Vitamin D deficiency and segregation status in prisoners

• DOI: https://doi.org/10.1108/IJPH-11-2016-0067
• Published date: 12 March 2018
• Date: 12 March 2018
• Pages: 16-25
• Author: Zelda Doyle,John Walton Dearin,Joe McGirr
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice

Vitamin D deficiency and segregation

status in prisoners

Zelda Doyle, John Walton Dearin and Joe McGirr

Abstract

Purpose –The purpose of this paper is to investigate if any exposure to segregation minimal association in a

single male prison population had any association with an increased risk of vitamin D deficiency.

Design/methodology/approach –A retrospective case study was under taken with all inmates who

had a 25-hyrdoxy-vitamin D test taken during the study period deemed eligible. Hand searching

of the medical records by an independent party identified eligible participants whose data were recorded

for analysis.

Findings –In total, 124 prisoners were deemed eligible for inclusion; 67 were vitamin D sufficient and 57

were vitamin D deficient by Australian standards. Time in segregation minimal association was shown not to

be significant, however, smoking (OR 2.93, 95% CI 1.27-6.81, p ¼0.012) and having Asian ethnicity (OR

4.16, 95% CI 1.56-11.10, p ¼0.004) independently significantly increased the risk of vitamin D deficiency.

Research limitations/implications –This research is limited by its study design, small sample size and

single location.

Originality/value –This paper presents the first published research into vitamin D levels in a prison

population in Australia, and provides a basis for a larger prospective cohort study.

Keywords Australia, Public health, Segregation, Deficiency, Prison population, Vitamin D

Paper type Research paper

Introduction

Vitamin D is utilised predominately in the body in bone remineralisation and metabolism. It is

synthesisedin skin from 7-dehydrocholesterolby exposure to direct sunlight(ultraviolet B radiation)

and obtained in the diet chiefly through fish liver oils and salt water fish (Johnson, 2007). Adults

who are deficient in vitamin D can suffer from osteomalacia and/or osteopenia (Kumar and Clark,

2009). Low levels of vitamin D have also been linked to an increased risk of multiple sclerosis,

diabetes, heart disease, mental illness and various autoimmune diseases (Department of Health

State Governmentof Victoria, 2012; Holick,2004, 2006), and there is evidencethat deficiency may

play a role in multiple organ systems (Clifton-Bligh, 2012; Office of Dietary Supplements, 2011).

Physiologicalmechanisms limitthe formation and metabolismof vitamin D cutaneously,and while it

is possible to ingest large doses of vitamin D through supplementation vitamin D toxicity is rare

(Haines and Park, 2012).

Exposure to sunlight, cloud cover and other environmental factors may influence vitamin D serum

levels and explain the wide variation seen between individuals on which the reference levels in

Australia are based (Commonwealth of Australia, 2006; Glendenning, 2015). Cutaneous

exposure for vitamin D is also complicated by skin colour variations: highly melanised skin has

been shown to be less effective in vitamin D uptake (Clemens et al., 1982; Norman, 1998; Yuen

and Jablonski, 2010). It is often assumed that the majority of Australians will obtain most, if not all,

of their vitamin D through cutaneous exposure to sunlight (Holick, 2001), but current literature

suggests that this is not necessarily the case (Boyages and Bilinski, 2012; Erbas et al., 2008;

Fuller and Casparian, 2001; Holick, 1995, 2006; Nowson and Margerison, 2002; Paxton et al.,

2013; Pludowski et al., 2013; Teale and Cunningham, 2010; Vieth, 1999). There may be clusters

of people who do not have sufficient exposure to sunlight for adequate vitamin D production due

Received 15 November 2016

Revised 21 April 2017

Accepted 25 April 2017

Conflicts of interest: Associate

Professor Dearin is a Visitng

Medical Officer at the prison where

the study was undertaken.

The authors would like to thank

Associate Professor Sally Lord and

Professor Gavin Frost who

provided feedback on earlier

versions of this paper.

Dr Zelda Doyle and Dr John

Walton Dearin are both based

at the Lithgow Rural Clinical

School, School of Medicine,

University of Notre Dame,

Sydney, Australia.

Dr Joe McGirr is based at the

Wagga Wagga Rural Clinical

School, School of Medicine,

University of Notre Dame,

Sydney, Australia.

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VOL. 14 NO. 1 2018, pp. 16-25, © Emerald Publishing Limited, ISSN 1744-9200 DOI 10.1108/IJPH-11-2016-0067