{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T23:54:14Z","timestamp":1785801254532,"version":"3.56.0"},"reference-count":53,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2020,5,13]],"date-time":"2020-05-13T00:00:00Z","timestamp":1589328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>In this study, we aimed to examine the effect of vitamin D deficiency on all-cause mortality in ankylosing spondylitis (AS) patients and in the general population. This is a retrospective-cohort study based on the electronic database of the largest health-maintenance organization in Israel. AS patients who were first diagnosed between 2002\u20132007 were included. Controls were matched by age, gender and enrollment-time. Follow-up continued until death or end of study follow-up on 1 July 2019. Laboratory measures of serum 25-hydroxyvitamin-D levels during the entire follow-up period were obtained. A total of 919 AS patients and 4519 controls with a mean time of follow-up of 14.3 years were included. The mean age at the time of enrollment was 52 years, and 22% of them were females. AS was associated with a higher proportion of vitamin D deficiency (odds ratio 1.27 [95% confidence-interval (CI) 1.03\u20131.58]). In AS patients, insufficient levels of vitamin D (&lt;30 ng\/mL) were significantly associated with increased incidence of all-cause mortality (hazard ratio (HR) 1.59 [95% CI 1.02\u20132.50]). This association was more prominent with the decrease in vitamin D levels (&lt; 20 ng\/mL, HR 1.63 [95% CI 1.03\u20132.60]; &lt;10 ng\/mL, HR 1.79 [95% CI 1.01\u20133.20]) and among male patients (&lt;30 ng\/mL, HR 2.11 [95% CI 1.20\u20133.72]; &lt;20 ng\/mL, HR 2.12 [95% CI 1.19\u20133.80]; &lt;10 ng\/mL, HR 2.23 [95% CI 1.12\u20134.43]). However, inadequate levels of vitamin D among controls were not associated with an increased all-cause mortality. Our study has shown that vitamin D deficiency is more common in AS patients than controls and is linked to an increased risk for all-cause mortality. These results emphasize the need for randomized-controlled trials to evaluate the benefits of vitamin D supplementation as a secondary prevention of mortality in patients with chronic inflammatory rheumatic disease.<\/jats:p>","DOI":"10.3390\/nu12051400","type":"journal-article","created":{"date-parts":[[2020,5,14]],"date-time":"2020-05-14T02:55:41Z","timestamp":1589424941000},"page":"1400","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Low Vitamin D Levels Predict Mortality in Ankylosing Spondylitis Patients: A Nationwide Population-Based Cohort Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4721-2003","authenticated-orcid":false,"given":"Niv","family":"Ben-Shabat","sequence":"first","affiliation":[{"name":"Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1404-8027","authenticated-orcid":false,"given":"Abdulla","family":"Watad","sequence":"additional","affiliation":[{"name":"Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo 6997801, Israel"},{"name":"Department of Medicine \u2018B\u2019, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan 5265601, Israel"},{"name":"NIHR Leeds Musculoskeletal Biomedical Research Unit, Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, Chapel Allerton Hospital, University of Leeds, Leeds LS7 4SA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0809-4545","authenticated-orcid":false,"given":"Aviv","family":"Shabat","sequence":"additional","affiliation":[{"name":"Hadassah Faculty of Medicine, The Hebrew University, Jerusalem 9112001, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8409-868X","authenticated-orcid":false,"given":"Nicola Luigi","family":"Bragazzi","sequence":"additional","affiliation":[{"name":"Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doron","family":"Comaneshter","sequence":"additional","affiliation":[{"name":"Chief Physician\u2019s Office, Clalit Health Services Tel Aviv, Tel-Aviv 6209813, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnon D.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Chief Physician\u2019s Office, Clalit Health Services Tel Aviv, Tel-Aviv 6209813, Israel"},{"name":"Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard","family":"Amital","sequence":"additional","affiliation":[{"name":"Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo 6997801, Israel"},{"name":"Department of Medicine \u2018B\u2019, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan 5265601, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,5,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1111\/j.1529-8019.2009.01287.x","article-title":"Vitamin D and innate immunity","volume":"23","author":"Miller","year":"2010","journal-title":"Dermatol. 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