Vitamin D Status and Risk of All-Cause and Cause-Specific Mortality in Osteoarthritis Patients: Results from NHANES III and NHANES 2001–2018
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Measurement of Serum 25(OH)D
2.3. Mortality Ascertainment
2.4. Covariates
2.5. Statistical Analysis
3. Results
3.1. Baseline Characteristics
3.2. Vitamin D and Mortality
3.3. Stratified and Sensitivity Analyses
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Characteristic | Serum 25(OH)D Concentrations (nmol/L) a | ||||
---|---|---|---|---|---|
<25.0 (n = 136) | 25.0–49.9 (n = 1054) | 50.0–74.9 (n = 1579) | ≥75.0 (n = 1801) | p | |
Age (years, mean ± SD) | 60.89 ± 13.54 | 59.50 ± 13.96 | 59.89 ± 13.49 | 63.70 ± 11.95 | <0.001 |
Gender, n (%) | |||||
Male | 31 (15.40) | 355 (32.96) | 642 (40.57) | 591 (31.78) | <0.001 |
Female | 105 (84.60) | 699 (67.04) | 937 (59.43) | 1210 (68.22) | |
Race/ethnicity, n (%) | |||||
Non-Hispanic white | 45 (53.21) | 558 (71.70) | 1068 (81.44) | 1392 (88.78) | <0.001 |
Non-Hispanic black | 57 (26.47) | 255 (13.15) | 190 (5.48) | 145 (3.29) | |
Mexican American | 22 (11.86) | 137 (5.68) | 121 (2.69) | 89 (1.51) | |
Others | 12 (8.45) | 104 (9.47) | 200 (10.38) | 175 (6.41) | |
Education level, n (%) | |||||
Below high school | 49 (27.09) | 325 (19.84) | 359 (13.54) | 310 (10.32) | <0.001 |
High school or equivalent | 35 (22.50) | 270 (28.13) | 391 (24.78) | 420 (22.70) | |
Above high school | 52 (50.40) | 459 (52.03) | 829 (61.68) | 1071 (66.98) | |
Family poverty income ratio, n (%) | |||||
≤1 | 33 (18.19) | 192 (15.49) | 218 (9.40) | 194 (7.59) | <0.001 |
1< to ≤3 | 58 (45.14) | 465 (39.33) | 645 (34.74) | 725 (31.37) | |
>3 | 45 (36.68) | 397 (45.19) | 716 (55.85) | 882 (61.04) | |
Body mass index, n (%) | |||||
Normal | 18 (10.72) | 177 (15.42) | 340 (20.93) | 475 (22.74) | <0.001 |
Overweight | 36 (27.67) | 326 (30.33) | 495 (29.01) | 609 (33.86) | |
Obese | 82 (61.62) | 551 (54.26) | 744 (50.06) | 717 (43.40) | |
Physical activity, n (%) | |||||
Inactive | 112 (84.55) | 675 (59.63) | 816 (46.96) | 962 (48.79) | <0.001 |
Insufficient | 7 (3.90) | 157 (15.05) | 296 (19.64) | 259 (15.84) | |
Active | 17 (11.55) | 222 (25.32) | 467 (33.39) | 580 (35.37) | |
Smoking status, n (%) | |||||
Never smoker | 66 (37.58) | 506 (45.41) | 730 (44.55) | 890 (51.50) | <0.001 |
Current smoker | 35 (30.94) | 216 (24.13) | 242 (15.35) | 220 (13.40) | |
Past smoker | 35 (31.49) | 332 (30.46) | 607 (40.10) | 691 (35.09) | |
Drinking status, n (%) | |||||
Never drinker | 30 (18.71) | 188 (13.48) | 226 (10.23) | 221 (8.37) | <0.001 |
Current drinker | 74 (63.13) | 574 (59.82) | 1065 (72.22) | 1229 (73.97) | |
Abstainer | 32 (18.16) | 292 (26.70) | 288 (17.55) | 351 (17.67) | |
Comorbidities, n (%) | |||||
Diabetes mellitus | 44 (24.23) | 312 (26.38) | 363 (20.01) | 373 (19.44) | <0.001 |
Hypertension | 88 (67.56) | 693 (61.84) | 1006 (58.90) | 1229 (63.56) | 0.049 |
Cardiovascular disease | 29 (24.87) | 226 (18.75) | 293 (18.16) | 386 (18.87) | 0.154 |
Cancer | 15 (12.44) | 178 (19.57) | 299 (19.69) | 438 (25.67) | <0.001 |
Chronic lung disease | 31 (33.28) | 147 (12.93) | 207 (13.79) | 219 (10.11) | 0.004 |
Renal disease | 38 (28.21) | 224 (18.18) | 271 (13.05) | 277 (13.10) | <0.001 |
Whole-blood biochemical markers (GM, 95% CI) | |||||
Total cholesterol (n = 4529), mmol/L | 5.130 (1.941, 5.325) | 5.168 (5.096, 5.240) | 5.083 (5.030, 5.137) | 5.003 (4.952, 5.053) | <0.001 |
HDL (n = 4526), mmol/L | 1.349 (1.283, 1.417) | 1.297 (1.274, 1.320) | 1.325 (1.305, 1.344) | 1.419 (1.399, 1.439) | <0.001 |
LDL (n = 2149), mmol/L | 2.651 (2.431, 2.891) | 2.980 (2.893, 3.071) | 2.925 (2.856, 2.997) | 2.772 (2.711, 2.835) | 0.002 |
Triglyceride (n = 4549), mmol/L | 1.306 (1.144, 1.491) | 1.436 (1.377, 1.497) | 1.391 (1.341, 1.443) | 1.320 (1.275, 1.367) | 0.016 |
CRP (n = 3440), mg/dL | 0.423 (0.341, 0.526) | 0.334 (0.311, 0.359) | 0.269 (0.253, 0.287) | 0.230 (0.215, 0.245) | <0.001 |
Lead (n = 4023), umol/L | 0.105 (0.090, 0.122) | 0.095 (0.090, 0.099) | 0.080 (0.077, 0.083) | 0.068 (0.066, 0.071) | <0.001 |
Serum 25(OH)D Concentrations (nmol/L) | Per One-Unit Increment in Natural Log-Transformed 25(OH)D | ||||
---|---|---|---|---|---|
<25.0 | 25.0–49.9 | 50.0–74.9 | ≥75.0 | ||
All-cause mortality | |||||
Number of deaths/total | 58/136 | 429/1054 | 510/1579 | 391/1801 | |
Model 1 a | Ref. | 0.43 (0.27, 0.67) | 0.36 (0.23, 0.56) | 0.32 (0.20, 0.53) | 0.66 (0.53, 0.83) |
Model 2 b | Ref. | 0.46 (0.30, 0.71) | 0.40 (0.26, 0.62) | 0.39 (0.24, 0.63) | 0.76 (0.61, 0.94) |
Model 3 c | Ref. | 0.49 (0.31, 0.75) | 0.45 (0.29, 0.68) | 0.43 (0.27, 0.69) | 0.81 (0.65, 1.00) |
CVD mortality | |||||
Number of deaths | 22 | 138 | 156 | 111 | |
Model 1 a | Ref. | 0.27 (0.12, 0.57) | 0.20 (0.09, 0.41) | 0.17 (0.08, 0.38) | 0.47 (0.30, 0.73) |
Model 2 b | Ref. | 0.27 (0.13, 0.57) | 0.23 (0.11, 0.47) | 0.22 (0.10, 0.48) | 0.59 (0.37, 0.95) |
Model 3 c | Ref. | 0.28 (0.14, 0.59) | 0.25 (0.12, 0.51) | 0.24 (0.11, 0.49) | 0.61 (0.40, 0.94) |
Cancer mortality | |||||
Number of deaths | 8 | 75 | 96 | 89 | |
Model 1 a | Ref. | 0.70 (0.29, 1.73) | 0.56 (0.23, 1.37) | 0.65 (0.27, 1.59) | 0.85 (0.58, 1.26) |
Model 2 b | Ref. | 0.77 (0.31, 1.91) | 0.69 (0.27, 1.73) | 0.83 (0.34, 2.03) | 1.00 (0.70, 1.43) |
Model 3 c | Ref. | 0.74 (0.29, 1.87) | 0.68 (0.26, 1.73) | 0.81 (0.32, 2.04) | 1.00 (0.71, 1.42) |
Other mortality | |||||
Number of deaths | 28 | 216 | 258 | 191 | |
Model 1 a | Ref. | 0.52 (0.30, 0.90) | 0.47 (0.28, 0.78) | 0.39 (0.23, 0.68) | 0.73 (0.57, 0.94) |
Model 2 b | Ref. | 0.56 (0.32, 0.98) | 0.51 (0.31, 0.86) | 0.45 (0.26, 0.78) | 0.80 (0.63, 1.02) |
Model 3 c | Ref. | 0.64 (0.35, 1.15) | 0.61 (0.36, 1.03) | 0.54 (0.30, 0.96) | 0.88 (0.68, 1.14) |
Serum 25(OH)D Concentrations (nmol/L) | pinteractionb | ||||
---|---|---|---|---|---|
<25.0 a | 25.0–49.9 a | 50.0–74.9 a | ≥75.0 a | ||
Age (years) | 0.46 | ||||
≤60 (n = 1624) | Ref. | 0.13 (0.07, 0.25) | 0.15 (0.08, 0.26) | 0.19 (0.08, 0.43) | |
>60 (n = 2946) | Ref. | 0.71 (0.40, 1.24) | 0.58 (0.33, 1.03) | 0.57 (0.31, 1.04) | |
Gender | 0.83 | ||||
Male (n = 1619) | Ref. | 0.22 (0.09, 0.54) | 0.20 (0.08, 0.50) | 0.21 (0.08, 0.52) | |
Female (n = 2951) | Ref. | 0.58 (0.33, 1.02) | 0.53 (0.31, 0.91) | 0.51 (0.28, 0.92) | |
Race/ethnicity | 0.32 | ||||
Non-Hispanic white (n = 3063) | Ref. | 0.46 (0.26, 0.82) | 0.44 (0.26, 0.75) | 0.44 (0.24, 0.79) | |
Others (n = 1507) | Ref. | 0.56 (0.31, 1.01) | 0.44 (0.23, 0.83) | 0.28 (0.14, 0.56) | |
Body mass index | 0.63 | ||||
<30 (n = 2476) | Ref. | 0.67 (0.36, 1.26) | 0.71 (0.38, 1.32) | 0.61 (0.32, 1.17) | |
≥30 (n = 2094) | Ref. | 0.35 (0.20, 0.61) | 0.28 (0.15, 0.50) | 0.33 (0.17, 0.62) | |
Smoking status | 0.12 | ||||
Never smoker (n = 2192) | Ref. | 0.66 (0.38, 1.14) | 0.68 (0.40, 1.17) | 0.68 (0.39, 1.21) | |
Current smoker (n = 713) | Ref. | 0.18 (0.07, 0.45) | 0.19 (0.07, 0.54) | 0.16 (0.06, 0.43) | |
Past smoker (n = 1665) | Ref. | 0.57 (0.23, 1.46) | 0.43 (0.17, 1.08) | 0.42 (0.17, 1.03) | |
Drinking status | 0.27 | ||||
Never drinker (n = 665) | Ref. | 0.70 (0.29, 1.68) | 0.70 (0.30, 1.64) | 0.41 (0.17, 1.00) | |
Current drinker (n = 2942) | Ref. | 0.30 (0.14, 0.62) | 0.27 (0.13, 0.57) | 0.29 (0.13, 0.66) | |
Abstainer (n = 963) | Ref. | 0.83 (0.41, 1.70) | 0.68 (0.31, 1.47) | 0.64 (0.29, 1.40) | |
Physical activity | 0.98 | ||||
Inactive (n = 2565) | Ref. | 0.53 (0.30, 0.93) | 0.50 (0.29, 0.87) | 0.52 (0.28, 0.98) | |
Insufficient or active (n = 2005) | Ref. | 0.38 (0.18, 0.79) | 0.32 (0.15, 0.68) | 0.29 (0.13, 0.63) | |
Chronic lung disease | 0.73 | ||||
Yes (n = 604) | Ref. | 0.45 (0.15, 1.34) | 0.33 (0.10, 1.09) | 0.28 (0.08, 0.99) | |
No (n = 3966) | Ref. | 0.48 (0.31, 0.75) | 0.46 (0.29, 0.72) | 0.44 (0.27, 0.71) | |
Renal disease | 0.18 | ||||
Yes (n = 810) | Ref. | 0.71 (0.32, 1.58) | 0.78 (0.35, 1.70) | 0.68 (0.31, 1.49) | |
No (n = 3760) | Ref. | 0.42 (0.24, 0.73) | 0.37 (0.21, 0.65) | 0.37 (0.19, 0.71) | |
Any type of comorbidities | <0.001 | ||||
Yes (n = 3704) | Ref. | 0.53 (0.32, 0.88) | 0.47 (0.29, 0.77) | 0.44 (0.25, 0.77) | |
No (n = 866) | Ref. | 0.08 (0.03, 0.24) | 0.11 (0.04, 0.30) | 0.11 (0.03, 0.34) |
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Wang, J.; Fan, J.; Yang, Y.; Moazzen, S.; Chen, D.; Sun, L.; He, F.; Li, Y. Vitamin D Status and Risk of All-Cause and Cause-Specific Mortality in Osteoarthritis Patients: Results from NHANES III and NHANES 2001–2018. Nutrients 2022, 14, 4629. https://doi.org/10.3390/nu14214629
Wang J, Fan J, Yang Y, Moazzen S, Chen D, Sun L, He F, Li Y. Vitamin D Status and Risk of All-Cause and Cause-Specific Mortality in Osteoarthritis Patients: Results from NHANES III and NHANES 2001–2018. Nutrients. 2022; 14(21):4629. https://doi.org/10.3390/nu14214629
Chicago/Turabian StyleWang, Jing, Jiayao Fan, Ye Yang, Sara Moazzen, Dingwan Chen, Lingling Sun, Fan He, and Yingjun Li. 2022. "Vitamin D Status and Risk of All-Cause and Cause-Specific Mortality in Osteoarthritis Patients: Results from NHANES III and NHANES 2001–2018" Nutrients 14, no. 21: 4629. https://doi.org/10.3390/nu14214629