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BMC Public Health

, 17:519

Occupational health


BackgroundVitamin D deficiency is prevalent worldwide, but some groups are at greater risk. We aim to evaluate vitamin D levels in different occupations and identify groups vulnerable to vitamin D deficiency.

MethodsAn electronic search conducted in Medline, Embase, the Cochrane Central Register of Controlled Trials, and CINAHL Plus with Full Text generated 2505 hits; 71 peer-reviewed articles fulfilled the inclusion criteria. Occupations investigated included outdoor and indoor workers, shiftworkers, lead-smelter workers, coalminers, and healthcare professionals. We calculated the pooled average metabolite level as mean ± SD; deficiency-insufficiency status was described as % of the total number of subjects in a given category.

ResultsCompared to outdoor workers, indoor workers had lower 25-hydroxyvitamin D 25-OHD levels 40.6 ± 13.3 vs. 66.7 ± 16.7 nmol-L; p < 0.0001. Mean 25-OHD levels in nmol-L in shiftworkers, lead-smelter workers and coalminers were 33.8 ± 10.0, 77.8 ± 5.4 and 56.6 ± 28.4, respectively. Vitamin D deficiency 25-OHD < 50 nmol-L, was high in shiftworkers 80% and indoor workers 78% compared to outdoor workers 48%. Among healthcare professionals, medical residents and healthcare students had the lowest levels of mean 25-OHD, 44.0 ± 8.3 nmol-L and 45.2 ± 5.5 nmol-L, respectively. The mean 25-OHD level of practising physicians, 55.0 ± 5.8 nmol-L, was significantly different from both medical residents p < 0.0001 and healthcare students p < 0.0001. Nurses and other healthcare employees had 25-OHD levels of 63.4 ± 4.2 nmol-L and 63.0 ± 11.0 nmol-L, respectively, which differed significantly compared to practising physicians p = 0.01, medical residents p < 0.0001 and healthcare students p < 0.0001.

Rates of vitamin D deficiency among healthcare professionals were: healthcare students 72%, medical residents 65%, practising physicians 46%, other healthcare employees 44%, and nurses 43%. Combined rates of vitamin D deficiency or insufficiency 25-OHD < 75 nmol-L were very high in all investigated groups.

Potential confounders such as gender and body composition were not consistently reported in the primary studies and were therefore not analyzed. Furthermore, the descriptions of occupational characteristics may be incomplete. These are limitations of our systematic review.

ConclusionsOur review demonstrates that shiftworkers, healthcare workers and indoor workers are at high risk to develop vitamin D deficiency, which may reflect key lifestyle differences e.g. sunlight exposure. This may help target health promotion and preventive efforts.

KeywordsVitamin D level vitamin D deficiency 25-hydroxyvitamin D 25-OHD occupation systematic review Abbreviations1α, 25-OH2D1α, 25-dihydroxyvitamin D

25-OHD25-hydroxyvitamin D

CIConfidence interval

CVCoefficient of variation

EIAEnzyme immunoassay

ELISAEnzyme-linked immunosorbent assay

ESEndocrine Society


HPLCHigh performance liquid chromatography

IQRInterquartile range


ml Milliliter






RRRelative risk

SDStandard deviation

SEStandard error of the mean

UVBUltraviolet B

Electronic supplementary materialThe online version of this article doi:10.1186-s12889-017-4436-z contains supplementary material, which is available to authorized users.

Autor: Daniel Sowah - Xiangning Fan - Liz Dennett - Reidar Hagtvedt - Sebastian Straube


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