Epidemiology

The epidemiology of scurvy in the modern era is poorly described. Outside of infrequent epidemics, scurvy is thought to be rare in developed countries. While no outbreaks of adult scurvy have been reported in North America in many years and the last western infantile scurvy epidemic ended in the 1960s, the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) reported that approximately 13% of the US population was vitamin C deficient (serum concentrations <11.4 micromol/L [<0.2 mg/100 mL]).[1][4]​​ Similarly, in a Canadian nationwide survey from 2012 to 2013, less than 3% of the population was deficient in vitamin C.[5]​ A similar frequency of deficiency is reported in European populations and New Zealand.​[6][7][8]​​​ Scurvy is most often seen in countries with endemic malnutrition, with a study indicating that up to 38.1% of Mexican school-age children with obesity have low vitamin C levels, and 8.1% are classified as vitamin C deficient.[9]​​​ An even higher frequency of deficiency is reported in Indian adults.[10]

Epidemics in refugee camps in Africa occurred from 1982 to 1994, with a prevalence as high as 44%.[1][11]​​​​ In 2001 to 2002, 6.5% of all deaths in northwestern Afghanistan were attributed to scurvy.[12][13]​​​​ The most recent known non-refugee scurvy epidemic was in 2010 at a prison near Yirgalem, Ethiopia. From an estimated prison population of at least 2000 inmates, 38 cases (1.9%) of scurvy were identified upon presentation to a local hospital (following incarceration for at least 8 months).[14] Epidemics among refugees are becoming more rare, possibly related to adopted policies of fortification of food rations provided to these populations. Nonetheless, small scale epidemics have occurred as recently as in 2017-2018, among adolescents and young male South Sudanese refugees in Kenya, following efforts towards food diversification in lieu of standard rations.[15]​ One study at an Australian tertiary children's hospital found that out of 887 people who had their vitamin C levels measured, 272 (31%) had low vitamin C levels (<23 micromol/L [<0.4 mg/100 mL]). Among these 272 people, 13 (5%) were diagnosed with scurvy and clearly symptomatic of vitamin C deficiency, while 19 (7%) may have been symptomatic.[16]

Case reports have also identified adult scurvy occurring with unclear (but also presumably rare) prevalence among people with prolonged restricted access to complete human micronutrient needs.[1][3][17][18][19][20] In the US, the NHANES 2003-2004 showed the prevalence of vitamin C deficiency was significantly lower than that during NHANES III, but smokers and individuals with a low-income were among those at increased risk of deficiency.[21] Other at-risk populations include older people, and individuals with underlying medical or psychiatric conditions.[22][23][24]

Use of this content is subject to our disclaimer