Abstract
Epidemiological evidence supports vitamin D deficiency as a risk factor for tuberculosis. Differences in solar ultraviolet B (UV-B) exposure, the major source of vitamin D, might therefore partially explain global variation in tuberculosis incidence. In a global country-based ecological study, we explored the correlation between vitamin D-proxies, such as solar UV-B exposure, and other relevant variables with tuberculosis incidence, averaged over the period 2004-2013. Across 154 countries, annual solar UV-B exposure was associated with tuberculosis incidence. Tuberculosis incidence in countries in the highest quartile of UV-B exposure was 78% (95% CI 57-88%, p<0.001) lower than that in countries in the lowest quartile, taking into account other vitamin D-proxies and covariates. Of the explained global variation in tuberculosis incidence, 6.3% could be attributed to variations in annual UV-B exposure. Exposure to UV-B had a similar, but weaker association with tuberculosis notification rates in the multilevel analysis with sub-national level data for large countries (highest versus lowest quartile 29% lower incidence; p=0.057). The potential preventive applications of vitamin D supplementation in high-risk groups for tuberculosis merits further investigation.
| Original language | English |
|---|---|
| Article number | 1601979 |
| Journal | European Respiratory Journal |
| Volume | 49 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - 1 Jun 2017 |
Funding
We wish to thank Patricia Bartholomay (Tuberculosis National Control Program, Secretariat of Health Surveillance, Ministry of Health of Brazil, DF, Brazil), Anete Trajman (Federal University of Rio de Janeiro, Rio de Janeiro, Brazil), Nguyen Viet Nhung and Nguyen Binh Hoa (Viet Nam National Tuberculosis Control Program), Soledad Beltrame (National Tuberculosis and Lepra Control Programme, Buenos Aires, Argentina), Zhao Yong (Dept. of Nutrition and Food Hygiene, School of Public Health and Management, Chongqing Medical University, Chongqing, China), Sergey Sterlikov (Federal TB Monitoring Center, Federal Research Institute for Health Organization and Informatics, Moscow, Russian Federation), Puneet Dewan (Senior Program Officer for TB, Bill and Melinda Gates Foundation, New Delhi, India), Richard Menzies (Montreal Chest Institute, Montreal, Canada), and Gunta Dravniece (Senior Consultant, KNCV Tuberculosis Foundation, The Hague, Netherlands) for their assistance in the collection of sub-national tuberculosis case notification data. Lastly, we thank Ente Rood (Environmental epidemiologist, KIT Biomedical Research, Amsterdam) and Mirjam Bakker (Senior epidemiologist, KIT Biomedical Research, Amsterdam) for their guidance in using the Geographical Information System software.
| Funders | Funder number |
|---|---|
| Dept. of Nutrition and Food Hygiene | |
| Federal University of Rio de Janeiro, Rio de Janeiro, Brazil | |
| Montreal Chest Institute | |
| Nguyen Viet Nhung and Nguyen Binh Hoa | |
| Richard Menzies | |
| School of Public Health and Management | |
| Bill and Melinda Gates Foundation | |
| Karlsruhe Institute of Technology | |
| Chongqing Medical University | |
| KNCV Tuberculosis Foundation |
