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Paediatrics
Original research
Vitamin D prescribing in children in UK primary care practices: a population-based cohort study
  1. Mandy Wan1,2,
  2. Laura J Horsfall3,
  3. Emre Basatemur4,
  4. Jignesh Prakash Patel2,5,
  5. Rukshana Shroff6,
  6. Greta Rait3
  1. 1 Evelina Pharmacy, Guy’s and Saint Thomas’ NHS Foundation Trust, London, UK
  2. 2 Institute of Pharmaceutical Science, King’s College London, London, UK
  3. 3 Research Department of Primary Care and Population Health, University College London, London, UK
  4. 4 Population, Policy and Practice Programme, University College London, London, UK
  5. 5 Department of Haematological Medicine, King’s College Hospital Foundation NHS Trust, London, UK
  6. 6 Renal Unit, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
  1. Correspondence to Mandy Wan; Mandy.Wan{at}gstt.nhs.uk

Abstract

Objective To examine temporal changes in the incidence and patterns of vitamin D supplementation prescribing by general practitioners (GPs) between 2008 and 2016.

Design Population-based cohort study.

Setting UK general practice health records from The Health Improvement Network.

Participants Children aged 0 to 17 years who were registered with their general practices for at least 3 months.

Outcome measures Annual incidence rates of vitamin D prescriptions were calculated, and rate ratios were estimated using multivariable Poisson regression to explore differences by sociodemographic factors. Data on the type of supplementation, dose, dosing schedule, linked 25-hydroxyvitamin D (25(OH)D) laboratory test results and clinical symptoms suggestive of vitamin D deficiency were analysed.

Results Among 2 million children, the crude annual incidence of vitamin D prescribing increased by 26-fold between 2008 and 2016 rising from 10.8 (95% CI: 8.9 to 13.1) to 276.8 (95% CI: 264.3 to 289.9) per 100 000 person-years. Older children, non-white ethnicity and general practices in England (compared with Wales/Scotland/Northern Ireland) were independently associated with higher rates of prescribing. Analyses of incident prescriptions showed inconsistent supplementation regimens with an absence of pre-supplementation 25(OH)D concentrations in 28.7% to 56.4% of prescriptions annually. There was an increasing trend in prescribing at pharmacological doses irrespective of 25(OH)D concentrations, deviating in part from UK recommendations. Prescribing at pharmacological doses for children with deficient status increased from 3.8% to 79.4%, but the rise was also observed in children for whom guidelines recommended prevention doses (0% to 53%). Vitamin D supplementation at pharmacological doses was also prescribed in at least 40% of children with no pre-supplementation 25(OH)D concentrations annually.

Conclusions There has been a marked and sustained increase in vitamin D supplementation prescribing in children in UK primary care. Our data suggests that national guidelines on vitamin D supplementation for children are not consistently followed by GPs.

  • paediatrics
  • paediatric endocrinology
  • epidemiology

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2019-031870

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    Footnotes

    • RS and GR are joint senior authors.

    • Contributors MW, GR, RS and JPP were involved in the conception of the study and obtaining funding. MW, LJH, EB, JPP, RS and GR contributed to the study protocol and interpretation of data. MW had full access to the database, programming code, and performed the data extraction and analysis. MW drafted the manuscript which LJH, EB, JPP, RS and GR contributed to and revised critically before approval of the final manuscript. MW is the guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

    • Funding This study was funded by a Clinical Doctoral Research Fellowship grant (ICA-CDRF-2016-02-057) from the UK National Institute for Health Research (NIHR). MW is a doctoral student supported by this grant. Independent expert peer reviewers provided feedback on the grant application underpinning this study but had no further role in study design, data collection, analysis, interpretation or drafting of the manuscript. LJH is fully funded by the Wellcome Trust (209207/Z/17/Z). RS holds a Career Development Fellowship with the National Institute for Health Research. A part of the work took place in the Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as supplementary information.