Vitamin D Deficiency Trends, Risk Factors, and Occupational Risk in Active Component Service Members of the U.S. Armed Forces, 2018–2022

Vitamin D contains 2 related fat-soluble substances, D3 and D2, that are essential for bone health and overall well-being. The burden of vitamin D deficiency within the active component of the armed forces is unknown. This study describes trends of vitamin D deficiency diagnoses in the active component of the U.S. Armed Forces. Risk factors for vitamin D, such as military occupation, were examined to see if preventive measures and targeted vitamin D screening would be beneficial, as the United States Preventive Task Force does not recommend universal screening for vitamin D, nor does TRICARE cover screening for asymptomatic individuals. The surveillance period covered January 1, 2018 through December 31, 2022. The data were derived from the Defense Medical Surveillance System (DMSS). Vitamin D deficiency was measured using ICD-9-CM and ICD-10-CM diagnoses recorded in inpatient and outpatient medical encounters. Incidence rate and average annual prevalence were calculated. A logistic regression was performed to obtain adjusted odds ratios. The rates of vitamin D deficiency diagnoses among active component service members (ACSMs) remained steady during the study period, with an incidence rate of 16.4 per 1,000 personyears and an average annual prevalence of 2.2%. Female service members, those of older age groups, and indoor workers demonstrated higher rates of vitamin D deficiency. Previously described demographic risk factors such as indoor work and history of obesity or malabsorption syndrome were also associated in this study with vitamin D deficiency in ACSMs, although older age groups in this study were not associated with vitamin D deficiency. Pilots and air crew had the lowest rates of vitamin D deficiency, while health care workers had the highest, when evaluating by occupation.