EDUCATIONAL ATTAINMENT MODIFIES THE ASSOCIATION BETWEEN SERUM VITAMIN D AND HEMOGLOBIN CONCENTRATIONS IN WOMEN OF REPRODUCTIVE AGE: A CROSS-SECTIONAL STUDY

Abstract

Background and Objective: Vitamin D deficiency and anemia represent synergistic public health challenges among women of reproductive age in South Asia, with profound implications for maternal and child health. Emerging evidence suggests socioeconomic factors, particularly educational attainment, may modify their relationship through complex pathways. This study aimed to investigate the correlation between serum vitamin D (25(OH)D) and hemoglobin (Hb) levels and to examine how educational status influences this relationship among Pakistani women.

Methods: This hospital-based cross-sectional study enrolled 134 women aged 18-40 years at Hayatabad Medical Complex, Peshawar. Serum 25(OH)D and hemoglobin were measured using chemiluminescent immunoassay and automated hematology analysis, respectively. Educational status was categorized as illiterate, intermediate, or graduate. Statistical analyses included Pearson correlation, Kruskal-Wallis test, chi-square test, and multiple linear regression using SPSS version 25.

Results: The mean age was 28.5 ± 7.4 years. Mean hemoglobin was 12.0 ± 1.5 g/dL, and mean vitamin D was 27.7 ± 15.5 ng/mL. A significant positive correlation existed between vitamin D and hemoglobin (r=0.28, p=0.004). Educational status significantly influenced both parameters: graduates exhibited higher median vitamin D (38.7 ng/mL) compared to illiterate women (24.5 ng/mL, p=0.042). Anemia prevalence decreased with increasing education (illiterate: 48.5%, intermediate: 28.1%, graduate: 0%, p=0.028). In multiple regression, education level remained an independent predictor of vitamin D status (β=3.45, p=0.008) after controlling sunlight exposure and supplementation.

Conclusion: This study confirms a significant association between vitamin D and hemoglobin levels while identifying educational attainment as a critical modifier of this relationship. The findings suggest that nutritional interventions addressing micronutrient deficiencies should be integrated with broader educational and socioeconomic empowerment strategies for women in Pakistan.