Association of Vitamin D Status with Infectious Diseases, Hospitalization, and COVID-19 Mortality

In a recent study published in PLOS ONEThe researchers investigated the association between vitamin D levels in the United Kingdom and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, hospitalization, and death.

Background

Coronavirus disease 2019 (COVID-19) vaccine is effective. However, global control of the COVID-19 pandemic remains a challenge. Understanding the etiology of COVID-19 is essential for developing efficient strategies for COVID-19 prevention.

Vitamin D is essential for bone health. It regulates calcium and phosphate levels and has been reported to be immunomodulatory in recent studies. However, the association between vitamin D levels and SARS-CoV-2 infection and associated severity consequences (hospitalization and death) is unclear.

About research

In this study, researchers investigated the potential protective effect of vitamin D on SARS-CoV-2 infection, hospitalization, and death in the United Kingdom.

The study participants were part of the UK Biobank, which consisted of UK residents aged 40-69 years enrolled between 2006 and 2010.Individuals who have undergone several (> 1) serological vitamin D tests for analysis, their electronic health records [primary care records, inpatient records, and death records (certificates)] The link was included and was followed up until March 16, 2020. Primary care data was obtained from the UK Test Productivity Pack (TPP) and Educational Management Information System (EMIS), and inpatient care records and death certificates were obtained from the United Kingdom National Health Service. Service (NHS) England.

The primary study exposure was serological 25-hydroxyvitamin D levels measured at enrollment by the chemoluminescence immunoassay, with vitamin D levels of <25 nmol / L, 25-49 nmol / L, and ≥50. Based on, it was described as deficient, deficient, and sufficient. Each is nmol / L. Individuals tested between April and October and between November and March were assigned as "summer" and "non-summer," respectively.

Secondary exposure consisted of prescribed or self-reported vitamin D supplementation, and relevant data were obtained via a self-reported questionnaire. All medications listed in the UK National Prescription Section 9.6.4, including Vitamin D and related minerals such as calcium, fish oil, and multivitamins, were considered vitamin D supplements.

The result of the primary study was COVID-19, either clinically diagnosed or confirmed by the polymerase chain reaction (PCR), and the secondary result was hospitalization and death from SARS-CoV-2 infection. The clinical diagnosis of COVID-19 is based on the SNOMED-CT (Systematic Nomenclature of Medicine-Clinical Term), CTV3 (Clinical Term Version 3), and ICD-10 (International Classification of Diseases, 10th Amendment) Code. I did. Hospitalizations and deaths associated with COVID-19 were recorded under ICD-10 codes U071 and U072. The analysis used a Cox regression model that adjusted for demographic factors and comorbidities, as well as summer and non-summer lunar stratification.

result

A total of 307,512 individuals were included in the analysis, most of whom were female and over 70 years of age.During the summer, some evidence was found regarding the association between vitamin D deficiency and the risk of COVID-19 diagnosis. [hazard ratio (HR) 0.9].. On the contrary, during non-summer months, vitamin D deficiency was associated with a higher risk of SARS-CoV-2 infection than vitamin D deficiency (HR = 1.1). However, there was no evidence of a link between vitamin D deficiency or deficiency and hospitalization and summer and non-summer deaths associated with SARS-CoV-2 infection.

A total of 10,165 study participants were diagnosed with COVID-19 in the fall (51%), winter (31%), and spring (14%), but only a few were diagnosed in the summer (4%). did. Similar trends were observed for COVID-19-related hospitalizations and deaths. After data adjustment, there was no evidence of an association between vitamin D deficiency or deficiency during or after the UK summer and the increased risk of COVID-19-related hospitalization (UK Summer Month: Deficiency and Deficiency Adjustment). The completed HR was 0.9, and the corresponding adjusted HRs were 1.1 and 0.9, respectively, during the non-summer months, respectively).

Similarly, no evidence of an increased risk of SARS-CoV-2 infection-related death in individuals with vitamin D deficiency or deficiency during or after the UK summer was found (UK Summer Month: Deficiency and Deficiency Adjustment HR). Was 0.8 and 1.1, respectively; during the non-summer months, the corresponding adjusted HRs were 1.4 and 1.5, respectively).

After data adjustment, people with vitamin D deficiency had a 14% lower risk of diagnosing SARS-CoV-2 infection than people with vitamin D deficiency in the summer in the UK (HR = 0.9). During non-summer months, the risk of COVID-19 was 14% higher among people with vitamin D deficiency (HR = 1.1).

Some evidence is that participants prescribed vitamin D supplementation during the summer are at risk of COVID-19 (adjusted HR = 1.2), hospitalization (adjusted HR = 1.6), and mortality (adjusted HR = 2.3). Showed to be high. There was no evidence that individuals receiving self-reported vitamin D supplementation had a low risk of COVID-19 in the UK summer (adjusted HR = 0.9), and were at high risk in non-summer months. (Adjusted HR = 1.2).

Conclusion

Overall, the study results showed an inconsistent association between serological levels of vitamin D and the diagnosis of COVID-19, and the association between vitamin D levels and COVID-19-related hospitalization and death. There was not. However, accurate investigation of the presumed role of vitamin D in the prevention of SARS-CoV-2 infection requires further studies using recent vitamin D measurement data and systematic SARS-CoV-2 tests. ..