title: Race and vitamin D status and monitoring in male veterans.
abstract: African Americans have lower vitamin D levels and reduced health outcomes compared to white Americans. Vitamin D deficiency may contribute to adverse health outcomes in African Americans. We hypothesized that race would be associated with vitamin D status and testing in African Americans veterans, and that vitamin D status is a major contributor to health care costs in African American veterans compared to white veterans. A retrospective analysis of the medical data in the Veterans Integrated Service Network 9 (southeastern United States) was performed, and 14148 male veterans were identified. Race was designated by the patient and its relationship to vitamin D levels/status and costs was assessed. Vitamin D levels were significantly lower and the percent of patients with vitamin D deficiency was significantly higher in African American veterans. This difference was independent of latitude and seasonality. Vitamin D testing was done significantly more in white veterans compared to African American veterans (5.4% vs 3.8%). While follow-up testing was 42% more likely if a patient was found to be vitamin D deficient, white veterans were 34% more likely than African American veterans to have at least 1 follow-up 25-hydroxyvitamin D performed. African American veterans had significantly higher health care costs, which were linked to lower vitamin D levels; however, the cost differential persisted even after adjusting for vitamin D status. Vitamin D deficiency is highly prevalent in African American veterans and needs improved management within the Veteran Administration system. Vitamin D status appears not to be the sole contributor to increased health care costs in African American veterans.
authors.affiliation: Department of Internal Medicine, East Tennessee State University, Johnson City, USA. alan.peiris@va.gov
authors.forename: Alan N
authors.initials: AN
authors.lastname: Peiris
authors.forename: Beth A
authors.initials: BA
authors.lastname: Bailey
authors.forename: Prith
authors.initials: P
authors.lastname: Peiris
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Copeland
authors.forename: Todd
authors.initials: T
authors.lastname: Manning
mesh_terms: D001741:Black or African American; D000368:Aged; D002112:Calcifediol / Q000097:blood; D017048:Health Care Costs; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010346:Patient Care Management / Q000592:standards*; D012189:Retrospective Studies; D015144:Southeastern United States; D014481:United States; D014493:United States Department of Veterans Affairs / Q000592:standards; D014728:Veterans; D058014:Veterans Health / Q000208:ethnology*; D014808:Vitamin D Deficiency / Q000097:blood / Q000175:diagnosis / Q000191:economics / Q000208:ethnology; D044465:White People
chemical_list: D002112:Calcifediol