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Assessment of the Association of Vitamin D Level With SARS-CoV-2 Seropositivity Among Working-Age Adults

Educational Objective
To identify the key insights or developments described in this article
Key Points

Question  Are low levels of vitamin D independently associated with the risk of SARS-CoV-2 seropositivity?

Findings  In this cohort study of 18 148 individuals whose vitamin D levels were measured before the COVID-19 pandemic, low levels of vitamin D were associated with SARS-CoV-2 seropositivity in unadjusted univariable analysis. However, after adjusting for potentially confounding factors, including age, sex, race/ethnicity, education, body mass index, blood pressure, smoking status, and geographical location, vitamin D level was not associated with SARS-CoV-2 seropositivity.

Meaning  Although SARS-CoV-2–seropositive individuals did have lower vitamin D levels than seronegative individuals, low vitamin D levels were not independently associated with the risk of seropositivity.

Abstract

Importance  Low vitamin D levels have been reported to be associated with increased risk of SARS-CoV-2 infection. Independent, well-powered studies could further our understanding of this association.

Objective  To examine whether low levels of vitamin D are associated with SARS-CoV-2 seropositivity, an indicator of previous infection.

Design, Setting, and Participants  This is a cohort study of employees and spouses who elected to be tested for SARS-CoV-2 IgG as part of an annual employer-sponsored health screening program conducted in August to November 2020. This program includes commonly assessed demographic, biometric, and laboratory variables, including total vitamin D measurement. Baseline (prepandemic) levels of vitamin D and potential confounders were obtained from screening results from the previous year (September 2019 to January 2020). Data analysis was performed from December 2020 to March 2021.

Exposures  Low total serum 25-hydroxyvitamin D, defined as either less than 20 ng/mL or less than 30 ng/mL.

Main Outcomes and Measures  The main outcome was SARS-CoV-2 seropositivity, as determined with US Food and Drug Administration emergency use–authorized assays. The association of SARS-CoV-2 seropositivity with vitamin D levels was assessed by multivariable logistic regression analyses and propensity score analyses.

Results  The 18 148 individuals included in this study had test results for SARS-CoV-2 IgG in 2020 and vitamin D levels from the prepandemic and pandemic periods. Their median (interquartile range) age was 47 (37-56) years, 12 170 (67.1%) were women, 900 (5.0%) were seropositive, 4498 (24.8%) had a vitamin D level less than 20 ng/mL, and 10 876 (59.9%) had a vitamin D level less than 30 ng/mL before the pandemic. In multivariable models adjusting for age, sex, race/ethnicity, education, body mass index, blood pressure, smoking status, and geographical location, SARS-CoV-2 seropositivity was not associated with having a vitamin D level less than 20 ng/mL before (odds ratio [OR], 1.04; 95% CI, 0.88-1.22) or during (OR, 0.93; 95% CI, 0.79-1.09) the pandemic; it was also not associated with having a vitamin D level less than 30 ng/mL before (OR, 1.09; 95% CI, 0.93-1.27) or during (OR, 1.05; 95% CI, 0.91-1.23) the pandemic. Similar results were observed in propensity score analyses. SARS-CoV-2 seropositivity was associated with obesity (OR, 1.26; 95% CI, 1.08-1.46), not having a college degree (OR, 1.40; 95% CI, 1.21-1.62), and Asian (OR, 1.46; 95% CI, 1.13-1.87), Black (OR, 2.74; 95% CI, 2.25-3.34), Hispanic (OR, 2.65; 95% CI, 2.15-3.27), American Indian or Alaska Native, and Native Hawaiian or other Pacific Islander (OR, 2.01; OR, 1.54-2.62) race/ethnicity, and was inversely associated with high blood pressure (OR, 0.82; 95% CI, 0.70-0.96), smoking (OR, 0.60; 95% CI, 0.47-0.78), and residing in the US Northeast (OR, 0.75; 95% CI, 0.62-0.92) and West (OR, 0.54; 95% CI, 0.44-0.67).

Conclusions and Relevance  In this cohort study, SARS-CoV-2 seropositivity was not associated with low levels of vitamin D independently of other risk factors.

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Article Information

Accepted for Publication: April 1, 2021.

Published: May 19, 2021. doi:10.1001/jamanetworkopen.2021.11634

Open Access: This is an open access article distributed under the terms of the CC-BY-NC-ND License. © 2021 Li Y et al. JAMA Network Open.

Corresponding Author: Yonghong Li, PhD, Quest Diagnostics, 33608 Ortega Hwy, San Juan Capistrano, CA 92675 (yonghong.x.li2@questdiagnostics.com).

Author Contributions: Dr Li had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Li, Devlin.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Li.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Li, Tong.

Obtained funding: Devlin.

Administrative, technical, or material support: Bare, Devlin.

Supervision: Li, Devlin.

Conflict of Interest Disclosures: None reported.

Funding/Support: Quest Diagnostics provided funding for this study.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, and decision to submit the manuscript for publication. The funder reviewed and approved the manuscript.

Additional Contributions: Jeff Radcliff, BS (Director, Global Scientific Publications and Medical Education, Quest Diagnostics), edited the manuscript; Andre A. Arellano, BS (Staff Scientist, Quest Diagnostics), helped with data acquisition; and Charles M. Rowland, MS (Director of Science, Quest Diagnostics), provided statistical advice. No compensation was received beyond usual salary.

References
1.
Ogedegbe  G , Ravenell  J , Adhikari  S ,  et al.  Assessment of racial/ethnic disparities in hospitalization and mortality in patients with COVID-19 in New York City.   JAMA Netw Open. 2020;3(12):e2026881. doi:10.1001/jamanetworkopen.2020.26881PubMedGoogle Scholar
2.
Price-Haywood  EG , Burton  J , Fort  D , Seoane  L .  Hospitalization and mortality among black patients and white patients with Covid-19.   N Engl J Med. 2020;382(26):2534-2543. doi:10.1056/NEJMsa2011686PubMedGoogle ScholarCrossref
3.
Wadhera  RK , Wadhera  P , Gaba  P ,  et al.  Variation in COVID-19 hospitalizations and deaths across New York City boroughs.   JAMA. 2020;323(21):2192-2195. doi:10.1001/jama.2020.7197PubMedGoogle ScholarCrossref
4.
Meltzer  DO , Best  TJ , Zhang  H , Vokes  T , Arora  V , Solway  J .  Association of vitamin D status and other clinical characteristics with COVID-19 test results.   JAMA Netw Open. 2020;3(9):e2019722. doi:10.1001/jamanetworkopen.2020.19722PubMedGoogle Scholar
5.
Kaufman  HW , Niles  JK , Kroll  MH , Bi  C , Holick  MF .  SARS-CoV-2 positivity rates associated with circulating 25-hydroxyvitamin D levels.   PLoS One. 2020;15(9):e0239252. doi:10.1371/journal.pone.0239252PubMedGoogle Scholar
6.
Merzon  E , Tworowski  D , Gorohovski  A ,  et al.  Low plasma 25(OH) vitamin D level is associated with increased risk of COVID-19 infection: an Israeli population-based study.   FEBS J. 2020;287(17):3693-3702. doi:10.1111/febs.15495PubMedGoogle ScholarCrossref
7.
Yetley  EA .  Assessing the vitamin D status of the US population.   Am J Clin Nutr. 2008;88(2):558S-564S. doi:10.1093/ajcn/88.2.558SPubMedGoogle ScholarCrossref
8.
Holick  MF , Binkley  NC , Bischoff-Ferrari  HA ,  et al; Endocrine Society.  Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline.   J Clin Endocrinol Metab. 2011;96(7):1911-1930. doi:10.1210/jc.2011-0385PubMedGoogle ScholarCrossref
9.
Faries  DE , Leon  AC , Haro  JM , Obenchain  RL .  Analysis of Observational Health Care Data Using SAS. SAS Institute; 2010.
10.
Cohen  J .  Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Lawrence Erlbaum Associates Publishers; 1988.
11.
D’Avolio  A , Avataneo  V , Manca  A ,  et al.  25-Hydroxyvitamin D concentrations are lower in patients with positive PCR for SARS-CoV-2.   Nutrients. 2020;12(5):1359. doi:10.3390/nu12051359PubMedGoogle ScholarCrossref
12.
Faniyi  AA , Lugg  ST , Faustini  SE ,  et al.  Vitamin D status and seroconversion for COVID-19 in UK healthcare workers.   Eur Respir J. 2020;2004234:2004234. doi:10.1183/13993003.04234-2020PubMedGoogle Scholar
13.
Yanes-Lane  M , Winters  N , Fregonese  F ,  et al.  Proportion of asymptomatic infection among COVID-19 positive persons and their transmission potential: a systematic review and meta-analysis.   PLoS One. 2020;15(11):e0241536. doi:10.1371/journal.pone.0241536PubMedGoogle Scholar
14.
Hastie  CE , Mackay  DF , Ho  F ,  et al.  Vitamin D concentrations and COVID-19 infection in UK Biobank.   Diabetes Metab Syndr. 2020;14(4):561-565. doi:10.1016/j.dsx.2020.04.050PubMedGoogle ScholarCrossref
15.
Sims  MD , Maine  GN , Childers  KL ,  et al.  COVID-19 seropositivity and asymptomatic rates in healthcare workers are associated with job function and masking.   Clin Infect Dis. Published online November 5, 2020. doi:10.1093/cid/ciaa1684PubMedGoogle Scholar
16.
Simons  D , Shahab  L , Brown  J , Perski  O .  The association of smoking status with SARS-CoV-2 infection, hospitalization and mortality from COVID-19: a living rapid evidence review with Bayesian meta-analyses (version 7).   Addiction. Published online October 2, 2020. doi:10.1111/add.15276PubMedGoogle Scholar
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