在当今很少有坏血病的流行病学介绍。由于很少流行,坏血病罕见。在北美多年没有成人坏血病暴发的报道,最后一次西方婴儿坏血病的流行于 20 世纪 60 年代结束。[1]Weise Prinzo Z. Scurvy and its prevention and control in major emergencies. 1999. http://www.unhcr.org/ (last accessed 16 June 2016).http://www.unhcr.org/4cbef0599.pdf然而,在第三次全国健康和营养调查 (NHANES III, 1988-1994) 中,美国总人口中约有 13% 的人缺乏维生素 C (血清浓度<11.4 μmol/L)。[4]Hampl JS, Taylor CA, Johnston CS. Vitamin C deficiency and depletion in the
United States: the Third National Health and Nutrition Examination Survey, 1988
to 1994. Am J Public Health. 2004;94:870-875.http://www.ncbi.nlm.nih.gov/pubmed/15117714?tool=bestpractice.com1982 年至 1994 年,在非洲难民营发生流行,患病率高达 44%。[1]Weise Prinzo Z. Scurvy and its prevention and control in major emergencies. 1999. http://www.unhcr.org/ (last accessed 16 June 2016).http://www.unhcr.org/4cbef0599.pdf[5]Desenclos JC, Berry AM, Padt R, et al. Epidemiological patterns of scurvy among Ethiopian refugees. Bull World Health Organ. 1989;67:309-316.http://whqlibdoc.who.int/bulletin/1989/Vol67-No3/bulletin_1989_67(3)_309-316.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/2788528?tool=bestpractice.com此后未见在难民中流行的报道,可能与提供给这些人群的食物采取强化营养的政策有关。2001 年至 2002 年,阿富汗西北部全部死亡中 6.5% 归因于坏血病。[6]Cheung E, Mutahar R, Assefa F, et al. An epidemic of scurvy in Afghanistan: assessment and response. Food Nutr Bull. 2003;24:247-255.http://www.ncbi.nlm.nih.gov/pubmed/14564929?tool=bestpractice.com[7]Assefa F, Jabarkhil MZ, Salama P, et al. Malnutrition and mortality in Kohistan District, Afghanistan, April 2001. JAMA. 2001;286:2723-2728.http://www.ncbi.nlm.nih.gov/pubmed/11730450?tool=bestpractice.com已知最近的坏血病流行是在 2010 年,发生在埃塞俄比亚伊尔加勒姆附近的一所监狱。估计该监狱至少有 2000 名囚犯,有 38 例 (1.9%)于当地一家医院就诊时被查出患有坏血病(在监禁至少 8 个月后)。[8]Giday J. Outbreak of scurvy among prisoners in South Ethiopia. Ethiop J Health Dev. 2012;26:60-62.http://www.ajol.info/index.php/ejhd/article/viewFile/83830/73839
病例报告也发现在微量元素获取长时间受到限制的人群中有成人坏血病病例,其患病率不明(但推测罕见)。[1]Weise Prinzo Z. Scurvy and its prevention and control in major emergencies. 1999. http://www.unhcr.org/ (last accessed 16 June 2016).http://www.unhcr.org/4cbef0599.pdf[3]Noble JM, Mandel A, Patterson MC. Scurvy and rickets masked by chronic neurologic illness: revisiting "psychologic malnutrition". Pediatrics. 2007;119:e783-e790.http://www.ncbi.nlm.nih.gov/pubmed/17332193?tool=bestpractice.com[9]Ratanachu-Ek S, Sukswai P, Jeerathanyasakun Y, et al. Scurvy in pediatric patients: a review of 28 cases. J Med Assoc Thai. 2003;86:S734-S740.http://www.ncbi.nlm.nih.gov/pubmed/14700174?tool=bestpractice.com[10]Olmedo JM, Yiannias JA, Windgassen EB, et al. Scurvy: a disease almost forgotten. Int J Dermatol. 2006;45:909-913.http://www.ncbi.nlm.nih.gov/pubmed/16911372?tool=bestpractice.com[11]Hirschmann JV, Raugi GJ. Adult scurvy. J Am Acad Dermatol. 1999;41:895-906.http://www.ncbi.nlm.nih.gov/pubmed/10570371?tool=bestpractice.com[12]Levine M, Rumsey SC, Daruwala R, et al. Criteria and recommendations for vitamin C intake. JAMA. 1999;281:1415-1423.http://www.ncbi.nlm.nih.gov/pubmed/10217058?tool=bestpractice.com在美国,NHANES 2003-2004 显示维生素 C 缺乏症的患病率显著低于 NHANES III 期间,但吸烟者和低收入者的风险更高。[13]Schleicher RL, Carroll MD, Ford ES, et al. Serum vitamin C and the prevalence of vitamin C deficiency in the United States: 2003-2004 National Health and Nutrition Examination Survey (NHANES). Am J Clin Nutr. 2009;90:1252-1263.http://www.ajcn.org/content/90/5/1252.longhttp://www.ncbi.nlm.nih.gov/pubmed/19675106?tool=bestpractice.com其他风险人群包括老年人或有精神疾病或潜在疾病的个体。[14]Velandia B, Centor RM, McConnell V, et al. Scurvy is still present in developed countries. J Gen Intern Med. 2008;23:1281-1284.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2517958/?tool=pubmedhttp://www.ncbi.nlm.nih.gov/pubmed/18459013?tool=bestpractice.com[15]Mertens MT, Gertner E. Rheumatic manifestations of scurvy: a report of three recent cases in a major urban center and a review. Semin Arthritis Rheum. 2011;41:286-290.http://www.ncbi.nlm.nih.gov/pubmed/21185063?tool=bestpractice.com[16]Holley AD, Osland E, Barnes J, et al. Scurvy: historically a plague of the sailor that remains a consideration in the modern intensive care unit. Intern Med J. 2011;41:283-285.http://www.ncbi.nlm.nih.gov/pubmed/21426466?tool=bestpractice.com