No association of 25-hydroxyvitamin D with exacerbations in primary care patients with COPD

Milo A. Puhan, Lara Siebeling, Anja Frei, Marco Zoller, Heike Bischoff-Ferrari, Gerben Ter Riet

Research output: Contribution to journalArticle

Abstract

Background: Cross-sectional studies suggest an association of 25-hydroxyvitamin D with exacerbations in patients with COPD, but longitudinal evidence from cohort studies is scarce. The aim of this study was to assess the association of serum 25-hydroxyvitamin D with exacerbations and mortality in primary care patients with COPD. Methods: In the main analysis, we included 356 patients with COPD (GOLD [Global Initiative for Chronic Obstructive Lung Disease] stages II-IV, free from exacerbations for ≥4 weeks) from a prospective cohort study in Dutch and Swiss primary care settings. We used negative binomial and Cox regression to assess the association of 25-hydroxyvitamin D with (centrally adjudicated) exacerbations and mortality, respectively. Results: Baseline mean ± SD serum 25-hydroxyvitamin D concentration was 15.5 ± 8.9 ng/dL, and 274 patients (77.0%) had 25-hydroxyvitamin D deficiency (<20 ng/dL). Compared with patients with severe 25-hydroxyvitamin D deficiency (<10 ng/dL, n = 106 [29.8%]), patients with moderately deficient (10-19.99 ng/dL, n = 168 [47.2%]) and insufficient (20-29.99 ng/dL, n = 58 [16.3%]) concentrations had the same risk for exacerbations (incidence rate ratio, 1.01 [95% CI, 0.77-1.57] vs 1.00 [95% CI, 0.62-1.61], respectively). In patients with desirable concentrations (> 30 ng/dL, n = 24 [6.7%]), the risk was lower, although not significantly (incidence rate ratio, 0.72 [95% CI, 0.37-1.42]). In patients taking vitamin D supplements, using different cutoffs for 25-hydroxyvitamin D or competing risk models did not materially change the results. We did not find a statistically significant association of 25-hydroxyvitamin D concentration with mortality. Conclusions: This longitudinal study in a real-world COPD population that carefully minimized misclassification of exacerbations and the influence of confounding did not show an association of 25-hydroxyvitamin D with exacerbations and mortality.

Original languageEnglish (US)
Pages (from-to)37-43
Number of pages7
JournalChest
Volume145
Issue number1
DOIs
StatePublished - Jan 2014

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Chronic Obstructive Pulmonary Disease
Primary Health Care
Mortality
Cohort Studies
25-hydroxyvitamin D
Serum
Vitamin D
Longitudinal Studies
Cross-Sectional Studies
Prospective Studies
Incidence
Population

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Puhan, M. A., Siebeling, L., Frei, A., Zoller, M., Bischoff-Ferrari, H., & Ter Riet, G. (2014). No association of 25-hydroxyvitamin D with exacerbations in primary care patients with COPD. Chest, 145(1), 37-43. https://doi.org/10.1378/chest.13-1296

No association of 25-hydroxyvitamin D with exacerbations in primary care patients with COPD. / Puhan, Milo A.; Siebeling, Lara; Frei, Anja; Zoller, Marco; Bischoff-Ferrari, Heike; Ter Riet, Gerben.

In: Chest, Vol. 145, No. 1, 01.2014, p. 37-43.

Research output: Contribution to journalArticle

Puhan, MA, Siebeling, L, Frei, A, Zoller, M, Bischoff-Ferrari, H & Ter Riet, G 2014, 'No association of 25-hydroxyvitamin D with exacerbations in primary care patients with COPD', Chest, vol. 145, no. 1, pp. 37-43. https://doi.org/10.1378/chest.13-1296
Puhan MA, Siebeling L, Frei A, Zoller M, Bischoff-Ferrari H, Ter Riet G. No association of 25-hydroxyvitamin D with exacerbations in primary care patients with COPD. Chest. 2014 Jan;145(1):37-43. https://doi.org/10.1378/chest.13-1296
Puhan, Milo A. ; Siebeling, Lara ; Frei, Anja ; Zoller, Marco ; Bischoff-Ferrari, Heike ; Ter Riet, Gerben. / No association of 25-hydroxyvitamin D with exacerbations in primary care patients with COPD. In: Chest. 2014 ; Vol. 145, No. 1. pp. 37-43.
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abstract = "Background: Cross-sectional studies suggest an association of 25-hydroxyvitamin D with exacerbations in patients with COPD, but longitudinal evidence from cohort studies is scarce. The aim of this study was to assess the association of serum 25-hydroxyvitamin D with exacerbations and mortality in primary care patients with COPD. Methods: In the main analysis, we included 356 patients with COPD (GOLD [Global Initiative for Chronic Obstructive Lung Disease] stages II-IV, free from exacerbations for ≥4 weeks) from a prospective cohort study in Dutch and Swiss primary care settings. We used negative binomial and Cox regression to assess the association of 25-hydroxyvitamin D with (centrally adjudicated) exacerbations and mortality, respectively. Results: Baseline mean ± SD serum 25-hydroxyvitamin D concentration was 15.5 ± 8.9 ng/dL, and 274 patients (77.0{\%}) had 25-hydroxyvitamin D deficiency (<20 ng/dL). Compared with patients with severe 25-hydroxyvitamin D deficiency (<10 ng/dL, n = 106 [29.8{\%}]), patients with moderately deficient (10-19.99 ng/dL, n = 168 [47.2{\%}]) and insufficient (20-29.99 ng/dL, n = 58 [16.3{\%}]) concentrations had the same risk for exacerbations (incidence rate ratio, 1.01 [95{\%} CI, 0.77-1.57] vs 1.00 [95{\%} CI, 0.62-1.61], respectively). In patients with desirable concentrations (> 30 ng/dL, n = 24 [6.7{\%}]), the risk was lower, although not significantly (incidence rate ratio, 0.72 [95{\%} CI, 0.37-1.42]). In patients taking vitamin D supplements, using different cutoffs for 25-hydroxyvitamin D or competing risk models did not materially change the results. We did not find a statistically significant association of 25-hydroxyvitamin D concentration with mortality. Conclusions: This longitudinal study in a real-world COPD population that carefully minimized misclassification of exacerbations and the influence of confounding did not show an association of 25-hydroxyvitamin D with exacerbations and mortality.",
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T1 - No association of 25-hydroxyvitamin D with exacerbations in primary care patients with COPD

AU - Puhan, Milo A.

AU - Siebeling, Lara

AU - Frei, Anja

AU - Zoller, Marco

AU - Bischoff-Ferrari, Heike

AU - Ter Riet, Gerben

PY - 2014/1

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N2 - Background: Cross-sectional studies suggest an association of 25-hydroxyvitamin D with exacerbations in patients with COPD, but longitudinal evidence from cohort studies is scarce. The aim of this study was to assess the association of serum 25-hydroxyvitamin D with exacerbations and mortality in primary care patients with COPD. Methods: In the main analysis, we included 356 patients with COPD (GOLD [Global Initiative for Chronic Obstructive Lung Disease] stages II-IV, free from exacerbations for ≥4 weeks) from a prospective cohort study in Dutch and Swiss primary care settings. We used negative binomial and Cox regression to assess the association of 25-hydroxyvitamin D with (centrally adjudicated) exacerbations and mortality, respectively. Results: Baseline mean ± SD serum 25-hydroxyvitamin D concentration was 15.5 ± 8.9 ng/dL, and 274 patients (77.0%) had 25-hydroxyvitamin D deficiency (<20 ng/dL). Compared with patients with severe 25-hydroxyvitamin D deficiency (<10 ng/dL, n = 106 [29.8%]), patients with moderately deficient (10-19.99 ng/dL, n = 168 [47.2%]) and insufficient (20-29.99 ng/dL, n = 58 [16.3%]) concentrations had the same risk for exacerbations (incidence rate ratio, 1.01 [95% CI, 0.77-1.57] vs 1.00 [95% CI, 0.62-1.61], respectively). In patients with desirable concentrations (> 30 ng/dL, n = 24 [6.7%]), the risk was lower, although not significantly (incidence rate ratio, 0.72 [95% CI, 0.37-1.42]). In patients taking vitamin D supplements, using different cutoffs for 25-hydroxyvitamin D or competing risk models did not materially change the results. We did not find a statistically significant association of 25-hydroxyvitamin D concentration with mortality. Conclusions: This longitudinal study in a real-world COPD population that carefully minimized misclassification of exacerbations and the influence of confounding did not show an association of 25-hydroxyvitamin D with exacerbations and mortality.

AB - Background: Cross-sectional studies suggest an association of 25-hydroxyvitamin D with exacerbations in patients with COPD, but longitudinal evidence from cohort studies is scarce. The aim of this study was to assess the association of serum 25-hydroxyvitamin D with exacerbations and mortality in primary care patients with COPD. Methods: In the main analysis, we included 356 patients with COPD (GOLD [Global Initiative for Chronic Obstructive Lung Disease] stages II-IV, free from exacerbations for ≥4 weeks) from a prospective cohort study in Dutch and Swiss primary care settings. We used negative binomial and Cox regression to assess the association of 25-hydroxyvitamin D with (centrally adjudicated) exacerbations and mortality, respectively. Results: Baseline mean ± SD serum 25-hydroxyvitamin D concentration was 15.5 ± 8.9 ng/dL, and 274 patients (77.0%) had 25-hydroxyvitamin D deficiency (<20 ng/dL). Compared with patients with severe 25-hydroxyvitamin D deficiency (<10 ng/dL, n = 106 [29.8%]), patients with moderately deficient (10-19.99 ng/dL, n = 168 [47.2%]) and insufficient (20-29.99 ng/dL, n = 58 [16.3%]) concentrations had the same risk for exacerbations (incidence rate ratio, 1.01 [95% CI, 0.77-1.57] vs 1.00 [95% CI, 0.62-1.61], respectively). In patients with desirable concentrations (> 30 ng/dL, n = 24 [6.7%]), the risk was lower, although not significantly (incidence rate ratio, 0.72 [95% CI, 0.37-1.42]). In patients taking vitamin D supplements, using different cutoffs for 25-hydroxyvitamin D or competing risk models did not materially change the results. We did not find a statistically significant association of 25-hydroxyvitamin D concentration with mortality. Conclusions: This longitudinal study in a real-world COPD population that carefully minimized misclassification of exacerbations and the influence of confounding did not show an association of 25-hydroxyvitamin D with exacerbations and mortality.

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