Association of Vitamin D Status and COVID-19-Related Hospitalization and Mortality

DOI record: { "DOI": "10.1007/s11606-021-07170-0", "ISSN": [ "0884-8734", "1525-1497" ], "URL": "http://dx.doi.org/10.1007/s11606-021-07170-0", "abstract": "<jats:title>Abstract</jats:title><jats:sec>\n <jats:title>Background</jats:title>\n <jats:p>The relationship between vitamin D status and COVID-19-related clinical outcomes is controversial. Prior studies have been conducted in smaller, single-site, or homogeneous populations limiting adjustments for social determinants of health (race/ethnicity and poverty) common to both vitamin D deficiency and COVID-19 outcomes.</jats:p>\n </jats:sec><jats:sec>\n <jats:title>Objective</jats:title>\n <jats:p>To evaluate the dose-response relationship between continuous 25(OH)D and risk for COVID-19-related hospitalization and mortality after adjusting for covariates associated with both vitamin D deficiency and COVID-19 outcomes.</jats:p>\n </jats:sec><jats:sec>\n <jats:title>Design</jats:title>\n <jats:p>Retrospective cohort study.</jats:p>\n </jats:sec><jats:sec>\n <jats:title>Patients</jats:title>\n <jats:p>Veteran patients receiving care in US Department of Veteran Affairs (VA) health care facilities with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test and a blood 25(OH)D test between February 20, 2020, and November 8, 2020, followed for up to 60 days.</jats:p>\n </jats:sec><jats:sec>\n <jats:title>Main Measures</jats:title>\n <jats:p>Exposure was blood 25(OH)D concentration ascertained closest to and within 15 to 90 days preceding an index positive SARS-CoV-2 test. Co-primary study outcomes were COVID-19-related inpatient hospitalization requiring airborne, droplet, contact, or other isolation and mortality ascertained within 60 days of an index positive SARS-CoV-2 test.</jats:p>\n </jats:sec><jats:sec>\n <jats:title>Key Results</jats:title>\n <jats:p>Of 4,599 veterans with a positive SARS-CoV-2 test, vitamin D deficiency (&lt; 20 ng/mL) was identified in 665 (14.5%); 964 (21.0%) were hospitalized; and 340 (7.4%) died. After adjusting for all covariates, including race/ethnicity and poverty, there was a significant independent inverse dose-response relationship between increasing continuous 25(OH)D concentrations (from 15 to 60 ng/mL) and decreasing probability of COVID-19-related hospitalization (from 24.1 to 18.7%, <jats:italic>p</jats:italic>=0.009) and mortality (from 10.4 to 5.7%, <jats:italic>p</jats:italic>=0.001). In modeling 25(OH)D as a log-transformed continuous variable, the greatest risk for hospitalization and death was observed at lower 25(OH)D concentrations.</jats:p>\n </jats:sec><jats:sec>\n <jats:title>Conclusions</jats:title>\n <jats:p>Continuous blood 25(OH)D concentrations are independently associated with COVID-19-related hospitalization and mortality in an inverse dose-response relationship in this large racially and ethnically diverse cohort of VA patients. Randomized controlled trials are needed to evaluate the impact of vitamin D supplementation on COVID-19-related outcomes.</jats:p>\n </jats:sec>", "alternative-id": [ "7170" ], "assertion": [ { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Received", "name": "received", "order": 1, "value": "9 June 2021" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Accepted", "name": "accepted", "order": 2, "value": "24 September 2021" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "First Online", "name": "first_online", "order": 3, "value": "1 January 2022" } ], "author": [ { "ORCID": "http://orcid.org/0000-0002-6676-9117", "affiliation": [], "authenticated-orcid": false, "family": "Seal", "given": "Karen H.", "sequence": "first" }, { "affiliation": [], "family": "Bertenthal", "given": "Daniel", "sequence": "additional" }, { "affiliation": [], "family": "Carey", "given": "Evan", "sequence": "additional" }, { "affiliation": [], "family": "Grunfeld", "given": "Carl", "sequence": "additional" }, { "affiliation": [], "family": "Bikle", "given": "Daniel D.", "sequence": "additional" }, { "affiliation": [], "family": "Lu", "given": "Chuanyi M.", "sequence": "additional" } ], "container-title": [ "Journal of General Internal Medicine" ], "content-domain": { "crossmark-restriction": false, "domain": [ "link.springer.com" ] }, "created": { "date-parts": [ [ 2022, 1, 4 ] ], "date-time": "2022-01-04T01:02:27Z", "timestamp": 1641258147000 }, "deposited": { "date-parts": [ [ 2022, 1, 4 ] ], "date-time": "2022-01-04T01:13:18Z", "timestamp": 1641258798000 }, "funder": [ { "DOI": "10.13039/100008460", "award": [ "UG3AT009765", "UH3AT009765" ], "doi-asserted-by": "publisher", "name": "National Center for Complementary and Integrative Health" }, { "DOI": "10.13039/100000063", "award": [ "Administrative Supplement" ], "doi-asserted-by": "publisher", "name": "Office of Dietary Supplements" }, { "DOI": "10.13039/100000002", "award": [ "U24AT009769" ], "doi-asserted-by": "publisher", "name": "National Institutes of Health" } ], "indexed": { "date-parts": [ [ 2022, 1, 4 ] ], "date-time": "2022-01-04T06:11:34Z", "timestamp": 1641276694349 }, "is-referenced-by-count": 0, "issn-type": [ { "type": "print", "value": "0884-8734" }, { "type": "electronic", "value": "1525-1497" } ], "issued": { "date-parts": [ [ 2022, 1, 1 ] ] }, "language": "en", "license": [ { "URL": "https://creativecommons.org/licenses/by/4.0", "content-version": "tdm", "delay-in-days": 0, "start": { "date-parts": [ [ 2022, 1, 1 ] ], "date-time": "2022-01-01T00:00:00Z", "timestamp": 1640995200000 } }, { "URL": "https://creativecommons.org/licenses/by/4.0", "content-version": "vor", "delay-in-days": 0, "start": { "date-parts": [ [ 2022, 1, 1 ] ], "date-time": "2022-01-01T00:00:00Z", "timestamp": 1640995200000 } } ], "link": [ { "URL": "https://link.springer.com/content/pdf/10.1007/s11606-021-07170-0.pdf", "content-type": "application/pdf", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://link.springer.com/article/10.1007/s11606-021-07170-0/fulltext.html", "content-type": "text/html", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://link.springer.com/content/pdf/10.1007/s11606-021-07170-0.pdf", "content-type": "application/pdf", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "297", "original-title": [], "prefix": "10.1007", "published": { "date-parts": [ [ 2022, 1, 1 ] ] }, "published-online": { "date-parts": [ [ 2022, 1, 1 ] ] }, "publisher": "Springer Science and Business Media LLC", "reference": [ { "key": "7170_CR1", "unstructured": "United Nations Development Program (UNDP). 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