Basatemur Emre, Horsfall Laura, Marston Louise, Rait Greta, Sutcliffe Alastair
Population, Policy and Practice Programme, UCL Institute of Child Health, London, United Kingdom; and
Research Department of Primary Care and Population Health, University College London, London, United Kingdom.
Pediatrics. 2017 Mar;139(3). doi: 10.1542/peds.2016-2748. Epub 2017 Feb 3.
Vitamin D has attracted considerable interest in recent years, and health care providers have reported large increases in vitamin D test requests. However, rates of diagnosis of vitamin D deficiency in clinical practice have not been investigated. We examined trends in diagnosis of vitamin D deficiency in children in England over time, and by sociodemographic characteristics.
Cohort study using primary care records of 711 788 children aged 0 to 17 years, from the Health Improvement Network database. Incidence rates for diagnosis of vitamin D deficiency were calculated per year between 2000 and 2014. Rate ratios exploring differences by age, sex, ethnicity, and social deprivation were estimated using multivariable Poisson regression.
The crude rate of vitamin D deficiency diagnosis increased from 3.14 per 100 000 person-years in 2000 (95% confidence interval [CI], 1.31-7.54) to 261 per 100 000 person-years in 2014 (95% CI, 241-281). After accounting for changes in demographic characteristics, a 15-fold (95% CI, 10-21) increase in diagnosis was seen between 2008 and 2014. Older age (≥10 years), nonwhite ethnicity, and social deprivation were independently associated with higher rates of diagnosis. In children aged <5 years, diagnosis rates were higher in boys than girls, whereas in children aged ≥10 they were higher in girls.
There has been a marked increase in diagnosis of vitamin D deficiency in children over the past decade. Future research should explore the drivers for this change in diagnostic behavior and the reasons prompting investigation of vitamin D status in clinical practice.
近年来，维生素D引起了广泛关注，医疗保健人员报告称维生素D检测请求大幅增加。然而，临床实践中维生素D缺乏症的诊断率尚未得到研究。我们研究了英格兰儿童维生素D缺乏症诊断率随时间的变化趋势，以及按社会人口学特征划分的情况。
采用队列研究，数据来自健康改善网络数据库中711788名0至17岁儿童的初级保健记录。计算2000年至2014年期间每年维生素D缺乏症的诊断发病率。使用多变量泊松回归估计按年龄、性别、种族和社会剥夺程度划分的发病率比值，以探究差异。
维生素D缺乏症的粗诊断率从2000年的每10万人年3.14例（95%置信区间[CI]，1.31 - 7.54）增至2014年的每10万人年261例（95%CI，241 - 281）。在考虑人口特征变化后，2008年至2014年期间诊断率增长了15倍（95%CI，10 - 21）。年龄较大（≥10岁）、非白人种族和社会剥夺与较高的诊断率独立相关。在5岁以下儿童中，男孩的诊断率高于女孩，而在10岁及以上儿童中，女孩的诊断率更高。
在过去十年中，儿童维生素D缺乏症的诊断率显著上升。未来的研究应探讨这种诊断行为变化的驱动因素，以及在临床实践中促使对维生素D状态进行检测的原因。
