Vitamin D and socioeconomic deprivation mediate COVID-19 ethnic health disparities

  1. Leonardo Mariño-Ramírez
  2. Maria Ahmad
  3. Lavanya Rishishwar
  4. Shashwat Deepali Nagar
  5. Kara K. Lee
  6. Emily T. Norris
  7. I. King Jordan

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Abstract

Ethnic minorities in developed countries suffer a disproportionately high burden of COVID-19 morbidity and mortality, and COVID-19 ethnic disparities have been attributed to social determinants of health. Vitamin D has been proposed as a modifiable risk factor that could mitigate COVID-19 health disparities. We investigated the relationship between vitamin D and COVID-19 susceptibility and severity using the UK Biobank, a large progressive cohort study of the United Kingdom population. Structural equation modelling was used to evaluate the ability of vitamin D, socioeconomic deprivation, and other known risk factors to mediate COVID-19 ethnic health disparities. Asian ethnicity is associated with higher COVID-19 susceptibility, compared to the majority White population, and Asian and Black ethnicity are both associated with higher COVID-19 severity. Socioeconomic deprivation mediates all three ethnic disparities and shows the highest overall signal of mediation for any COVID-19 risk factor. Vitamin supplements, including vitamin D, mediate the Asian disparity in COVID-19 susceptibility, and serum 25-hydroxyvitamin D (calcifediol) levels mediate Asian and Black COVID-19 severity disparities. Several measures of overall health also mediate COVID-19 ethnic disparities, underscoring the importance of comorbidities. Our results support ethnic minorities’ use of vitamin D as both a prophylactic and a supplemental therapeutic for COVID-19.

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    SciScore for 10.1101/2021.09.20.21263865: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We extracted the following information for UK Biobank participants: (1) age (Field 21022 Age at recruitment), (2) sex (Field 31: Sex), (3) ethnicity (Field 21000: ethnic background), (4) body mass index (Field 21001: Body mass index (BMI)), (5) smoking status (Field 20116: Smoking status), (6) diastolic blood pressure (Field 4079: Diastolic blood pressure, automated reading), (7) systolic blood pressure (Field 4080: Systolic blood pressure, automated reading), (8) Townsend deprivation index (Field 189: Townsend deprivation index at recruitment), (9) overall health rating (Field 2178: Overall health rating), (10) long-standing illness (Field 2188: Long-standing illness, disability, or infirmity), (11) supplements (Field 6155: Vitamin and mineral supplements), (12) vitamin D (Field 30890: Vitamin D), and (13) skin color (Field 1717: Skin colour).
    Field
    suggested: (Field of Genes, RRID:SCR_016155)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations of the study and future directions: Our evaluation of the role of vitamin D in COVID-19 ethnic disparities is limited by the reliance on observational data from the UK Biobank. As discussed previously, the SEM approach allowed us to formulate and test hypotheses using observational data regarding the causes of COVID-19 disparities and to characterize potential intervening mechanisms that could be used to mitigate the disparities. However, our results could be effected by unobserved confounders, and randomized control trials are the gold standard for definitely proving the efficacy of any medical intervention. Nevertheless, our results can be taken to support the establishment of clinical trials on the efficacy of vitamin D as a prophylactic and treatment for COVID-19, with an emphasis on the recruitment of participants from ethnic minority groups.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.09.20.21263865v1 on medRxiv