Analysis of 191,779 patients in the US finding COVID-19 positivity strongly and inversely associated with circulating 25(OH)D levels. The relationship persists across latitudes, races/ethnicities, gender, and age ranges.
COVID-19 adjusted odds ratio OR 0.984 per ng/mL increment, p<0.001). The decrease in positivity rate appeared to plateau as values approached 55 ng/mL.
Patients with high D levels (>55 ng/mL) compared to patients with very low D levels (<20 ng/mL) have a much lower risk of COVID-19 cases, with unadjusted RR 0.47, p<0.001.
risk of case, 53.0% lower, RR 0.47, p < 0.001, high D levels 12,321, low D levels 39,190, >55 ng/mL vs. <20 ng/mL.
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Kaufman et al., 17 Sep 2020, retrospective, population-based cohort, USA, peer-reviewed, median age 54.0, 5 authors.
SARS-CoV-2 positivity rates associated with circulating 25-hydroxyvitamin D levels
Harvey W Kaufman, Justin K Niles, Martin H Kroll, Caixia Bi, Michael F Holick
PLOS ONE, doi:10.1371/journal.pone.0239252
Until treatment and vaccine for coronavirus disease-2019 (COVID-19) becomes widely available, other methods of reducing infection rates should be explored. This study used a retrospective, observational analysis of deidentified tests performed at a national clinical laboratory to determine if circulating 25-hydroxyvitamin D (25(OH)D) levels are associated with severe acute respiratory disease coronavirus 2 (SARS-CoV-2) positivity rates. Over 190,000 patients from all 50 states with SARS-CoV-2 results performed mid-March through mid-June, 2020 and matching 25(OH)D results from the preceding 12 months were included. Residential zip code data was required to match with US Census data and perform analyses of race/ethnicity proportions and latitude. A total of 191,779 patients were included (median age, 54 years [interquartile range 40.4-64.7]; 68% female. The SARS-CoV-2 positivity rate was 9.3% (95% C.I. 9.2-9.5%) and the mean seasonally adjusted 25(OH)D was 31.7 (SD 11.7). The SARS-CoV-2 positivity rate was higher in the 39,190 patients with "deficient" 25(OH)D values (<20 ng/mL) (12.5%, 95% C.I. 12.2-12.8%) than in the 27,870 patients with "adequate" values (30-34 ng/mL) (8.1%, 95% C.I. 7.8-8.4%) and the 12,321 patients with values �55 ng/mL (5.9%, 95% C.I. 5.5-6.4%). The association between 25 (OH)D levels and SARS-CoV-2 positivity was best fitted by the weighted second-order polynomial regression, which indicated strong correlation in the total population (R 2 = 0.96) and in analyses stratified by all studied demographic factors. The association between lower SARS-CoV-2 positivity rates and higher circulating 25(OH)D levels remained significant in a multivariable logistic model adjusting for all included demographic factors (adjusted odds ratio 0.984 per ng/mL increment, 95% C.I. 0.983-0.986; p<0.001). SARS-CoV-2 positivity is strongly and inversely associated with circulating 25(OH)D levels, a relationship that persists across latitudes, races/ethnicities, both sexes, and age ranges. Our findings provide impetus to explore the role of vitamin D supplementation in reducing the risk for SARS-CoV-2 infection and COVID-19 disease.
Author Contributions Conceptualization: Harvey W. Kaufman, Justin K. Niles, Martin H. Kroll
References
Berry, Hesketh, Power, Hypponen, Vitamin D status has a linear association with seasonal infections and lung function in British adults, The British Journal of Nutrition,
doi:10.1017/S0007114511001991
D'avolio, Avataneo, Manca, 25-Hydroxyvitamin D Concentrations are Lower in Patients with Positive PCR for SARS-CoV-2, Nutrients,
doi:10.3390/nu12051359
Grant, Lahore, Mcdonnell, Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths, Nutrients
Holick, Binkley, Bischoff-Ferrari, Evaluation, Treatment & Prevention of Vitamin D Deficiency: An Endocrine Society Clinical Practice Guideline, J Clin Endocrinol Metab,
doi:10.1210/jc.2011-0385
Ingham, Jones, Camargo, Study, G. Association of vitamin D deficiency with severity of acute respiratory infection: A case-control study in New Zealand children, European Respiratory Journal
Martineau, 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.i6583
Rhodes, Dunstan, Laird, COVID-19 mortality increases with northerly latitude after adjustment for age suggesting a link with ultraviolet and vitamin D, BMJ Nutrition, Prevention & Health,
doi:10.1136/bmjnph-2020-000110
Sabetta, Depetrillo, Cipriani, Smardin, Burns et al., Serum 25-hydroxyvitamin d and the incidence of acute viral respiratory tract infections in healthy adults, PLoS One,
doi:10.1371/journal.pone.0011088
Zdrenghea, Makrinioti, Bagacean, Bush, Johnston et al., Vitamin D modulation of innate immune responses to respiratory viral infections, Rev Med Virol,
doi:10.1002/rmv.1909