Contemporary Scurvy in Vulnerable Populations in High-Income Countries: A Systematic Review and Multilevel Meta-Analysis.

Background: Scurvy, a condition caused by vitamin C deficiency, has traditionally been considered eradicated in high-income countries (HICs; World Bank classification). However, emerging evidence suggests its re-emergence within identifiable vulnerability clusters, challenging the conventional assumptions about nutritional adequacy in affluent settings. This study aimed to systematically characterize the contemporary clinical and epidemiological profile of scurvy in HICs and quantify its multisystem burden. Methods: A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251013454). PubMed, Embase, Web of Science, and Scopus were searched (2012-2025). Case reports, case series, and observational studies reporting clinically or biochemically confirmed scurvy in HICs were included in this review. A multilevel random-effects meta-analysis was performed using restricted maximum likelihood estimation, incorporating robust variance estimation to account for within-study dependence and hierarchical data structures. Multisystem involvement was modeled as a count outcome, and system-specific prevalence was estimated using logit-transformed proportions. Results: Twenty-five studies, including 147 patients, were analyzed. Patients diagnosed with scurvy frequently presented with involvement of multiple organ systems, with a pooled mean of 2.29 affected organ systems per patient (95% CI: 1.62-2.96; I2 = 66.8%), highlighting clinically relevant heterogeneity in presentation. Musculoskeletal involvement was the most frequent clinical domain (OR 1.82; 95% CI: 0.98-3.38), whereas neurological manifestations were significantly less common (OR 0.42; 95% CI: 0.28-0.62; p < 0.001). Age was the only significant moderator, showing a modest inverse association with musculoskeletal involvement (OR 0.97; p = 0.035). Across studies, cases predominantly clustered in pediatric patients with neurodevelopmental disorders, restrictive dietary patterns, medically complex conditions, and psychosocial vulnerability. Conclusions: Scurvy persists in high-income countries as a clinically under-recognized condition occurring predominantly in vulnerable populations with restrictive dietary patterns, neurodevelopmental disorders, and psychosocial vulnerability. The available evidence suggests that contemporary scurvy is frequently associated with multisystem manifestations; however, the contribution of concomitant micronutrient deficiencies cannot be excluded. These findings highlight the need for comprehensive nutritional assessment and targeted nutritional screening in high-risk populations to prevent diagnostic delays and avoidable morbidity.