Analyses of Risk, Racial Disparity, and Outcomes Among US Patients With Cancer and COVID-19 Infection
JAMA Oncol. 2021;7(2):220-227. doi:10.1001/jamaoncol.2020.6178
QuanQiu Wang, MS1; Nathan A. Berger, MD2,3; Rong Xu, PhD1,3
Probable reasons include:
1) Suppressed immune system due to chemotherapy
2) Lower vitamin D levels due to cancer
3) Lower vitamin D levels due to dark skin
Note: The word vitamin does not occur once in the PDF
COVID-19 more frequent and deadly for those with dark skins (high risk of low vitamin D)
African American Health Disparities are associated with low Vitamin D - Feb 2021 contains the following chart
Low Vitamin D increases health problems - independent of skin color
Items in both categories Cancer and Skin-Dark are listed here:
- Newly diagnosed Children with Cancer have low vitamin D, especially if black - May 2022
- Cancers and Vitamin D Receptors, including change with race – Feb 2021
- 26 health factors increase the risk of COVID-19 – all are proxies for low vitamin D
- Those with recent cancer diagnosis had 7X increased risk of COVID-19 (more if A-A )- Dec 2020
- More US deaths due to cancer than heart if dark skinned – Sept 2012
- Hypothesis: Blacks get more cancer than whites due to lower levels of vitamin D – June 2012
Download the PDF from VitaminDWiki
2X to 5X increased risk if African-American vs White
Death rate vs race from COVID-19
Importance Patients with specific cancers may be at higher risk than those without cancer for coronavirus disease 2019 (COVID-19) and its severe outcomes. At present, limited data are available on the risk, racial disparity, and outcomes for COVID-19 illness in patients with cancer.
Objectives To investigate how patients with specific types of cancer are at risk for COVID-19 infection and its adverse outcomes and whether there are cancer-specific race disparities for COVID-19 infection.
Design, Setting, and Participants This retrospective case-control analysis of patient electronic health records included 73.4 million patients from 360 hospitals and 317 000 clinicians across 50 US states to August 14, 2020. The odds of COVID-19 infections for 13 common cancer types and adverse outcomes were assessed.
Exposures The exposure groups were patients diagnosed with a specific cancer, whereas the unexposed groups were patients without the specific cancer.
Main Outcomes and Measures The adjusted odds ratio (aOR) and 95% CI were estimated using the Cochran-Mantel-Haenszel test for the risk of COVID-19 infection.
Results Among the 73.4 million patients included in the analysis (53.6% female), 2 523 920 had at least 1 of the 13 common cancers diagnosed (all cancer diagnosed within or before the last year), and 273 140 had recent cancer (cancer diagnosed within the last year). Among 16 570 patients diagnosed with COVID-19, 1200 had a cancer diagnosis and 690 had a recent cancer diagnosis of at least 1 of the 13 common cancers.
Those with recent cancer diagnosis were at significantly increased risk for COVID-19 infection (aOR, 7.14 [95% CI, 6.91-7.39]; P < .001), with the strongest association for recently diagnosed
- leukemia (aOR, 12.16 [95% CI, 11.03-13.40]; P < .001),
- non–Hodgkin lymphoma (aOR, 8.54 [95% CI, 7.80-9.36]; P < .001), and
- lung cancer (aOR, 7.66 [95% CI, 7.07-8.29]; P < .001) and
weakest for thyroid cancer (aOR, 3.10 [95% CI, 2.47-3.87]; P < .001).
Among patients with recent cancer diagnosis, African Americans had a significantly higher risk for COVID-19 infection than White patients; this racial disparity was largest for breast cancer (aOR, 5.44 [95% CI, 4.69-6.31]; P < .001), followed by prostate cancer (aOR, 5.10 [95% CI, 4.34-5.98]; P < .001), colorectal cancer (aOR, 3.30 [95% CI, 2.55-4.26]; P < .001), and lung cancer (aOR, 2.53 [95% CI, 2.10-3.06]; P < .001). Patients with cancer and COVID-19 had significantly worse outcomes (hospitalization, 47.46%; death, 14.93%) than patients with COVID-19 without cancer (hospitalization, 24.26%; death, 5.26%) (P < .001) and patients with cancer without COVID-19 (hospitalization, 12.39%; death, 4.03%) (P < .001).
Conclusions and Relevance In this case-control study, patients with cancer were at significantly increased risk for COVID-19 infection and worse outcomes, which was further exacerbated among African Americans. These findings highlight the need to protect and monitor patients with cancer as part of the strategy to control the pandemic.
In addition, it appears that many cancers have learned how to deactivate the vitamin D Receptor, so that even less Vitamin D gets to cells
Vitamin D Receptor and Cancers
Items in both categories Vitamin D Receptor and Cancer - Breast:
- Some breast cancers may be treated RNA changes caused by Vitamin D – March 2022
- Breast Cancer, Vitamin D, and genes – Welsh Nov 2021
- After lactation Vitamin D levels are low, increased risk of Breast Cancer, vitamin D should decrease risk – Aug 2021
- Breasts process Vitamin D and change gene activation, might prevent breast cancer if given more Vit. D – July 2021
- Breast cancer associated with Vitamin D Receptor (14th study) – Oct 2019
- After breast cancer treatment 4,000 IU of Vitamin D was not enough to help if have poor Vitamin D receptor – June 2019
- Breast Cancer death 1.8 X more likely if poor Vitamin D Receptor – April 2019
- Breast Cancer and Vitamin D review – March 2018
- Women with Breast Cancer were 16.9 times more likely to have a poor Vitamin D Receptor – Jan 2019
- Cancer treatment by Vitamin D sometimes is restricted by genes – Oct 2018
- Two chemicals increase the Vitamin D receptor and decrease the growth of breast cancer cells in the lab - March 2018
- Breast Cancer reduces receptor and thus blocks Vitamin D to the cells – several studies
- Vitamin D receptor as a target for breast cancer therapy (abstract only) – Feb 2017
- Breast Cancer was 4.6 times more likely if have a poor Vitamin D Receptor – Dec 2016
- Increased Breast Cancer metastasis if low vitamin D or poor VDR – Feb 2016
- Increased risk of some female cancers if low vitamin D (due to genes) – meta-analysis June 2015
- Vitamin D receptor in breasts and breast cancer vary with race – March 2013
- Breast Cancer incidence change by 40 percent with vitamin D receptor genes – Oct 2012
- Genes breast cancer and vitamin D receptor - Sept 2010
Items in both categories Vitamin D Receptor and Cancer - Colon:
- Another activator of the Vitamin D Receptor – Butyrate (from gut bacteria, or supplement)
- Colon cancer risk increases 30X if you have the worst vitamin D receptor mutation – Jan 2021
- Book: Sunlight, UV, Vitamin D and Receptor, Skin and other Cancers - Dec 2020
- Colorectal Cancer Patients 2.4 X more likely to have poor Vitamin D receptors (less D to cells) – April 2020
- Colorectal cancer linked to poor Vitamin D Receptor (yet again) – Jan 2020
- Colorectal Cancer risk increases when genes reduce the vitamin D levels – Aug 2019
- Risks of Colorectal Cancer, IBD, etc slightly increased if poor Vitamin D Receptor – Aug 2018
- Cancer and the Vitamin D Receptor, a primer – Sept 2017
- Advanced Colon Cancer risk is doubled or halved with 1000 IU of Vitamin D, depends on Vitamin D Receptors – RCT May 2017
- Colon Cancer survival 3.1 X less likely if poor Vitamin D Receptor – Aug 2017
- Risk of Cancer increased if poor Vitamin D Receptor – meta-analysis of 73 studies Jan 2016
- 10 percent of colon cancer linked to Vitamin D Receptor – meta-analysis April 2012
Items in both categories Vitamin D Receptor and Cancer
- Cancers and Vitamin D Receptors, including change with race – Feb 2021
- Needing a high level of vitamin D is a good clue that the Vitamin D Receptor is deactivated
- Vitamin D Receptor and Cancer
- Book: Sunlight, UV, Vitamin D and Receptor, Skin and other Cancers - Dec 2020
- How cancer is fought by Vitamin D (Ovarian this time) – Feb 2020
- 8 ways that Cancer might be prevented by Vitamin D - June 2019
- Cancer is leading cause of death - Vitamin D and Receptor activators help
- The Role of Resveratrol in Cancer Therapy – Dec 2017
- A poor Vitamin D Receptor is associated with many cancers (oral cancer in this case) – Jan 2019
- Overview of Vitamin D Actions in Cancer – 31 page chapter in a book – 2018
- Cancer treatment by Vitamin D sometimes is restricted by genes – Oct 2018
- Vitamin D receptor is essential for both normal and cancerous cells in the lab – June 2018
- Active Vitamin D reduces Ovarian Cancer stem cells growth by 4X (via Vitamin D receptor in lab rat) – March 2018
- Cancer and the Vitamin D Receptor, a primer – Sept 2017
- Cancer risks and Vitamin D Receptors – association is unclear – 2017
- Vitamin D, Vitamin D Receptor and Cancer – Nov 2016
- Risk of Cancer increased if poor Vitamin D Receptor – meta-analysis of 73 studies Jan 2016
- Role of Vitamin D in human Diseases and Disorders – An Overview – DBP, VDR June 2014
- Vitamin D Receptor role in Autoimmune Diseases and or cancers – Nov 2013
- Vitamin D receptor polymorphisms are risk factors for various cancers – meta-analysis Jan 2014
Items in both categories Vitamin D Receptor and Cancer - other:
- Oral Cancers - increased risk if low vitamin D or poor vitamin D genes
- Blood cell cancer is associated with a 3X worse Vitamin D Receptor – June 2019
- A poor Vitamin D Receptor is associated with many cancers (oral cancer in this case) – Jan 2019
- Endometriosis, Endometrial Cancer, and poor Vitamin D or Receptor – Aug 2018
- Thyroid Cancer rate has increased 3X in 3 decades, Vitamin D Receptor decreases, Calcium increases – Aug 2017
- Gastric Cancer 2.7 X more likely if poor Vitamin D Receptor (Chinese) – 2015
- 2X more likely to survive a form of esophageal cancer in China if have good vitamin D receptor – Feb 2017
- 2X more Thyroid Cancer malignancy if less than 15 ng of vitamin D – June 2012
- Brain cancer in 175 countries related to low UVB and low vitamin D – Oct 2010
Items in both categories Vitamin D Receptor and Cancer - Skin:
- Book: Sunlight, UV, Vitamin D and Receptor, Skin and other Cancers - Dec 2020
- Melanoma cancer growth slowed by increased Vitamin D Receptor (yet again) – Oct 2019
- Nonmelanoma Skin Cancer 2X more likely if poor Vitamin D Receptor – Oct 2017
- UVB improvements to Vitamin D receptor appear to improve melanoma survival – Oct 2017
- Skin Cancers, Vitamin D, Vitamin D Receptor and Genes – Jan 2015
- Malignant melanoma may be reduced by skin-activated vitamin D – Nov 2016
- Skin cancer 20 percent more likely with some Vitamin D receptor gene polymorphisms – Oct 2015
- Death from melanoma (without ulcers) greatly decreased if have lots of vitamin D receptors – May 2014
- Melanoma risk 2X to 4X higher if Vitamin D receptor genes had morphed – March 2014
- Vitamin D receptor may suppress skin cancer – Dec 2013
Items in both categories Vitamin D Receptor and Cancer - Prostate:
- Book: Sunlight, UV, Vitamin D and Receptor, Skin and other Cancers - Dec 2020
- Prostate Cancer associated with various genes, including Vitamin D Receptor and CYP24A1 – Nov 2019
- Prostate surgery outcomes vary with Vitamin D Receptors– May 2017
- Prostate cancer in black men is 1.6 times more likely if a poor Vitamin D Receptor – Feb 2017
- Aggressive Prostate Cancer in blacks with low vitamin D – 7X more likely if added Calcium – Jan 2017
- High PSA readings with Prostate Cancer 4 times more likely if poor Vitamin D receptor – March 2016
- 2X less prostate cancer in A-A with low Calcium is due vitamin D receptor gene – July 2013
Items in both categories Vitamin D Receptor and Cancer - Ovarian:
- How cancer is fought by Vitamin D (Ovarian this time) – Feb 2020
- Ovarian Cancer risk reduced if higher vitamin D, more UVB, or better vitamin D receptor – Nov 2018
- Active Vitamin D reduces Ovarian Cancer stem cells growth by 4X (via Vitamin D receptor in lab rat) – March 2018
- Ovarian Cancer in Asia is 1.5 X more likely if poor Vitamin D receptor – meta-analysis Dec 2017
- Increased risk of some female cancers if low vitamin D (due to genes) – meta-analysis June 2015
- Ovarian Cancer 5.8 X more likely if both low vitamin D and Fok1 gene change – May 2013