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Licensed Unlicensed Requires Authentication Published by De Gruyter March 4, 2015

Rickets and vitamin D deficiency in Alaska native children

Rosalyn Singleton, Rachel Lescher, Bradford D. Gessner, Matthew Benson, Lisa Bulkow, John Rosenfeld, Timothy Thomas, Robert C. Holman, Dana Haberling, Michael Bruce, Michael Bartholomew and James Tiesinga


Background: Rickets and vitamin D deficiency appeared to increase in Alaskan children starting in the 1990s. We evaluated the epidemiology of rickets and vitamin D deficiency in Alaska native (AN) children in 2001–2010.

Methods: We analyzed 2001–2010 visits with rickets or vitamin D deficiency diagnosis for AN and American Indian children and the general US population aged <10 years. We conducted a case-control study of AN rickets/vitamin D deficient cases and age- and region-matched controls.

Results: In AN children, annual rickets-associated hospitalization rate (2.23/100,000 children/year) was higher than the general US rate (1.23; 95% CI 1.08–1.39). Rickets incidence increased with latitude. Rickets/vitamin D deficiency cases were more likely to have malnutrition (OR 38.1; 95% CI 4.9–294), had similar breast-feeding prevalence, and were less likely to have received vitamin D supplementation (OR 0.23; 95% CI 0.1–0.87) than controls.

Conclusions: Our findings highlight the importance of latitude, malnutrition, and lack of vitamin D supplementation as risk factors for rickets.

Corresponding author: Rosalyn Singleton, MD, MPH, Arctic Investigations Program, CDC, 4055 Tudor Centre Dr., Anchorage, AK 99508, USA, Phone: +1-907-729-3418, Fax: +1-907-729-3429, E-mail: ; and Alaska Native Tribal Health Consortium, Anchorage, AK, USA; and Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Anchorage, AK, USA


The authors thank the Alaska native children from study regions and the staff from Arctic Investigations Program-CDC, Yukon Kuskokwim Health Corporation, Southcentral Foundation, Arctic Slope Native Association, Norton Sound Corporation, Yukon Kuskokwim Health Corporation, Bristol Bay Area Native Health Corporation, and Tanana Chiefs Conference who facilitated the study. The authors thank Anthony Kretz, Gail Thompson, and Jonathan Peterson from Arctic Investigations Program-CDC for their substantial contribution to study implementation and database management. The authors also thank Claudia Steiner MD, Healthcare Cost and Utilization Project, Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality, USDHHS, for her assistance with the Nationwide Inpatient Sample, and the state data organizations that voluntarily contribute their hospitalization data to the Healthcare Cost and Utilization Project to create the Nationwide Inpatient Sample.

Conflict of interest statement

Funding source: No honorarium or grant or any other form of payment was given to anyone to produce the manuscript or conduct the study.

Financial disclosure: No authors have any financial relationships relevant to this work to disclose.

Conflict of interest statement: The authors have no conflicts of interest to disclose.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official positions of CDC or the Indian Health Service.


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Received: 2014-10-28
Accepted: 2015-1-29
Published Online: 2015-3-4
Published in Print: 2015-7-1

©2015 by De Gruyter

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