Rickets and vitamin D deficiency in Alaska native children

Rosalyn Singleton, Rachel Lescher 1 , Bradford D. Gessner 3 , Matthew Benson 1 , Lisa Bulkow 2 , John Rosenfeld 1 , Timothy Thomas 1 , Robert C. Holman 4 , Dana Haberling 4 , Michael Bruce 2 , Michael Bartholomew 5 , and James Tiesinga 1
  • 1 Alaska Native Tribal Health Consortium, Anchorage, AK, USA
  • 2 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
  • 3 Epidemiology and Vaccinology Consulting, Anchorage, AK, USA
  • 4 Division of High-Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, GA, USA
  • 5 Indian Health Service, Rockville, MD, USA
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

Abstract

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.

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