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Trends in the Diagnosis of Vitamin D Deficiency
Emre Basatemur1, Laura Horsfall2, Louise Marston2
1Population, Policy and Practice Programme, UCL Institute of Child Health, London, United Kingdom; and emre.basatemur@ucl.ac.uk.
Insights
Diagnoses of vitamin D deficiency in children significantly increased from 2000 to 2014. Higher diagnosis rates were observed in older children, those of nonwhite ethnicity, and socially deprived groups.
Area of Science:
- Pediatrics
- Public Health
- Nutritional Science
Background:
- Growing interest in vitamin D and increased testing requests by healthcare providers.
- Lack of investigation into vitamin D deficiency diagnosis rates in clinical practice.
- Need to understand trends in childhood vitamin D deficiency diagnoses.
Purpose of the Study:
- To examine trends in the diagnosis of vitamin D deficiency in children in England.
- To analyze diagnosis rates over time and by sociodemographic factors.
Main Methods:
- Cohort study utilizing primary care records from the Health Improvement Network database (711,788 children aged 0-17).
- Calculation of incidence rates for vitamin D deficiency diagnosis annually from 2000 to 2014.
- Multivariable Poisson regression to estimate rate ratios by age, sex, ethnicity, and social deprivation.
Main Results:
- A significant increase in crude diagnosis rates from 3.14 to 261 per 100,000 person-years between 2000 and 2014.
- A 15-fold increase in diagnoses between 2008 and 2014 after adjusting for demographics.
- Higher diagnosis rates associated with older age (≥10 years), nonwhite ethnicity, and social deprivation. Sex differences varied by age group.
Conclusions:
- A substantial rise in childhood vitamin D deficiency diagnoses over the last decade.
- Importance of further research into the drivers of this diagnostic trend.
- Need to investigate reasons for vitamin D status assessment in clinical practice.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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