Ethnic minorities in developed countries suffer a disproportionately high burden of COVID-19 morbidity and mortality, and COVID-19 ethnic disparities have been attributed to social determinants of health. Vitamin D has been proposed as a modifiable risk factor that could mitigate COVID-19 health disparities. We investigated the relationship between vitamin D and COVID-19 susceptibility and severity using the UK Biobank, a large progressive cohort study of the United Kingdom population. Structural equation modelling was used to evaluate the ability of vitamin D, socioeconomic deprivation, and other known risk factors to mediate COVID-19 ethnic health disparities. Asian ethnicity is associated with higher COVID-19 susceptibility, compared to the majority White population, and Asian and Black ethnicity are both associated with higher COVID-19 severity. Socioeconomic deprivation mediates all three ethnic disparities and shows the highest overall signal of mediation for any COVID-19 risk factor. Vitamin supplements, including vitamin D, mediate the Asian disparity in COVID-19 susceptibility, and serum 25-hydroxyvitamin D (calcifediol) levels mediate Asian and Black COVID-19 severity disparities. Several measures of overall health also mediate COVID-19 ethnic disparities, underscoring the importance of comorbidities. Our results support ethnic minorities’ use of vitamin D as both a prophylactic and a supplemental therapeutic for COVID-19.
Competing Interest Statement
The authors have declared no competing interest.
Funding: LMR, MA, and LR were supported by the Division of Intramural Research (DIR) of the National Institute on Minority Health and Health Disparities (NIMHD) at NIH, (Award Numbers: 1ZIAMD000016 and 1ZIAMD000018). LMR was supported by the National Institutes of Health (NIH) Distinguished Scholars Program (DSP). SDN, KKL, and IKJ were supported by the by the IHRC-Georgia Tech Applied Bioinformatics Laboratory (Award Number: RF383).
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Ethics approval for the UK Biobank was obtained from the North West Multi-centre Research Ethics Committee (MREC) for the United Kingdom, the Patient Information Advisory Group (PIAG) for England and Wales, and the Community Health Index Advisory Group (CHIAG) for Scotland (see https://www.ukbiobank.ac.uk/learn-more-about-uk-biobank/about-us/ethics).
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Paper in collection COVID-19 SARS-CoV-2 preprints from medRxiv and bioRxiv