Monitoring changes in vitamin D levels during the COVID-19 pandemic with routinely-collected laboratory data

Vitamin D is critical for bone health and immune function, but the COVID-19 pandemic, characterized by lockdowns and reduced outdoor activity, raised concerns about potential declines in vitamin D levels due to dietary changes and limited sunlight exposure. In this study, we analyzed routinely-collected laboratory data (N = 292,187 patients) from a large laboratory chain in Bavaria, Germany, to assess changes in vitamin D levels before (March 2018 to February 2020) and during (March 2020 to February 2022) the pandemic. Different statistical approaches (i.e., descriptive statistics, propensity score matching, and a causal forest) were used to evaluate confounder-adjusted changes in vitamin D levels and deficiency rates. Mean vitamin D levels decreased significantly from 26.7 μg/l pre-pandemic to 26.0 μg/l during the pandemic (p-value < 0.001), with a corresponding increase in deficiency rates from 31.2% to 35.2% (p-value < 0.001). Across all statistical approaches, the decline in mean levels and the increase in deficiency rates were particularly pronounced among elderly women. These findings highlight the importance of public health strategies to monitor and improve vitamin D status, especially during periods of restricted outdoor activity.