Predicted Vitamin D Status and Colorectal Cancer Incidence in the Black Women’s Health Study

Abstract

Background: Observational studies, mostly among White populations, suggest that low vitamin D levels increase colorectal cancer risk. African Americans, who are disproportionately burdened by colorectal cancer, often have lower vitamin D levels compared with other populations. Methods: We assessed predicted vitamin D score in relation to colorectal cancer among 49,534 participants in the Black Women’s Health Study, a cohort of African American women followed from 1995 to 2017 through biennial questionnaires. We derived predicted vitamin D scores at each questionnaire cycle for all participants using a previously validated prediction model based on actual 25-hydroxyvitamin D values from a subset of participants. We calculated cumulative average predicted vitamin D score at every cycle by averaging scores from cycles up to and including that cycle. Using Cox proportional hazards regression, we estimated hazard ratios (HR) and 95% confidence intervals (CI) for colorectal cancer incidence according to predicted score quartiles. Results: Over follow-up, 488 incident colorectal cancers occurred. Compared with women in the highest quartile of predicted vitamin D score, those in the lowest had an estimated 41% (HR ¼ 1.41; 95% CI, 1.05–1.90) higher colorectal cancer risk. Comparable HRs were 1.44 (95% CI, 1.02–2.01) for colon and 1.34 (95% CI, 0.70–2.56) for rectal cancer. Conclusions: Low vitamin D status may lead to elevated colorectal cancer risk in African American women. Impact: Our findings, taken together with established evidence that vitamin D levels are generally lower in African Americans than other U.S. groups, suggest that low vitamin D status may contribute to the disproportionately high colorectal cancer incidence among African Americans.