The Role of Vitamin D in the All-Cause Mortality of General Population Open Access

Abstract

This thesis is focused on investigating the association between vitamin D deficiency and all-cause mortality. We conducted analyses among a retrospective cohort of 1159 patients, who were admitted to Emory hospital from 2008-2012 and had vitamin D tests. Of the1159 subjects, 77% had vitamin D deficiency (25-hydroxyvitamin D (25(OH)D) <30 ng/mL); 44% had chronic kidney disease (CKD) (defined as estimated glomerular filtration rate (eGFR) <=60 mL/min/1.73 m2); and 380 died during an average follow-up of 427.3 days. We conducted survival analysis with the primary time-to-event outcome specified as time from admission to death. Based on multivariate Cox regression, we find that older age and lower eGFR are significantly associated with a higher risk of mortality (P<0.001 for age; P<0.001 for eGFR). Although no statistically significant association between vitamin D deficiency and mortality is found after adjusting for age and eGFR (Hazard ratio, 1.049; 95% confidence interval, 0.822-1.337), our multivariate analysis detects a significant interaction effect between vitamin D deficiency and eGFR on mortality risk (P=0.0208). A further analysis stratified on vitamin D deficiency status suggests that a decrease in eGFR in patients with vitamin D deficiency has a significant negative impact on mortality risk (Hazard ratio, 0.997; 95% confidence interval, 0.994-1.000), while the effect of eGFR diminishes in patients with normal vitamin D level.

Table of Contents

I Introduction ............................................................................1

II Methods .................................................................................4

III Results ..................................................................................9

IV Discussion ...........................................................................13

References ...............................................................................15

Appendix A ..............................................................................19

About this Master's Thesis

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School	Rollins School of Public Health
Department	Biostatistics and Bioinformatics
Subfield / Discipline	Biostatistics - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Medicine and Surgery Health Sciences, Epidemiology
Keyword	all-cause mortality chronic kidney disease vitamin D deficiency
Committee Chair / Thesis Advisor	Peng, Limin, Emory University
Committee Members	Tangpricha, Vin, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Hospital or other health care provider

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