Ethnic Differences in Vitamin D Levels and Comorbid Conditions in Low Income Childbearing Women

Vitamin D deficiency is associated with many chronic health conditions such as osteoporosis, hypertension, and diabetes.  Persons who are obese have low vitamin D levels.  Low vitamin D levels have also been observed in persons who have depression and have potential adverse effects in pregnancy.   African Americans have typically lower levels of vitamin D than Hispanics, but wanted to see if this held true in a predominantly Medicaid patient receiving care at an underserved health care center.  A descriptive study was conducted to determine if there are any ethnic differences in the levels of vitamin D and the co morbid conditions (hypertension, diabetes, prediabetes, obesity, and depression) and associations among these variables in a low income population (45% AA, 55 % Hispanic).   Retrospective de-identified electronic medical record (EMR) data collected from June 2008 to June 2014 was utilized for this study. Inclusion criteria were: women aged 15 and 50 years of age, a serum vitamin D level in the EMR, and a current or previous diagnosis for pregnancy. Other variables included: age, ethnicity, type of insurance, body mass index, and comorbidities.   The total sample size was 302 women who were classified using vitamin D guidelines as severely deficient (vitamin D <10 ng/ml), deficient (vitamin D level 11 to 19 ng/ml), insufficient (vitamin D level 20 to 30 ng/ml) and sufficient (vitamin D level >30).  Findings indicated that 12% were severely deficient, 47% were deficient, 29% were insufficient, and 12% were sufficient.  Although 88% of women had insufficient or deficient levels of vitamin D, only 5% had hypertension, 3% had diabetes,12% had prediabetes, 28% had depression and 16% had anxiety.   The major finding of the present study is that even though the percentage of comorbidities was relatively low, women who had a vitamin D level < 30 had a higher frequency of having the comorbid condition.   African American women were more likely to be vitamin D deficient and had lower levels of vitamin D, and were more likely to be depressed, have prediabetes and have obesity when compared with Hispanic women.  For example, 25% (34/138) of African American women had a severely deficient (vitamin D < 10ng/ml) level compared with 7% (12/164) of Hispanic women.  This study provides evidence for the prevalence of Vitamin D insufficiency/deficiency in the African American and Hispanic patient population but also recognizes ethnic differences in vitamin D deficiency which should be considered when caring for this vulnerable patient population.