Medicaid Participants in Long-Term Care at Increased Risk of Insufficient 25-Hydroxyvitamin D [25 (OH)D] Serum Levels

Objectives: There is no agreement among health organization on 25-hydroxyvitamin D 25 (OH)D serum cut-points used to define vitamin D insufficiency. While the U.S. Endocrine Society defines levels < 30 ng/ml as insufficient, the National Academy of Science deems serum levels < 20 ng/ml as insufficient. To determine if the < 30 ng/ml level overclassifies risk, we examined baseline characteristics and health-related conditions associated with serum levels < 30 ng/ml in older adults living in long-term care (LTC) communities. Design and Setting: This cross-sectional study recruited residents from LTC communities in Austin, Texas. Onsite medical records were used to collect a one-year medical history and a one-time blood draw was obtained. Participants: 173 older adults > 65 years old in LTC communities. Measurements: Sociodemographic, lifestyle factors, diagnoses, medications, vitamin/mineral supplementation, anthropometric and biochemical measurements (including 25 (OH)D). Methods: Baseline characteristics, mean 25 (OH)D serum levels, prevalence of insufficiency, and supplementation rates were determined through descriptive statistics. T-test, Chi-square, or ANOVA determined differences in prevalence of vitamin D insufficiency and in mean serum levels across health-related conditions. Multiple logistic regression described the relationship between healthrelated conditions and insufficient serum levels. Results: Prevalence of vitamin D insufficiency (defined as < 30 ng/ml) was 56%, despite a mean supplementation rate of 58.5%. When compared to private pay individuals, Medicaid participants had significantly higher prevalence of insufficiency (48% vs 58%, p = 0.021) and were 3.26 times more to have insufficient 25 (OH)D serum levels ([OR (95%CIs)] (3.26, 1.25 8.48). Across health conditions, individuals diagnosed with dementia (p = 0.013), depression (p = 0.027), Alzheimer’s (p = 0.016) and autoimmune conditions (p = 0.05) had significantly lower mean 25 (OH)D serum levels, compared to those not diagnosed; prevalence of insufficiency was between 51% and 70% in people with any of these conditions. Participants prescribed sertraline had lower serum levels (p = 0.009) compared to those not prescribed and had higher prevalence of insufficiency (71% vs 51%). Diagnosis of rheumatoid arthritis (p = 0.001), psoriasis (p = 0.002, irritable bowel syndrome (p = 0.002), and those prescribed sertraline (p = 0.002) were associated with lower 25 (OH)D serum levels. Health-related factors associated with insufficiency included, prescribed sertraline (2.48, 1.065.82), Alzheimer’s (3.04, 1.26 7.35), depression (3.02, 1.06 8.62) and supplementation < 800 IU per day (OR 9.20 1.67 20.2). Conclusion: Despite no significant difference in supplementation rates the prevalence of vitamin D insufficiency was greater in Medicaid participant, those diagnosed with dementia, depression, Alzheimer’s, autoimmune diseases, and those taking antidepressants including Sertraline. Non-skeletal health conditions associated with serum levels < 20 ng/ml, were found to also be associated with serum levels < 30 ng/ml. These health conditions include autoimmune disease, depression, dementia and Alzheimer’s.