Association between vitamin D and pressure ulcers in older ambulatory adults: results of a matched case–control study

Abstract

Background

Pressure ulcers are common among older adults, but knowledge about nutritional risk factors is still developing. Vitamin D deficiency is common in the elderly population and is required for normal skin proliferation. The role of vitamin D in pressure ulceration and wound healing is not known. The purpose of this case–control study was to determine the association between vitamin D levels and pressure ulceration in an older community-dwelling cohort.

Methods

All cases and controls were community-dwelling elderly older than 60 years in a primary care panel in Olmsted County, MN. Pressure ulcer cases were defined clinically. The controls were age-matched and gender-matched to controls without pressure ulceration. The main exposure variable was 25-hydroxyvitamin D levels in both groups. The other exposure variable was the Charlson Comorbidity Index used to measure medical comorbidity. The analysis included univariate and conditional logistic regression for 25-hydroxyvitamin D levels.

Results

The average (standard deviation) age of the study participants with a pressure ulcer was 80.46 years (±8.67), and the average vitamin D level was 30.92 ng/mL (±12.46). In univariate analysis, Vitamin D deficiency (levels < 25 ng/mL) was associated with pressure ulcers (odds ratio: 1.871, P = 0.0154). Comorbidities of the subjects calculated using the Charlson Comorbidity Index were also associated with pressure ulcers (odds ratio: 1.136, P < 0.001). In the final conditional logistical regression model, the association of Vitamin D and pressure ulcers became nonsignificant after adjustment for comorbid illness.

Conclusion

Medical comorbidities increased the risk of pressure ulceration. Vitamin D deficiency was not an independent risk factor for pressure ulceration, and may be a marker of comorbid illness.

Keywords:

• pressure ulcer
• vitamin D
• case-control study
• aging
• geriatrics

Acknowledgment

This research was supported by a National Institutes of Health National Center for Research Resources Clinical and Translational Science Awards grant.

Disclosure

The authors report no conflicts of interest in this work.