Hu Yaowen, Gao Faliang, Yang Yuan, Yang Wei, He Huibo, Zhou Jie, Zhao Yujie, Chen Xi, Zhao Wenyan, He Xiaopeng
Center for General Practice Medicine, Healthcare Department, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China.
Center for Rehabilitation Medicine, Department of Neurosurgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China.
PLoS One. 2025 Jul 24;20(7):e0328907. doi: 10.1371/journal.pone.0328907. eCollection 2025.
To investigate the prevalence of vitamin D deficiency and its relationship with all-cause and cause-specific mortality among middle-aged and elderly populations in the U.S.
Data were sourced from the National Health and Nutrition Examination Survey (NHANES) 2001-2018. A total of 22,130 participants aged 40-70 years were included. Serum 25-hydroxy vitamin D [25(OH)D] concentrations were measured and categorized. The primary outcome was all-cause mortality, and secondary outcomes were cardiovascular disease (CVD) and cancer mortality. Multivariable-adjusted models and various statistical analyses were employed.
The prevalence of vitamin D deficiency (≤50.00 nmol/L) was 33.59%, and insufficiency (≤75.00 nmol/L) was 71.74%. For all-cause mortality, the multivariate adjusted hazard ratios (HRs) across different 25(OH)D levels (< 25.00, 25.00-49.99, 50.00-74.99, and ≥ 75.00 nmol/L) were 1.00, 0.78 (0.65, 0.93) p = 0.0069, 0.59 (0.49,0.72) p < 0.0001, and 0.54 (0.44, 0.66) p < 0.0001 respectively. Similar patterns were observed for CVD mortality. There was no significant difference in cancer mortality between the moderately deficient and severely deficient groups, but lower mortality was found in the insufficient and sufficient groups compared to the severely deficient group. An L-shaped association between serum vitamin D levels and mortality was identified. Subgroup analyses were consistent with the main findings.
This study found that higher serum 25-hydroxyvitamin D concentrations are linked to lower all-cause, cardiovascular, and cancer mortality. The relationship is nonlinear: increases in concentration reduce death risk below a certain threshold, but above it, the association weakens. Further research is needed to understand causal mechanisms.
调查美国中老年人群维生素D缺乏症的患病率及其与全因死亡率和特定病因死亡率的关系。
数据来源于2001 - 2018年美国国家健康与营养检查调查（NHANES）。共纳入22130名年龄在40 - 70岁的参与者。测量血清25 - 羟基维生素D [25(OH)D]浓度并进行分类。主要结局是全因死亡率，次要结局是心血管疾病（CVD）和癌症死亡率。采用多变量调整模型和各种统计分析方法。
维生素D缺乏（≤50.00 nmol/L）的患病率为33.59%，不足（≤75.00 nmol/L）的患病率为71.74%。对于全因死亡率，不同25(OH)D水平（< 25.00、25.00 - 49.99、50.00 - 74.99和≥ 75.00 nmol/L）的多变量调整风险比（HRs）分别为1.00、0.78（0.65，0.93）p = 0.0069、0.59（0.49，0.72）p < 0.0001和0.54（0.44，0.66）p < 0.0001。CVD死亡率也观察到类似模式。中度缺乏组和重度缺乏组之间的癌症死亡率无显著差异，但与重度缺乏组相比，不足组和充足组的死亡率较低。确定了血清维生素D水平与死亡率之间的L型关联。亚组分析与主要发现一致。
本研究发现较高的血清25 - 羟基维生素D浓度与较低的全因、心血管和癌症死亡率相关。这种关系是非线性的：浓度增加会降低低于某个阈值的死亡风险，但高于该阈值时，这种关联会减弱。需要进一步研究以了解因果机制。
