Department of Community Medicine and Epidemiology, Carmel Medical Center, Clalit Health Services, and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 34362, Israel.
J Clin Endocrinol Metab. 2012 Aug;97(8):2792-8. doi: 10.1210/jc.2012-1747. Epub 2012 May 30.
Vitamin D plays a key role in maintaining bone health, but evidence for its nonskeletal effects is inconsistent. This study aims to examine the association between serum 25-hydroxyvitamin D [25(OH)D] levels and all-cause mortality in a large general population cohort.
DESIGN, PARTICIPANTS, AND SETTING: Using the computerized database of the largest health care provider in Israel, we identified a cohort of subjects 20 years old or older with serum 25(OH)D levels measured between January 2008 and December 2009. Vital status was ascertained through August 2011.
Median follow-up was 28.5 months (interquartile range 23.8-33.5 months); 7,247 of 182,152 participants (4.0%) died. Subjects who died had significantly lower serum 25(OH)D levels (mean 44.8 ± 24.2 nmol/liter) than those alive at the end of follow-up (51.0 ± 23.2 nmol/liter), P < 0.001. After adjustment for age, gender, ethnicity, and seasonality, the hazard ratio (HR) for all-cause mortality was 2.02 [95% confidence interval (CI) 1.89-2.15] for the lowest serum 25(OH)D quartile (<33.8 nmol/liter) compared with the highest. After further adjustment for comorbidity, use of vitamin D supplements and statins, smoking, socioeconomic status, and body mass index, the HR was 1.81 (95% CI 1.69-1.95). This remained, even after adjustment for serum low-density lipoprotein, high-density lipoprotein, calcium level (corrected for serum albumin levels), and glomerular filtration rate, 1.85 (95% CI 1.70-2.01). The fully adjusted HR associated with being in the second 25(OH)D quartile (33.8-49.4 nmol/liter) was 1.25 (95% CI 1.16-1.34).
All-cause mortality is independently and inversely associated with serum 25(OH)D levels at levels less than 50 nmol/liter.
维生素 D 在维持骨骼健康方面起着关键作用，但关于其非骨骼作用的证据并不一致。本研究旨在检查在一个大型普通人群队列中血清 25-羟维生素 D [25(OH)D]水平与全因死亡率之间的关联。
设计、参与者和设置：我们使用以色列最大医疗保健提供者的计算机化数据库，确定了一个年龄在 20 岁或以上的队列，他们的血清 25(OH)D 水平在 2008 年 1 月至 2009 年 12 月之间进行了测量。通过 2011 年 8 月确定生存状态。
中位随访时间为 28.5 个月（四分位距 23.8-33.5 个月）；182152 名参与者中有 7247 人（4.0%）死亡。与随访结束时存活的参与者相比，死亡的参与者血清 25(OH)D 水平明显较低（平均 44.8 ± 24.2 nmol/liter），差异有统计学意义（P < 0.001）。在校正年龄、性别、种族和季节性因素后，与最高血清 25(OH)D 四分位数（≥51.0 nmol/liter）相比，最低血清 25(OH)D 四分位数（<33.8 nmol/liter）的全因死亡率的危险比（HR）为 2.02（95%可信区间[CI]为 1.89-2.15）。在校正合并症、维生素 D 补充剂和他汀类药物使用、吸烟、社会经济地位和体重指数后，HR 为 1.81（95%CI 1.69-1.95）。即使在校正血清低密度脂蛋白、高密度脂蛋白、钙水平（校正血清白蛋白水平）和肾小球滤过率后，HR 仍为 1.85（95%CI 1.70-2.01）。与处于第二 25(OH)D 四分位数（33.8-49.4 nmol/liter）相关的完全调整 HR 为 1.25（95%CI 1.16-1.34）。
全因死亡率与血清 25(OH)D 水平呈负相关，且血清 25(OH)D 水平低于 50 nmol/liter 时与死亡率独立相关。
