TABLE 2.
Rates and HRs by serum 25(OH)D category for mortality by cause and hospitalization for cardiovascular disease, respiratory disease, and fractures in 14,641 men and women in the EPIC-Norfolk 1997–20121
| Serum 25(OH)D category (nmol/L) |
|||||||
| <30 (n = 1640) | 30 to <50 (n = 4546) | 50 to <70 (n = 4702) | 70 to <90 (n = 2580) | ≥90 (n = 1173) | HR (95% CI) per 20-nmol/L increase in serum 25(OH)D | P-linear trend | |
| Deaths: all causes | |||||||
| % (n) | 24.2 (397) | 21.2 (966) | 17.7 (834) | 16.1 (416) | 13.9 (163) | — | <0.0001 |
| HR (95% CI)2 | 1 | 0.84 (0.74, 0.94) | 0.72 (0.63, 0.81) | 0.71 (0.62, 0.82) | 0.66 (0.55, 0.79) | 0.89 (0.86, 0.93) | <0.0001 |
| HR (95% CI)3 | 1 | 0.90 (0.79, 1.03) | 0.78 (0.68, 0.90) | 0.80 (0.68, 0.94) | 0.73 (0.59, 0.90) | 0.92 (0.88, 0.96) | <0.0001 |
| Deaths from cardiovascular causes | |||||||
| % (n) | 7.7 (126) | 6.8 (308) | 5.4 (254) | 4.7 (121) | 3.8 (45) | — | <0.0001 |
| HR (95% CI)2 | 1 | 0.86 (0.70, 1.06) | 0.72 (0.58, 0.90) | 0.70 (0.54, 0.91) | 0.62 (0.44, 0.88) | 0.88 (0.83, 0.94) | <0.0001 |
| HR (95% CI)3 | 1 | 0.95 (0.74, 1.21) | 0.84 (0.65, 1.09) | 0.82 (0.61, 1.11) | 0.73 (0.49, 1.09) | 0.92 (0.85, 0.99) | 0.03 |
| Deaths from cancer causes | |||||||
| % (n) | 7.7 (126) | 8.3 (376) | 7.0 (331) | 6.9 (179) | 6.3 (74) | — | 0.014 |
| HR (95% CI)2 | 1 | 0.97 (0.79, 1.19) | 0.85 (0.79, 1.05) | 0.86 (0.68, 1.09) | 0.85 (0.62, 1.09) | 0.93 (0.88, 0.99) | 0.017 |
| HR (95% CI)3 | 1 | 1.11 (0.89, 1.40) | 0.94 (0.74, 1.19) | 0.96 (0.73, 1.25) | 0.90 (0.65, 1.26) | 0.94 (0.89, 1.00) | 0.07 |
| Deaths from respiratory causes | |||||||
| % (n) | 3.4 (56) | 1.8 (81) | 1.3 (60) | 1.2 (30) | 0.7 (8) | — | <0.0001 |
| HR (95% CI)2 | 1 | 0.47 (0.34, 0.67) | 0.34 (0.24, 0.50) | 0.35 (0.22, 0.56) | 0.22 (0.10, 0.46) | 0.70 (0.62, 0.81) | <0.0001 |
| HR (95% CI)3 | 1 | 0.48 (0.33, 0.70) | 0.36 (0.24, 0.55) | 0.42 (0.26, 0.69) | 0.24 (0.11, 0.54) | 0.73 (0.63, 0.85) | <0.0001 |
| Deaths from other causes (noncardiovascular, noncancer, and nonrespiratory) | |||||||
| % (n) | 5.4 (89) | 4.4 (201) | 4.0 (189) | 3.3 (86) | 3.1 (36) | <0.0001 | |
| HR (95% CI)2 | 1 | 0.79 (0.61, 1.01) | 0.74 (0.57, 0.96) | 0.69 (0.51, 0.94) | 0.69 (0.46, 1.02) | 0.91 (0.84, 0.99) | 0.02 |
| HR (95% CI)3 | 1 | 0.83 (0.62, 1.11) | 0.79 (0.58, 1.07) | 0.84 (0.59, 1.18) | 0.82 (0.53, 1.28) | 0.96 (0.88, 1.05) | 0.38 |
| All cancer incidence | |||||||
| % (n) | 21.0 (345) | 22.0 (999) | 21.2 (996) | 21.2 (546) | 20.0 (235) | — | 0.25 |
| HR (95% CI)2 | 1 | 0.97 (0.86, 1.10) | 0.95 (0.84, 1.08) | 1.05 (0.91, 1.20) | 1.00 (0.85, 1.19) | 1.01 (0.97, 1.04) | 0.77 |
| HR (95% CI)3 | 1 | 1.00 (0.88, 1.15) | 1.02 (0.89, 1.17) | 1.12 (0.96, 1.31) | 1.08 (0.89, 1.30) | 1.02 (0.99, 1.06) | 0.21 |
| Cardiovascular disease events | |||||||
| % (n) | 36.2 (593) | 3331 (1561) | 29.2 (1372) | 27.3 (704) | 24.2 (284) | — | <0.0001 |
| HR (95% CI)2 | 1 | 0.91 (0.82, 0.99) | 0.80 (0.73, 0.89) | 0.78 (0.70, 0.87) | 0.75 (0.70, 0.88) | 0.92 (0.90, 0.95) | <0.0001 |
| HR (95% CI)3 | 1 | 0.96 (0.85, 1.07) | 0.87 (0.78, 0.98) | 0.90 (0.79, 1.02) | 0.89 (0.75, 1.05) | 0.96 (0.93, 0.99) | 0.014 |
| Respiratory disease events | |||||||
| % (n) | 21.0 (345) | 15.8 (718) | 13.2 (621) | 12.4 (321) | 10.8 (127) | — | <0.0001 |
| HR (95% CI)2 | 1 | 0.72 (0.63, 0.82) | 0.59 (0.51, 0.68) | 0.57 (0.48, 0.67) | 0.55 (0.44, 0.68) | 0.85 (0.82, 0.90) | <0.0001 |
| HR (95% CI)3 | 1 | 0.73 (0.62, 0.84) | 0.61 (0.52, 0.72) | 0.65 (0.54, 0.78) | 0.59 (0.46, 0.75) | 0.89 (0.84, 0.93) | <0.0001 |
| All fracture events | |||||||
| % (n) | 5.4 (89) | 4.2 (189) | 3.5 (165) | 3.3 (86) | 2.9 (34) | — | <0.0001 |
| HR (95% CI)2 | 1 | 0.77 (0.59, 0.99) | 0.68 (0.52, 0.90) | 0.65 (0.47, 0.89) | 0.62 (0.40, 0.95) | 0.88 (0.81, 0.96) | 0.002 |
| HR (95% CI)3 | 1 | 0.78 (0.58, 1.05) | 0.70 (0.51, 0.95) | 0.65 (0.45, 0.93) | 0.64 (0.40, 1.03) | 0.89 (0.81, 0.97) | 0.012 |
| Hip-fracture events | |||||||
| % (n) | 2.2 (36) | 1.6 (72) | 1.2 (58) | 0.7 (19) | 1.1 (13) | — | <0.0001 |
| HR (95% CI)2 | 1 | 0.76 (0.51, 1.14) | 0.65 (0.42, 1.01) | 0.41 (0.22, 0.74) | 0.65 (0.34, 1.33) | 0.81 (0.79, 0.94) | 0.004 |
| HR (95% CI)3 | 1 | 0.67 (0.42, 1.07) | 0.60 (0.37, 0.98) | 0.38 (0.20, 0.74) | 0.55 (0.25, 1.23) | 0.78 (0.66, 0.93) | 0.004 |
Conversion factors for nanomoles per liter to nanograms per milliliter were as follows: for 25(OH)D3, divide nanomoles per liter by 2.496 to obtain nanograms per milliliter; for 25(OH)D2, divide nanomoles per liter by 2.42 to obtain nanograms per milliliter. As a general approximation, multiply nanomoles per liter by 0.4 to obtain nanograms per milliliter (30 nmol/L = 12 ng/mL, 50 nmol/L = 20 ng/mL, 70 nmol/L = 28 ng/mL, 90 nmol/L = 36 ng/mL, and 120 nmol = 48 ng/mL). EPIC-Norfolk, European Prospective Investigation into Cancer and Nutrition–Norfolk; 25(OH)D, 25-hydroxyvitamin D.
Age, sex, and month adjusted.
Age, sex, month, BMI, physical activity, smoking, alcohol, vitamin C, diabetes, history of cardiovascular disease, history of cancer, social class, and education adjusted.