Faced with a 34.5% increase in hospitalizations for cases of scurvy after the start of the Covid-19 pandemic, French teams are reporting a re-emergence of scurvy among children in France. The authors also finding an increase in cases of severe malnutrition, they establish a link with the worsening of socio-economic precariousness and inflation since the pandemic period. “The worrying return of this disease highlights the possible consequences of the increase in socio-economic insecurity since 2020 on the nutritional status of children in France,” indicates a press release from the AP-HP.
The investigators of this observational study published in The Lancet Régional Health – Europe come from the general pediatrics department and the reference center for inflammatory rheumatism and systemic autoimmune diseases in children (Raise) of the Robert-Debré hospital (AP-HP), Inserm, the University Paris Cité and the pediatrics department of Cayenne (Guyana). The authors call for recommendations to be made to set up targeted food aid programs, improve access to nutritious and affordable foods but also strengthen clinical training with the aim of preventing and early detection of dietary deficiencies.
A 20.3% increase in cases of severe malnutrition after the start of the pandemic
The main objective of this study was to describe the evolution of scurvy in children in France over the period 2015-2023 using data from the PMSI (program for the medicalization of information systems). The period having been marked by the Covid-19 pandemic, the authors were able to analyze how the latter had influenced the epidemiology of scurvy. The study also looked at malnutrition at different stages and was able to take into account socio-economic factors, such as the consumer price index.
The teams thus identified 888 patients aged 18 or under (average age of 11 years, 48.5% boys) hospitalized for scurvy over the study period. By comparing the incidence of 2015-2020 to that of 2020-2023, the researchers estimate the increase in hospitalizations for scurvy after the start of the Covid-19 pandemic in 2020 at + 34.5%, and at + 20, 3% that of cases of severe malnutrition (mild or moderate malnutrition was down by 11.2%). The increase in scurvy was particularly marked among children aged 5 to 10, and among girls, while that of severe malnutrition was more pronounced among 11-17 year olds. In addition, the authors found an increase in iron deficiency in their cohort. Regarding children hospitalized for scurvy after 2020, 22.6% were severely malnourished, 5.8% had autism spectrum disorders and 5% had anorexia nervosa.
Increases linked to the crisis context
According to the authors, increases in cases of scurvy and severe malnutrition were associated with worsening socio-economic insecurity and inflation. The association would be “plausibly causal”, according to scientists who report a “worsening food insecurity” since 2020 pointing fingers “the pandemic, socio-economic crises and global politics”. At the start of 2023 in France, inflation was 15% for food prices, with a heavy effect “particularly on precarious families”. Thus, the re-emergence of scurvy could be an indicator of socio-economic and dietary disparities.
Among children hospitalized for scurvy, the proportion who benefited from AME increased between the pre-Covid-19 and post-Covid-19 periods (+32.9%), suggesting “an increase in social poverty since the pandemic”.
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