Association of serum 25-hydroxy-vitamin D concentration and risk of mortality in cancer survivors in the United States

BMC Cancer. 2024 Apr 30;24(1):545. doi: 10.1186/s12885-024-12304-8.

Abstract

Purpose: Cancer survivors have a high risk of mortality, and vitamin D (VD) is associated with the risk of mortality. This study is aim to examine the impact of VD on mortality in cancer survivors.

Methods: A prospective study was conducted using data from the National Health and Nutrition Examination Survey. Participants were obtained information on their baseline characteristics, dietary habits, comorbidities, lifestyle, and serum 25-hydroxy VD [25(OH)D] concentrations. The weighted Cox proportional hazard and competing risk regression models were used to estimate the hazard ratio and 95% confidence intervals (HR, 95% CI) of mortality for different serum 25(OH)D concentrations. Restricted cubic spline (RCS) curves were utilized to illustrate the dose-response relationship between serum 25(OH)D concentrations and mortality.

Results: The study encompassed 2,495 participants with cancer diagnoses. Multivariate models indicated that, compared to serum 25(OH)D concentrations below 58.5 nmol/L, concentrations exceeding 81.6 nmol/L were associated with reduced HRs for all-cause mortality (HR = 0.70; 95% CI: 0.56-0.87), cardiovascular mortality (HR = 0.53; 95% CI: 0.32-0.86), and cancer-specific mortality (HR = 0.66; 95% CI: 0.45-0.99). RCS curves revealed "L-shaped" associations between serum 25(OH)D concentration and both all-cause and cancer-specific mortality, with threshold effects at 87.9 nmol/L and 84.6 nmol/L, respectively. Conversely, the relationship between serum 25(OH)D concentration and cardiovascular mortality exhibited a more linear pattern, with a threshold at 88.7 nmol/L. Subgroup analyses highlighted a gender-specific interaction that elevated serum 25(OH)D concentrations were significantly more protective against mortality in males than in females, especially regarding cancer-specific mortality (P-interaction = 0.009).

Conclusion: Elevated serum 25(OH)D concentrations were correlated with decreased risks of all-cause, cardiovascular, and cancer-specific mortality in cancer survivors, with benefit thresholds at 87.9, 88.7, and 84.6 nmol/L, respectively. These findings suggested that cancer survivors might benefit from higher vitamin D recommendations than the general population.

Keywords: Cancer diagnosis; Mortality; NHANES; Risk; Vitamin D.

MeSH terms

  • Adult
  • Aged
  • Cancer Survivors* / statistics & numerical data
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / mortality
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasms* / blood
  • Neoplasms* / mortality
  • Nutrition Surveys*
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • United States / epidemiology
  • Vitamin D* / analogs & derivatives*
  • Vitamin D* / blood

Substances

  • Vitamin D
  • 25-hydroxyvitamin D