A steep fall to high morbidity and disability; Vitamin D deficiency in Multiple Myeloma Patients.

Abstract

Background Multiple Myeloma (MM) has been associated with extensive morbidity and mortality in hospitalized patients. MM has been considered a treatable disease entity with the advent of novel therapeutics. Vitamin D deficiency (VDD) affects 1 in 7 individuals worldwide and is a key element in bone modulation. In this study, we aim to provide greater clarity on the relationship between VDD and MM and outcomes of VDD amongst multiple myeloma patients. Methods We performed a retrospective cross-sectional study using HCUP data from 2016 to 2018. Patients with MM and VDD were identified using ICD 10 codes. We used SAS 9.4 for univariate analyses (unpaired student’s t-test and chi-square test) and multivariate survey regression analysis to evaluate demographic characteristics, epidemiology, the association between VDD and MM, and outcomes of patients with VDD. Adjusted odds ratio and 95% confidence interval were calculated and sensitivity index (C-index) was obtained. A P-value less than 0.05 was considered significant. Results Analysis revealed 330,175 patients had multiple myeloma out of 11,480 (0.035%) had VDD. VDD was more common in the middle age group (50-75 years: 3.6% vs >75 years: 3.3%), female (4.1% vs male: 2.9%), Asian-Pacific Islander race (3.8% vs Black: 3.5% vs White: 3.5% vs Hispanics: 3.2%), and median household income 75-100 percentile (3.8% vs 0-25 percentile: 3.4%), Midwest or North Central region states (4.5% vs Northeast: 3.3%), patients with obese 4.6% vs non-obese: 3.4%, dyslipidemia 4.1% vs non-dyslipidemia: 3.1%, renal failure 3.5% vs non-failure: 3.4%, AIDS 4% vs non-AIDS: 3.5%, and alcohol abuse 4.1% vs no-abuse: 3.5%. Prevalence of morbidity (5.1% vs 3.9%; p<0.0001) and disability (77.2% vs 73.3%; p<0.0001) were higher amongst patients with VDD in comparison without VDD amongst MM. In regression analysis, prevalence odds of VDD were significantly higher (aOR 1.41, 95%CI: 1.35-1.47, p<.0001, c=0.636) in patients with MM in comparison without MM. We also found that VDD patients were associated with 24% higher morbidity (1.24, 1.14-1.36, p<.0001, c=0.667) and 26% higher disability (1.26, 1.20-1.33, p<.0001, c=0.725). Conclusion There was a significant association between VDD and MM with a significant increase in morbidity and disability in patients with concurrent VDD and MM. The vast array of actions of vitamin D in various cellular pathways yields a dramatic effect on patient outcomes in MM. It is imperative to treat VDD to improve clinical outcomes in patients with MM.