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Open Access Highly Accessed Research article

Hospital admissions for vitamin D related conditions and subsequent immune-mediated disease: record-linkage studies

Sreeram V Ramagopalan12, Raph Goldacre3, Giulio Disanto1, Gavin Giovannoni2 and Michael J Goldacre3*

Author Affiliations

1 Department of Physiology, Anatomy and Genetics and Medical Research Council Functional Genomics Unit, University of Oxford, Oxford, UK

2 Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK

3 Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK

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BMC Medicine 2013, 11:171  doi:10.1186/1741-7015-11-171

Published: 25 July 2013

Abstract

Background

Previous studies have suggested that there may be an association between vitamin D deficiency and the risk of developing immune-mediated diseases.

Methods

We analyzed a database of linked statistical records of hospital admissions and death registrations for the whole of England (from 1999 to 2011). Rate ratios for immune-mediated disease were determined, comparing vitamin D deficient cohorts (individuals admitted for vitamin D deficiency or markers of vitamin D deficiency) with comparison cohorts.

Results

After hospital admission for either vitamin D deficiency, osteomalacia or rickets, there were significantly elevated rates of Addison’s disease, ankylosing spondylitis, autoimmune hemolytic anemia, chronic active hepatitis, celiac disease, Crohn’s disease, diabetes mellitus, pemphigoid, pernicious anemia, primary biliary cirrhosis, rheumatoid arthritis, Sjogren’s syndrome, systemic lupus erythematosus, thyrotoxicosis, and significantly reduced risks for asthma and myxoedema.

Conclusions

This study shows that patients with vitamin D deficiency may have an increased risk of developing some immune-mediated diseases, although we cannot rule out reverse causality or confounding. Further study of these associations is warranted and these data may aid further public health studies.

Keywords:
Vitamin D; Immune disease; Hospital episode statistics