The Interaction of Vitamin D and Corticosteroids: A Mortality Analysis of 26,508 Veterans Who Tested Positive for SARS-CoV-2

Jimmy T. Efird, Ethan J. Anderson, Charulata Jindal, Thomas S. Redding, Andrew D. Thompson, Ashlyn M. Press, Julie Upchurch, Christina D. Williams, Yuk Ming Choi and Ayako Suzuki
Additional contact information
Jimmy T. Efird: Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, NC 27705, USA
Ethan J. Anderson: College of Pharmacy, University of Iowa, Iowa City, IA 52242, USA
Charulata Jindal: Harvard Medical School, Harvard University, Boston, MA 02115, USA
Thomas S. Redding: Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, NC 27705, USA
Andrew D. Thompson: Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, NC 27705, USA
Ashlyn M. Press: Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, NC 27705, USA
Julie Upchurch: Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, NC 27705, USA
Christina D. Williams: Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, NC 27705, USA
Yuk Ming Choi: Signify Health, Dallas, TX 75244, USA
Ayako Suzuki: Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, NC 27705, USA

IJERPH, 2021, vol. 19, issue 1, 1-19

Abstract: This data-based cohort consisted of 26,508 (7%) United States veterans out of the 399,290 who tested positive for SARS-CoV-2 from 1 March to 10 September 2020. We aimed to assess the interaction of post-index vitamin D (Vit D) and corticosteroid (CRT) use on 30-day mortality among hospitalized and non-hospitalized patients with coronavirus disease 2019 (COVID-19). Combination Vit D and CRT drug use was assessed according to four multinomial pairs (−|+, −|−, +|+, +|−). Respective categorical effects were computed on a log-binomial scale as adjusted relative risk (aRR). Approximately 6% of veterans who tested positive for SARS-CoV-2 died within 30 days of their index date. Among hospitalized patients, a significantly decreased aRR was observed for the use of Vit D in the absence of CRTs relative to patients who received CRTs but not Vit D (aRR = 0.30; multiplicity corrected, p = 0.0004). Among patients receiving systemically administered CRTs (e.g., dexamethasone), the use of Vit D was associated with fewer deaths in hospitalized patients (aRR = 0.51) compared with non-hospitalized patients (aRR = 2.5) ( P -for-Interaction = 0.0071). Evaluating the effect of modification of these compounds in the context of hospitalization may aid in the management of COVID-19 and provide a better understanding of the pathophysiological mechanisms underlying this and future infectious disease outbreaks.

Keywords: anti-inflammatory; corticosteroids; COVID-19; cytokine storm; SARS-CoV-2; vitamin D; veterans (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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