Abstract
Objective
To determine the relationship between 25-hydroxyvitamin D (25[OH]D) values and all-cause
and cause-specific mortality.
Patients and Methods
We identified all serum 25(OH)D measurements in adults residing in Olmsted County,
Minnesota, between January 1, 2005, and December 31, 2011, through the Rochester Epidemiology
Project. All-cause mortality was the primary outcome. Patients were followed up until
their last clinical visit as an Olmsted County resident, December 31, 2014, or death.
Multivariate analyses were adjusted for age, sex, race/ethnicity, month of measurement,
and Charlson comorbidity index score.
Results
A total of 11,022 individuals had a 25(OH)D measurement between January 1, 2005, and
December 31, 2011, with a mean ± SD value of 30.0±12.9 ng/mL. Mean age was 54.3±17.2
years, and most were female (77.1%) and white (87.6%). There were 723 deaths after
a median follow-up of 4.8 years (interquartile range, 3.4-6.2 years). Unadjusted all-cause
mortality hazard ratios (HRs) and 95% CIs for 25(OH)D values of less than 12, 12 to
19, and more than 50 ng/mL were 2.6 (95% CI, 2.0-3.2), 1.3 (95% CI, 1.0-1.6), and
1.0 (95% CI, 0.72-1.5), respectively, compared with the reference value of 20 to 50 ng/mL.
In a multivariate model, the interaction between the effect of 25(OH)D and race/ethnicity
on mortality was significant (P<.001). In white patients, adjusted HRs for 25(OH)D values of less than 12, 12 to
19, 20 to 50, and greater than 50 ng/mL were 2.5 (95% CI, 2.2-2.9), 1.4 (95% CI, 1.2-1.6),
1.0 (referent), and 1.0 (95% CI, 0.81-1.3), respectively. In patients of other race/ethnicity,
adjusted HRs were 1.9 (95% CI, 1.5-2.3), 1.7 (95% CI, 1.1-2.6), 1.5 (95% CI, 1.0-2.0),
and 2.1 (95% CI, 0.77-5.5).
Conclusion
White patients with 25(OH)D values of less than 20 ng/mL had greater all-cause mortality
than those with values of 20 to 50 ng/mL, and white patients had greater mortality
associated with low 25(OH)D values than patients of other race/ethnicity. Values of
25(OH)D greater than 50 ng/mL were not associated with all-cause mortality.
Abbreviations and Acronyms:
HR (hazard ratio), ICD-10 (International Classification of Diseases, Tenth Revision), NHANES (National Health and Nutrition Examination Survey), 25(OH)D (25-hydroxyvitamin D), REP (Rochester Epidemiology Project)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 02, 2018
Footnotes
For editorial comment, see page 679
Grant Support: This study was made possible by the Rochester Epidemiology Project (grant number R01-AG034676; Principal Investigators: Walter A. Rocca, MD, MPH and Jennifer L. St Sauver, PhD). The study was also supported by the Mayo Clinic Center for Translational Science Activities through grant number UL1 TR000135 from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health.
Potential Competing Interests: Dr Thacher is a consultant for Biomedical Systems Corporation and Ultragenyx Pharmaceutical. The other authors report no competing interests.
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- The Death D-fying VitaminMayo Clinic ProceedingsVol. 93Issue 6
- PreviewIn this issue of Mayo Clinic Proceedings, Dudenkov et al1 report on a retrospective study relating vitamin D status (serum 25-hydroxyvitamin D [25(OH)D]) with the risk of all-cause and cause-specific mortality in their patients registered in the Rochester Epidemiology Project. The article reported that vitamin D deficiency was associated with increased mortality. There was a statistically significant inverse relationship with mortality in both white and nonwhite patients, as well as with their serum 25(OH)D level.
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