Department of Laboratory, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China.
Department of Endocrinology, The Affiliated Chuzhou Hospital of Traditional Chinese Medicine of Jiangsu College of Nursing, Huaian, China.
Front Immunol. 2024 Oct 9;15:1425119. doi: 10.3389/fimmu.2024.1425119. eCollection 2024.
Inadequate levels of vitamin D (VitD) have been linked to increased rates of various health conditions and mortality. However, little is known about the relationship between mortality outcomes and 25-hydroxyvitamin D [25(OH)D] levels in individuals with rheumatoid arthritis (RA). This study aimed to examine this association using data from the National Health and Nutrition Examination Survey.
A cohort of 2,290 individuals aged 20 to 85 years with RA was analyzed. Lower 25(OH)D levels were inversely associated with all-cause mortality, with a hazard ratio (HR) of 0.91 (0.87 to 0.96) per 10 nmol/L increase. Comparatively, the HR for the VitD insufficiency group was 0.64 (0.50 to 0.83), and for the VitD sufficiency group, it was 0.60 (0.44 to 0.80), both compared to the VitD deficiency group. Cause-specific analysis showed that higher 25(OH)D levels were associated with reduced mortality from heart disease (HR: 0.88, 0.82 to 0.95) and malignant neoplasms (HR: 0.86, 0.79 to 0.94). No significant correlation was found between 25(OH)D levels and cause-specific mortalities for other conditions.
Stratified by gender, the HR for males was 0.92 (0.85 to 0.99) and for females was 0.91 (0.86 to 0.98) per 10 nmol/L increase in 25(OH)D levels. Among individuals aged 20-59 years, no significant correlation was observed, while for those aged 60 years and older, the HR was 0.86 (0.82 to 0.90) per 10 nmol/L increase. Nonlinear analysis identified a sharp increase in HR below 59.95 nmol/L, while HR remained below 1 for 25(OH)D levels above 59.95 nmol/L.
This study reveals a strong negative correlation between 25(OH)D levels and overall mortality in individuals with RA. Notably, this association is particularly significant for mortality related to heart disease and malignant neoplasms. Targeted VitD supplementation should be emphasized, especially in individuals aged 60 years and older with RA. The proposed minimum threshold for adequate 25(OH)D levels in the RA population is 60 nmol/L.
维生素 D（VitD）水平不足与各种健康状况和死亡率的增加有关。然而，人们对类风湿关节炎（RA）患者的死亡率与 25-羟维生素 D [25(OH)D]水平之间的关系知之甚少。本研究旨在利用来自国家健康和营养检查调查的数据来研究这种关联。
分析了 2290 名年龄在 20 至 85 岁的 RA 患者的队列。较低的 25(OH)D 水平与全因死亡率呈负相关，每增加 10 nmol/L 的风险比（HR）为 0.91（0.87 至 0.96）。相比之下，VitD 不足组的 HR 为 0.64（0.50 至 0.83），VitD 充足组为 0.60（0.44 至 0.80），均低于 VitD 缺乏组。病因特异性分析表明，较高的 25(OH)D 水平与心脏病（HR：0.88，0.82 至 0.95）和恶性肿瘤（HR：0.86，0.79 至 0.94）死亡率降低相关。未发现 25(OH)D 水平与其他疾病的病因特异性死亡率之间存在显著相关性。
按性别分层，男性 25(OH)D 水平每增加 10 nmol/L，HR 为 0.92（0.85 至 0.99），女性为 0.91（0.86 至 0.98）。在 20-59 岁的人群中，未观察到显著相关性，而在 60 岁及以上的人群中，每增加 10 nmol/L，HR 为 0.86（0.82 至 0.90）。非线性分析发现，59.95 nmol/L 以下的 HR 急剧增加，而 25(OH)D 水平高于 59.95 nmol/L 时，HR 仍低于 1。
本研究揭示了 RA 患者 25(OH)D 水平与全因死亡率之间存在强烈的负相关。值得注意的是，这种关联在与心脏病和恶性肿瘤相关的死亡率方面尤为显著。应强调针对 VitD 的补充，特别是在 60 岁及以上的 RA 患者中。建议 RA 人群的最低适宜 25(OH)D 水平阈值为 60 nmol/L。
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