The Relevance of Vitamin D Supplementation for People of Color in the Era of COVID-19

and 800 IU/d (20ug) for adults aged over 70 years to maintain a 25(OH)D concentration of 20ng/mL or higher. However, in individuals who are deficient in Vitamin D (25(OH)D level <20 ng/ mL), of which patients with skin of color are at a higher risk, supplementation is considerably higher. These recommendations are summarized summarized in Table 1.⁵

Numerous studies have addressed the relationship between Vitamin D and respiratory tract infections. A recent meta-analysis incorporating data from 21,000 patients showed that subjects with Vitamin D levels less than 20 ng/mL had a 64% increased risk of community-acquired pneumonia.⁶ An additional meta analysis of data from 10,933 subjects from 25 randomized controlled trials documented an overall protective effect of Vitamin D supplementation against acute respiratory tract infection. Protective effects were observed in those receiving daily or weekly dosing of Vitamin D and were strongest in patients with baseline levels less than 25nmol/L than in those with baseline levels greater than 25nmol/L.⁷

Recent investigations suggest a potential relationship between Vitamin D levels and COVID-19 mortality rates. Laird et al conducted a literature search of Vitamin D status in European countries, which were selected based on the severity of COVID-19 infection. Low Vitamin D concentrations were associated with increased mortality. Countries with a formal Vitamin D fortification policy appeared to have the lowest rates of infection while countries with no policy and highest deficiency rates appeared to be more adversely affected.⁸ 

Daneshkhah et al analyzed data from hospitals and clinics in Europe, Asia, and the United States. They noted that patients from countries with high COVID mortality rates had lower vitamin D levels compared to countries that were not as severely affected. There was a strong correlation between Vitamin D deficiency and cytokine storm characterized by a hyperinflammatory, overactive immune response common in patients with COVID-19.⁹

Vitamin D deficiency has been well documented in people of color, in particular AA. The aforementioned data suggest a relationship between low Vitamin D status and COVID-19 mortality rates. While myriad socioeconomic and health care disparities may be contributing factors, we must indeed consider key biological variables, including Vitamin D status, that may impact these observations. Future prospective studies are necessary to confirm these findings. As there is currently no readily available treatment or vaccine for COVID-19, treating physicians should be cognizant of the higher prevalence of Vitamin D deficiency in skin of color populations and its emerging potential role in COVID-19 outcomes. Given the devastating statistics of COVID-19 among minority communities and the multifaceted role of Vitamin D in skin and systemic health, dermatologists are essential partners in decreasing health care disparities by initiating the vitamin D dialogue. As such, we can play an invaluable role in improving the health outcomes of our patients, particularly people of color, during and beyond the COVID-19 pandemic.

The authors have no relevant conflicts to report.

1. Centers for Disease Control and Prevention. COVID-19 in Racial and Ethnic Minority Groups. 2020. Available from: URL: https://www.cdc.gov/ coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html. Accessed May 12, 2020
2. Ginde AA, Liu MC, Camargo CA Jr. Demographic differences and trends of Vitamin D insufficiency in the US population, 1988-2004. Arch Intern Med. 2009;169(6):626-32
3. Taksler, G., Cutler, D., Giovannucci, E., & Keating, N. Vitamin D deficiency in minority populations. Public Health Nutr. 2015;18(3):379-391.
4. Yang CY, Leung PS, Adamopoulos IE, Gershwin ME. The implication of Vitamin D and autoimmunity: a comprehensive review. Clin Rev Allergy Immunol. 2013; 45(2):217-26.
5. Pludowski P, Holick MF, Grant WB, et al. Vitamin D supplementation guidelines. J Steroid Biochem Mol Biol. 2018;175:125-135. doi:10.1016/j.jsbmb. 2017.01.021
6. Zhou YF, Luo BA, Qin LL. The association between Vitamin D deficiency and community-acquired pneumonia: A meta-analysis of observational studies. Medicine (Baltimore). 2019; 98(38):e17252.
7. Martineau AR, Jolliffe DA, Hooper RL, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017;356:i6583. Published 2017 Feb 15. doi:10.1136/bmj.i6583.
8. Laird E., Rhodes J., Kenny R.A. Vitamin D and inflammation: potential implications for severity of Covid-19. Ir Med J. 2020;113:81
9. Daneshkhah A., Agrawal V., Esheim A. 2020. The possible role of Vitamin D in suppressing cytokine storm and associated mortality in COVID-19 patients. MedRxiv. https://doi.org/10.1101/2020.04.08.20058578

Pearl E. Grimes MD [email protected]