Basatemur, Emre Doruk;
(2018)
Childhood vitamin D deficiency in the UK: diagnosis, clinical consequences and healthcare costs.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
BACKGROUND: Vitamin D has attracted considerable academic and clinical attention over the last two decades. However, the epidemiology of symptomatic vitamin D deficiency in UK children is poorly characterised, and the impact of the recent interest on paediatric clinical practice has not been explored. METHODS: A systematic review of the global incidence of symptomatic vitamin D deficiency in children was undertaken. A prospective surveillance study was conducted across the UK and Ireland to determine the incidence of hypocalcaemic seizures secondary to vitamin D deficiency in children. Cohort studies were undertaken to examine temporal trends in the diagnosis of vitamin D deficiency among children in clinical practice in the UK, and investigate healthcare expenditure related to vitamin D testing and prescribing in primary care. RESULTS: Four higher quality studies, from high-income countries with predominantly Caucasian populations, provided a pooled annual incidence estimate for symptomatic vitamin D deficiency of 3.4 per 100,000 children. The annual incidence of hypocalcaemic seizures secondary to vitamin D deficiency in the UK and Ireland was 3.5 per million children aged 0-15 years, with male infants from South Asian and black ethnic backgrounds at greatest risk. There was a 15-fold increase in the diagnosis of vitamin D deficiency among children in UK clinical practice between 2008-2014. Older age (≥10 years), non-white ethnicity, and social deprivation were associated with higher rates of diagnosis. Healthcare expenditure on vitamin D tests and prescriptions for children in primary care increased 13-fold between 2008-2014, with national costs in England estimated at £4.3 million in 2014. CONCLUSION: Considered in the context of the existing literature, these studies suggest that vitamin D deficiency may be over-tested and over-diagnosed, yet under-prevented, among children in the UK. These findings have implications for public health policy, clinical practice and health service delivery, and inform areas for future research.
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