Association of vitamin D deficiency with COVID-19 infection severity: Systematic review and meta-analysis

Zhen Wang, Avni Joshi, Kaitlin Leopold, Sarah Jackson, Stephanie Christensen, Tarek Nayfeh, Khaled Mohammed, Ana Creo, Peter Tebben, Seema Kumar, Zhen Wang, Avni Joshi, Kaitlin Leopold, Sarah Jackson, Stephanie Christensen, Tarek Nayfeh, Khaled Mohammed, Ana Creo, Peter Tebben, Seema Kumar

Abstract

Background: We sought to evaluate the association between vitamin D deficiency and the severity of coronavirus disease 2019 (COVID-19) infection.

Methods: Multiple databases from 1 January 2019 to 3 December 2020 were searched for observational studies evaluating the association between vitamin D deficiency and severity of COVID-19 infection. Independent reviewers selected studies and extracted data for the review. The main outcomes of interest were mortality, hospital admission, length of hospital stay and intensive care unit admission.

Results: Seventeen observational studies with 2756 patients were included in the analyses. Vitamin D deficiency was associated with significantly higher mortality (odds ratio [OR]: 2.47, 95% confidence interval [CI]: 1.50-4.05; 12 studies; hazard ratio [HR]: 4.11, 95% CI: 2.40-7.04; 3 studies), higher rates of hospital admissions (OR: 2.18, 95% CI: 1.48-3.21; 3 studies) and longer hospital stays (0.52 days; 95% CI: 0.25-0.80; 2 studies) as compared to nonvitamin D deficient status. Subgroup analyses based on different cut-offs for defining vitamin D deficiency, study geographic locations and latitude also showed similar trends.

Conclusions: Vitamin D deficiency is associated with greater severity of COVID-19 infection. Further studies are warranted to determine if vitamin D supplementation can decrease the severity of COVID-19.

Keywords: COVID-19; hospital admission; mortality; vitamin D.

Conflict of interest statement

The authors declare that there are no conflict of interests.

© 2021 John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Flowchart outlining the protocol adopted in this systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines [Color figure can be viewed at wileyonlinelibrary.com]
Figure 2
Figure 2
Forest plot showing odds ratio (OR) and 95% confidence interval (CI) for mortality for each of the 12 studies that reported this outcome [Color figure can be viewed at wileyonlinelibrary.com]

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