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Prior studies have been conducted in smaller, single-site, or homogeneous populations limiting adjustments for social determinants of health (race\/ethnicity and poverty) common to both vitamin D deficiency and COVID-19 outcomes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Objective<\/jats:title>\n                <jats:p>To evaluate the dose-response relationship between continuous 25(OH)D and risk for COVID-19-related hospitalization and mortality after adjusting for covariates associated with both vitamin D deficiency and COVID-19 outcomes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Design<\/jats:title>\n                <jats:p>Retrospective cohort study.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Patients<\/jats:title>\n                <jats:p>Veteran patients receiving care in US Department of Veteran Affairs (VA) health care facilities with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test and a blood 25(OH)D test between February 20, 2020, and November 8, 2020, followed for up to 60 days.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Main Measures<\/jats:title>\n                <jats:p>Exposure was blood 25(OH)D concentration ascertained closest to and within 15 to 90 days preceding an index positive SARS-CoV-2 test. Co-primary study outcomes were COVID-19-related inpatient hospitalization requiring airborne, droplet, contact, or other isolation and mortality ascertained within 60 days of an index positive SARS-CoV-2 test.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Key Results<\/jats:title>\n                <jats:p>Of 4,599 veterans with a positive SARS-CoV-2 test, vitamin D deficiency (&lt; 20 ng\/mL) was identified in 665 (14.5%); 964 (21.0%) were hospitalized; and 340 (7.4%) died. After adjusting for all covariates, including race\/ethnicity and poverty, there was a significant independent inverse dose-response relationship between increasing continuous 25(OH)D concentrations (from 15 to 60 ng\/mL) and decreasing probability of COVID-19-related hospitalization (from 24.1 to 18.7%, <jats:italic>p<\/jats:italic>=0.009) and mortality (from 10.4 to 5.7%, <jats:italic>p<\/jats:italic>=0.001). In modeling 25(OH)D as a log-transformed continuous variable, the greatest risk for hospitalization and death was observed at lower 25(OH)D concentrations.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Continuous blood 25(OH)D concentrations are independently associated with COVID-19-related hospitalization and mortality in an inverse dose-response relationship in this large racially and ethnically diverse cohort of VA patients. Randomized controlled trials are needed to evaluate the impact of vitamin D supplementation on COVID-19-related outcomes.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s11606-021-07170-0","type":"journal-article","created":{"date-parts":[[2022,1,4]],"date-time":"2022-01-04T01:02:27Z","timestamp":1641258147000},"page":"853-861","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":55,"title":["Association of Vitamin D Status and COVID-19-Related Hospitalization and Mortality"],"prefix":"10.1007","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6676-9117","authenticated-orcid":false,"given":"Karen H.","family":"Seal","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Bertenthal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evan","family":"Carey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carl","family":"Grunfeld","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel D.","family":"Bikle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chuanyi M.","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,1,1]]},"reference":[{"key":"7170_CR1","unstructured":"United Nations Development Program (UNDP). 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