Amsterdam Institute for Global Health and Development and Dept of Global Health, Academic Medical Centre, Amsterdam, The Netherlands.
Faculty of Earth and Life Sciences, Dept of Health Sciences, Section of Infectious Diseases, Vrije Universiteit, Amsterdam, The Netherlands.
Eur Respir J. 2017 Jun 15;49(6). doi: 10.1183/13993003.01979-2016. Print 2017 Jun.
Epidemiological evidence supports vitamin D deficiency as a risk factor for tuberculosis. Differences in solar ultraviolet B (UV-B) exposure, the major source of vitamin D, might therefore partially explain global variation in tuberculosis incidence.In a global country-based ecological study, we explored the correlation between vitamin D-proxies, such as solar UV-B exposure, and other relevant variables with tuberculosis incidence, averaged over the period 2004-2013.Across 154 countries, annual solar UV-B exposure was associated with tuberculosis incidence. Tuberculosis incidence in countries in the highest quartile of UV-B exposure was 78% (95% CI 57-88%, p<0.001) lower than that in countries in the lowest quartile, taking into account other vitamin D-proxies and covariates. Of the explained global variation in tuberculosis incidence, 6.3% could be attributed to variations in annual UV-B exposure. Exposure to UV-B had a similar, but weaker association with tuberculosis notification rates in the multilevel analysis with sub-national level data for large countries (highest lowest quartile 29% lower incidence; p=0.057).The potential preventive applications of vitamin D supplementation in high-risk groups for tuberculosis merits further investigation.
流行病学证据表明，维生素 D 缺乏是结核病的一个风险因素。因此，太阳紫外线 B（UV-B）暴露的差异（维生素 D 的主要来源）可能部分解释了全球结核病发病率的差异。在一项基于国家的全球生态学研究中，我们探讨了维生素 D 指标（如太阳 UV-B 暴露）与其他相关变量与 2004 年至 2013 年期间平均的结核病发病率之间的相关性。在 154 个国家中，年度太阳 UV-B 暴露与结核病发病率有关。在 UV-B 暴露最高四分位的国家中，结核病发病率比 UV-B 暴露最低四分位的国家低 78%（95%CI 57-88%，p<0.001），这考虑到了其他维生素 D 指标和协变量。在考虑了其他维生素 D 指标和协变量后，全球结核病发病率的变异中，有 6.3%可以归因于年度 UV-B 暴露的变异。在具有大国家次国家层面数据的多层次分析中，UV-B 暴露与结核病报告率也存在类似但较弱的关联（最高 最低四分位发病率低 29%；p=0.057）。在结核病高危人群中补充维生素 D 的潜在预防应用值得进一步研究。
