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Vitamin D prescribing in children in UK primary care practices: a population-based cohort study
Mandy Wan1,2, Laura J Horsfall3, Emre Basatemur4
1Evelina Pharmacy, Guy's and Saint Thomas' NHS Foundation Trust, London, UK Mandy.Wan@gstt.nhs.uk.
Insights
Vitamin D prescribing in UK children surged 26-fold from 2008-2016. General practitioners (GPs) often deviated from national guidelines, with inconsistent dosing and lack of blood tests.
Area of Science:
- Pediatric Endocrinology
- Public Health
- General Practice
Background:
- Vitamin D supplementation is crucial for pediatric bone health and overall well-being.
- Understanding prescribing patterns in primary care is essential for guideline adherence and resource allocation.
- Previous trends in pediatric vitamin D supplementation in the UK remain incompletely characterized.
Purpose of the Study:
- To analyze temporal trends in the incidence and patterns of vitamin D prescribing by UK general practitioners (GPs) for children (0-17 years) between 2008 and 2016.
- To investigate sociodemographic factors associated with vitamin D prescribing rates.
- To evaluate the adherence to national guidelines regarding supplementation regimens, dosage, and the use of 25-hydroxyvitamin D (25(OH)D) testing.
Main Methods:
- A population-based cohort study utilizing UK general practice records from The Health Improvement Network (THIN).
- Annual incidence rates of vitamin D prescriptions were calculated and analyzed using multivariable Poisson regression.
- Detailed analysis of supplementation type, dose, dosing schedule, linked 25(OH)D laboratory results, and clinical symptoms.
Main Results:
- A 26-fold increase in the crude annual incidence of vitamin D prescribing was observed, rising from 10.8 to 276.8 per 100,000 person-years between 2008 and 2016.
- Higher prescribing rates were associated with older children, non-white ethnicity, and practices in England.
- Inconsistent supplementation regimens were noted, with a significant proportion of prescriptions lacking pre-supplementation 25(OH)D levels (28.7%-56.4%) and increasing use of pharmacological doses, often deviating from UK recommendations.
Conclusions:
- A substantial and sustained rise in vitamin D supplementation prescribing for children has occurred in UK primary care.
- General practitioners (GPs) demonstrated inconsistent adherence to national guidelines for vitamin D supplementation in pediatric care.
- Further research and clearer guidance are needed to ensure optimal and evidence-based vitamin D prescribing practices for children.
Objective:
To examine temporal changes in the incidence and patterns of vitamin D supplementation prescribing by general practitioners (GPs) between 2008 and 2016.
Design:
Population-based cohort study.
Setting:
UK general practice health records from The Health Improvement Network.
Participants:
Children aged 0 to 17 years who were registered with their general practices for at least 3 months.
Outcome Measures:
Annual incidence rates of vitamin D prescriptions were calculated, and rate ratios were estimated using multivariable Poisson regression to explore differences by sociodemographic factors. Data on the type of supplementation, dose, dosing schedule, linked 25-hydroxyvitamin D (25(OH)D) laboratory test results and clinical symptoms suggestive of vitamin D deficiency were analysed.
Results:
Among 2 million children, the crude annual incidence of vitamin D prescribing increased by 26-fold between 2008 and 2016 rising from 10.8 (95% CI: 8.9 to 13.1) to 276.8 (95% CI: 264.3 to 289.9) per 100 000 person-years. Older children, non-white ethnicity and general practices in England (compared with Wales/Scotland/Northern Ireland) were independently associated with higher rates of prescribing. Analyses of incident prescriptions showed inconsistent supplementation regimens with an absence of pre-supplementation 25(OH)D concentrations in 28.7% to 56.4% of prescriptions annually. There was an increasing trend in prescribing at pharmacological doses irrespective of 25(OH)D concentrations, deviating in part from UK recommendations. Prescribing at pharmacological doses for children with deficient status increased from 3.8% to 79.4%, but the rise was also observed in children for whom guidelines recommended prevention doses (0% to 53%). Vitamin D supplementation at pharmacological doses was also prescribed in at least 40% of children with no pre-supplementation 25(OH)D concentrations annually.
Conclusions:
There has been a marked and sustained increase in vitamin D supplementation prescribing in children in UK primary care. Our data suggests that national guidelines on vitamin D supplementation for children are not consistently followed by GPs.
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