Chandler Paulette D, Giovannucci Edward L, Williams Michelle A, LeBoff Meryl S, Bates David W, Hicks LeRoi S
Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA ; Harvard Medical School, Boston, MA.
Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA ; Harvard Medical School, Boston, MA.
Am J Pharm Benefits. 2014;6(1):e1-e8.
Assess racial/ethnic and sex differences in treatment of vitamin D deficiency with high dose ergocalciferol ('vitamin D2') or other forms of vitamin D in a northeastern U.S. ambulatory clinic of an academic urban medical center.
Cross-sectional observational review of electronic medication prescribing records of patients with 25-hydroxyvitamin D (25OHD) deficiency (25OHD < 20 ng/ml) from 2004-2008.
Using multivariable logistic regression adjusting for patients' demographics, and Elixhauser comorbidity score, we examined the association of sex and race/ethnicity with prescription for at least one dose of vitamin D.
Among 2,140 patients without renal disease and tested for 25OHD deficiency (25OHD < 20 ng/ml), 66.2% received no vitamin D prescription for vitamin D deficiency. Blacks and Hispanics received vitamin D prescriptions at a higher frequency than whites, 37.8% 38.4% and 30.9%, respectively, p=0.003. The vitamin D prescription rate for women versus men was 26.3% and 7.5%, respectively, p=0.04. In a fully adjusted model, no difference in prescription likelihood for blacks and whites [OR=1.18 95% CI, 0.88-1.58; p=0.29] or Hispanics and whites was noted [OR=1.01 95% CI, 0.70-1.45;p=0.73]. Similarly, fully adjusted model showed no difference in prescription likelihood for females and males [OR=1.23 95% CI, 0.93-1.63; p=0.12].
Among primary care patients with vitamin D deficiency, vitamin D supplementation was low and white patients were less likely to receive vitamin D treatment than blacks or Hispanics. Interventions to correct the high prevalence of vitamin D deficiency should address the markedly low rate of vitamin D prescribing when 25OHD levels are measured.
在美国东北部一所学术性城市医疗中心的门诊诊所，评估使用高剂量麦角钙化醇（“维生素D2”）或其他形式的维生素D治疗维生素D缺乏症时的种族/族裔及性别差异。
对2004年至2008年期间25-羟维生素D（25OHD）缺乏（25OHD<20 ng/ml）患者的电子药物处方记录进行横断面观察性回顾。
使用多变量逻辑回归，对患者的人口统计学特征和埃利克斯豪泽合并症评分进行调整，我们研究了性别和种族/族裔与至少一剂维生素D处方之间的关联。
在2140例无肾脏疾病且检测出25OHD缺乏（25OHD<20 ng/ml）的患者中，66.2%未因维生素D缺乏而接受维生素D处方。黑人和西班牙裔接受维生素D处方的频率高于白人，分别为37.8%、38.4%和30.9%，p=0.003。女性与男性的维生素D处方率分别为26.3%和7.5%，p=0.04。在一个完全调整的模型中，未发现黑人和白人[比值比（OR）=1.18，95%置信区间（CI），0.88 - 1.58；p=0.29]或西班牙裔和白人之间在处方可能性上存在差异[OR=1.01，95%CI，0.70 - 1.45；p=0.73]。同样，完全调整的模型显示女性和男性在处方可能性上也无差异[OR=1.23，95%CI，0.93 - 1.63；p=0.12]。
在患有维生素D缺乏症的初级保健患者中，维生素D补充率较低，白人患者比黑人或西班牙裔患者接受维生素D治疗的可能性更小。当检测25OHD水平时，纠正维生素D缺乏症高患病率的干预措施应针对维生素D处方率明显较低的情况。
