Vitamin D Status in Veterans With Inflammatory Bowel Disease: Relationship to Health Care Costs and Services

Abstract

Vitamin D deficiency is a global pandemic associated with increased health care costs and could play a role in the pathogenesis and management of inflammatory bowel disease. This study examined vitamin D status in veterans with ulcerative colitis (UC) and Crohn's disease (CD) and assessed its relationship to health care costs and service utilization. Veteran patients (n = 125) with UC or CD and with an available 25-hydroxyvitamin D level were studied. CD patients were more likely to be vitamin D insufficient than the UC group. Despite the higher vitamin D levels among UC patients, they were significantly more likely to utilize laboratory and pharmacy services compared with CD patients, whereas patients with CD had significantly higher radiology and pharmacy costs. Thus, it is likely that disease-specific characteristics rather than vitamin D status determine the costs of health care services in veterans with established inflammatory bowel disease.

Differences in outcomes between cholecalciferol and ergocalciferol supplementation in veterans with inflammatory bowel disease

“…The present study presents two major findings. First, veterans with IBD might not have adequate follow up of vitamin D status, as has been identified in other studies 10 . In addition, and unique to the present study, vitamin D3 was found to be better than D2 in limiting health‐care costs and expenses.…”

“…Prior studies in veterans show that adequacy of vitamin D follow up is not reached in a significant number of veterans 11 . The work presented here extends similar prior findings in veterans to those with IBD 10 . Failure to test, treat, follow up and attain adequate levels could be the result of multiple factors, including the lack of formal testing guidelines, possible lack of providers' awareness of the vitamin D deficiency pandemic and its serious deleterious health consequences, and the availability of multiple treatment regimens.…”

Vitamin D deficiency associated with Crohn’s disease and ulcerative colitis: a meta-analysis of 55 observational studies

“…A total of 19 cohort studies [18, 34, 38, 41, 50–56, 64, 67, 68, 71, 73, 74, 76, 77], 22 case–control studies [16, 25–29, 31–33, 35, 42, 43, 46, 49, 59–63, 66, 69, 70] and 14 cross-sectional studies [30, 36, 37, 39, 40, 44, 45, 47, 48, 57, 58, 65, 72, 75] were included in the analysis. The total number of participants was 5123 patients and 3033 healthy controls.…”

Vitamin D and Inflammatory Bowel Disease

“…Comparing 25(OH)D 3 levels between CD and UC patients, no differences were found in 8 studies on adult or pediatric patients in basal conditions [ 47 , 54 , 55 , 57 – 61 ] and in 1 pediatric study on partially vitamin D supplemented patients [ 62 ]. Lower levels in CD compared with UC were found in 5 studies [ 46 , 63 – 66 ].…”

“…Changing methodology and introducing vitamin D reference values as parameter, the importance of vitamin D in IBD has become more convincing. Defining vitamin sufficiency as serum values above 30 ng/mL, vitamin D insufficiency as values between 10/20 and 30 ng/mL, and vitamin deficiency as concentrations below 10 to 15 ng/mL, data from 27 studies from all over the world were available [ 44 , 46 , 52 , 53 , 56 – 58 , 60 , 61 , 63 , 64 , 69 – 77 ], 6 of them on cohorts over 100 participants [ 59 , 62 , 66 , 78 – 80 ], and one with more than 1,000 patients [ 81 ]. In synthesis, vitamin deficiency was found in 8-100% of patients with CD and in 15-60% of patients with UC, vitamin insufficiency in 12-72.3% in CD or in mixed IBD populations and in 7-64% of UC patients.…”