Association of Vitamin D Deficiency and Treatment with COVID-19 Incidence

Abstract

Word Count: 350 Manuscript Word Count: 2967Importance: Vitamin D treatment has been found to decrease incidence of viral respiratory tract infection, especially in vitamin D deficiency. It is unknown whether COVID-19 incidence is associated with vitamin D deficiency and treatment.Objective: To examine whether vitamin D deficiency and treatment are associated with testing positive for COVID-19. Design: Retrospective cohort studySetting: University of Chicago Medicine Participants: Patients tested for COVID-19 from 3/3/2020-4/10/2020. Vitamin D deficiency was defined by the most recent 25-hydroxycholecalciferol <20ng/ml or 1,25-dihydroxycholecalciferol <18pg/ml within 1 year before COVID-19 testing. Treatment was defined by the most recent vitamin D type and dose, and treatment changes between the time of the most recent vitamin D level and time of COVID-19 testing. Vitamin D deficiency and treatment changes were combined to categorize vitamin D status at the time of COVID-19 testing as likely deficient(lastlevel-deficient/treatment-not-increased), likely sufficient(last-level-not-deficient/treatmentnot-decreased), or uncertain deficiency(last-level-deficient/treatment-increased or last-levelnot-deficient/treatment-decreased).Main Outcomes and Measures: The main outcome was testing positive for COVID-19. Multivariable analysis tested whether the most recent vitamin D level and treatment changes after that level were associated with testing positive for COVID-19 controlling for demographic and comorbidity indicators. Bivariate analyses of associations of treatment with vitamin D deficiency and COVID-19 were performed.Results: Among 4,314 patients tested for COVID-19, 499 had a vitamin D level in the year before testing. Vitamin D status at the time of COVID-19 testing was categorized as likely deficient for 127(25%) patients, likely sufficient for 291(58%) patients, and uncertain for 81(16%) patients. In multivariate analysis, testing positive for COVID-19 was associated with increasing age(RR(age<50)=1.05,p<0.021;RR(age≥50)=1.02,p<0.064)), non-white race(RR=2.54,p<0.01) and being likely vitamin D deficient (deficient/treatment-not-increased:RR=1.77,p<0.02) as compared to likely vitamin D sufficient(not-deficient/treatment-not-decreased), with predicted All rights reserved. No reuse allowed without permission.

Low plasma 25(OH) vitamin D level is associated with increased risk of COVID‐19 infection: an Israeli population‐based study

“…Hence, low 25(OH)D level was identified as independently associated with the likelihood of COVID‐19 infection. This finding is in agreement with the results of other studies [5,7,9–15,19,30–42]. Further, reduced risk of acute respiratory tract infection following vitamin D supplementation has been reported [43,44].…”

Vitamin D Clinical Pharmacology: Relevance to COVID-19 Pathogenesis

“…In fact, a recent large clinical study that included over four thousand COVID-19 positive patients, found that vitamin D deficiency was associated with almost double the risk of contracting COVID-19 disease. 26 This report also concluded that testing positive for COVID-19 was associated with (1) increasing age and (2) being both non-white race and likely vitamin D deficent. 26 …”

“… 26 This report also concluded that testing positive for COVID-19 was associated with (1) increasing age and (2) being both non-white race and likely vitamin D deficent. 26 …”

Association of 25 Hydroxyvitamin D Concentration with Risk of COVID-19: A Mendelian Randomization Study

“…vitamin D de ciency contributes to the seasonal increase of virus infections of the respiratory tract, from the common cold to in uenza, and now possibly also COVID-19 (7,8). Some systematic reviews indicated that vitamin D de ciency may increase infection risk of COVID-19 by discussing the biological mechanism of virus infection (2,9,10).…”

“…In addition, numerous population-based studies have evaluated the Vitamin D de ciency in COVID-19 patients relative to controls; however, the ndings have been inconsistent. Some studies showed that COVID-19 patients had a lower 25 hydroxyvitamin D (25OHD) concentration compared with healthy controls (8,(11)(12)(13), while others found no association (14)(15)(16). The inconsistent ndings from these epidemiological studies may be due to differences in the study design, study population, assays used for measuring Vitamin D de ciency.…”