Environmental and Occupation Factors Associated with Vitamin D Deficiency in Korean Adults: The Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2014

Abstract

While exposure to sunlight is a well-documented primary source of vitamin D supply, factors leading to vitamin D deficiency vary according to population characteristics. Using nationwide data from the Korea National Health and Nutrition Examination Survey (KNHANES), we aimed to investigate a diverse range of potential factors in association with vitamin D deficiency. Overall, 21,208 participants aged >= 20 years were selected from KNHANES conducted between 2010 and 2014. The associations between various environmental and occupational factors and vitamin D deficiency (defined as serum 25-hydroxyvitamin D [25(OH)D] < 20 ng/mL) were evaluated in logistic regression models after controlling for potential covariates and also after stratification for age and sex. Under given criteria, 15,138 (71.4%) participants were vitamin D deficient. Significant associations were observed between vitamin D deficiency and average environmental temperature and radiation, weekly walking frequency, type of occupation, and shift work. When participants were stratified by age and sex, we observed greater associations of vitamin D deficiency with walking frequency among young males (odds ratio [OR] and 95% confidence interval [95% CI]: 1.24 [1.05-1.47] for those walking <5 times per week compared to those walking >= 5 times per week) and shift work (OR [95% CI]: 1.40 [1.10-1.78] for those working at night compared to those working during the day). We also observed a significant association of vitamin D deficiency with educational attainment (OR [95% CI]: 1.43 [1.09-1.89] for those with <= middle school compared to those with >= high school) among older group of females. This study suggests that vitamin D deficiency is related to geographical conditions and subpopulation characteristics. The age and sex-specific associations may urge the effective promotion of vitamin D supply recommendations.