Urban Rural differences in Vitamin D status in Erbil Governorate: A Cross-Sectional Study

Urban Rural differences in Vitamin D status

Abstract

Vitamin D deficiency has become a widespread public health issue globally, with an estimated 1 billion people affected worldwide. Surprisingly, this includes countries with abundant sunlight, such as Iraq. This study focuses on differences in vitamin D status between urban and rural populations in the Erbil Governorate of the Kurdistan Region. It also aims to explore how demographic characteristics, lifestyle behaviors, and environmental factors influence the risk of deficiency.

A cross-sectional study was conducted out involving a total of 445 participants, comprising 316 individuals from urban areas and 129 from rural regions. Information on sociodemographic factors, lifestyle behaviors, dietary patterns, and awareness of vitamin D was gathered through structured face-to-face interviews. Serum levels of 25-hydroxyvitamin D [25(OH)D] were assessed using a chemiluminescence immunoassay method. Data analysis was performed using SPSS software, version 27, to identify patterns and associations within the studied population.

The study included 445 participants with complete data on sociodemographic, lifestyle, and clinical variables. The overall mean serum 25-hydroxyvitamin D [25(OH)D] level was 20.93 ng/mL (SD = 14.64), with a median of 18.31 ng/mL, indicating a non-normally distributed and generally low vitamin D status across the sample. Rural residents (n = 129) had significantly higher vitamin D levels (mean = 21.89 ng/mL, SD = 11.56) compared to urban residents (n = 316; mean = 20.54 ng/mL, SD = 15.73; p = 0.018). The mean age of participants was 31.96 years (SD = 18.12), and the sample comprised 206 males (46.3%) and 239 females (53.7%), with no substantial gender imbalance between urban and rural areas. Dietary intake of vitamin D-rich foods was generally low: only 5.4% consumed fortified milk or foods daily, and 58.9% reported rarely or never consuming fish. However, rural participants were more likely to consume milk or eggs daily (59.7% vs. 42.1%) and eggs several times per week (42.6% vs. 29.7%). Supplement use was limited, with only 13.5% reporting regular vitamin D supplementation, though urban residents were more likely to use supplements regularly (16.1% vs. 7.0%; p = 0.041). Common deficiency-related symptoms included fatigue (69.9%), hair loss (58.9%), bone pain (52.8%), and muscle weakness (47.2%). Despite 82% awareness of sunlight’s role in vitamin D synthesis, only 42% had modified their behavior to improve vitamin D status. The prevalence of vitamin D deficiency and insufficiency: 55.1% were deficient (<20 ng/mL), 26.9% were inadequate (20–29 ng/mL), and just 18.0% had enough (≥30 ng/mL). In general, 82.0% had low levels of vitamin D.

This study reveals a clear difference in vitamin D levels between urban and rural communities in the Erbil Governorate, emphasizing the significance of sun exposure and lifestyle behaviors in maintaining adequate vitamin D status. Although awareness about vitamin D and its sources is relatively high, actual preventive actions—such as increasing sun exposure or enhancing diet—are still limited. These results highlight the necessity of tailored public health initiatives that, depending on the unique requirements and cultural background of each group, not only increase awareness but also promote significant behavior change.