JAMA Netw Open. 2020;3(9):e2019722. doi:10.1001/jamanetworkopen.2020.19722
David O. Meltzer, MD, PhD1; Thomas J. Best, PhD2; Hui Zhang, PhD2; et alTamara Vokes, MD1; Vineet Arora, MD, MPP1; Julian Solway, MD1
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University of Chicago, March 2020
Vitamin D measurement were made 2 to 52 weeks before COVID-19 test
X less likely to test positive at each Vitamin D level
- Question Is vitamin D status, reflecting vitamin D levels and treatment, associated with test results for coronavirus disease 2019 (COVID-19)?
- Findings In this cohort study of 489 patients who had a vitamin D level measured in the year before COVID-19 testing, the relative risk of testing positive for COVID-19 was 1.77 times greater for patients with likely deficient vitamin D status compared with patients with likely sufficient vitamin D status, a difference that was statistically significant.
- Meaning These findings appear to support a role of vitamin D status in COVID-19 risk; randomized clinical trials are needed to determine whether broad population interventions and interventions among groups at increased risk of vitamin D deficiency and COVID-19 could reduce COVID-19 incidence.
Importance Vitamin D treatment has been found to decrease the incidence of viral respiratory tract infection, especially in patients with vitamin D deficiency. Whether vitamin D is associated with coronavirus disease 2019 (COVID-19) incidence is unknown.
Objective To examine whether the last vitamin D status before COVID-19 testing is associated with COVID-19 test results.
Design, Setting, and Participants This retrospective cohort study at an urban academic medical center included patients with a 25-hydroxycholecalciferol or 1,25-dihydroxycholecalciferol level measured within 1 year before being tested for COVID-19 from March 3 to April 10, 2020.
Exposures Vitamin D deficiency was defined by the last measurement of 25-hydroxycholecalciferol less than 20 ng/mL or 1,25-dihydroxycholecalciferol less than 18 pg/mL before COVID-19 testing. Treatment changes were defined by changes in vitamin D type and dose between the date of the last vitamin D level measurement and the date of COVID-19 testing. Vitamin D deficiency and treatment changes were combined to categorize the most recent vitamin D status before COVID-19 testing as likely deficient (last level deficient and treatment not increased), likely sufficient (last level not deficient and treatment not decreased), and 2 groups with uncertain deficiency (last level deficient and treatment increased, and last level not deficient and treatment decreased).
Main Outcomes and Measures The outcome was a positive COVID-19 polymerase chain reaction test result. Multivariable analysis tested whether vitamin D status before COVID-19 testing was associated with testing positive for COVID-19, controlling for demographic and comorbidity indicators.
Results A total of 489 patients (mean [SD] age, 49.2 [18.4] years; 366 [75%] women; and 331 [68%] race other than White) had a vitamin D level measured in the year before COVID-19 testing. Vitamin D status before COVID-19 testing was categorized as likely deficient for 124 participants (25%), likely sufficient for 287 (59%), and uncertain for 78 (16%). Overall, 71 participants (15%) tested positive for COVID-19.
In multivariate analysis, testing positive for COVID-19 was associated with
- increasing age up to age 50 years (relative risk, 1.06; 95% CI, 1.01-1.09; P = .02);
- non-White race (relative risk, 2.54; 95% CI, 1.26-5.12; P = .009), and
- likely deficient vitamin D status (relative risk, 1.77; 95% CI, 1.12-2.81; P = .02)
- compared with likely sufficient vitamin D status.
Predicted COVID-19 rates in the deficient group were 21.6% (95% CI, 14.0%-29.2%) vs 12.2%(95% CI, 8.9%-15.4%) in the sufficient group.
Conclusions and Relevance In this single-center, retrospective cohort study, likely deficient vitamin D status was associated with increased COVID-19 risk, a finding that suggests that randomized trials may be needed to determine whether vitamin D affects COVID-19 risk.
He describes his doubt that vitamin D can help but is running another COVID-19 clinical trial giving 4,000 or 10,000 IU of vitamin D for 9 months to everyone and see how what percentage in each group get COVID-19. Since there will be only 500 in each group getting the vitamin D it is very likely that the trial will be underpowdered. Example: 500 to get 4,000 IU of vitamin D and 500 get placebo. In 5 or so months only a few of the 500 will get COVID-19 - and not enough to be statistically significant.
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