School of Health Sciences, The University of Notre Dame Australia, Sydney, New South Wales, Australia.
School of Languages and Cultures, The University of Sydney, Sydney, New South Wales, Australia.
Am J Biol Anthropol. 2024 Oct;185(2):e25011. doi: 10.1002/ajpa.25011. Epub 2024 Aug 17.
The osteological paradox recognizes that the presence of lesions is not always directly related with increased mortality. When combined with the clinical, historical, and epidemiological literature on scurvy, survivorship analysis, a form of statistical analysis to assess the relationship between the presence of diseases in the archeological record and survival, helps determine the overall burden of the disease both in terms of morbidity and mortality. This article explores the relationship between scurvy and survivorship in 26 adults from Man Bac, a Neolithic site from northern Vietnam together with prepublished evidence of scurvy in the nonadult population (n = 44).
Diagnosis of scurvy included differential diagnosis combined with the Snoddy, A. M. E., Buckley, H. R., Elliott, G. E., Standen, V. G., Arriaza, B. T., & Halcrow, S. E. (2018). Macroscopic features of scurvy in human skeletal remains: A literature synthesis and diagnostic guide. American Journal of Physical Anthropology, 167(4), 876-895. https://doi.org/10.1002/ajpa.23699 threshold criteria and the Brickley, M. B., & Morgan, B. (2023). Assessing diagnostic certainty for scurvy and rickets in human skeletal remains. American Journal of Biological Anthropology, 181, 637-645 diagnostic certainty approaches. Kaplan-Meier survival curves were produced to assess the relationship between the presence of probable scurvy and age-at-death.
The prevalence of probable scurvy in adults (35%) was considerably lower than reported for the nonadults (80%). Almost all lesions observed in the adults were in a mixed stage of healing. Kaplan-Meier analysis demonstrated no difference in survivorship between infants and children (<15 years) with or without probable scurvy, whereas a meaningful difference was observed for the adults and adolescents (15+ years).
The findings demonstrate that scurvy considerably decreased survivorship to older age categories. The degree of lesion remodeling, however, indicates that scurvy was not necessarily the direct cause of death but contributed to an overall disease burden that was ultimately fatal.
骨骼学悖论认为，病变的存在并不总是与死亡率的增加直接相关。当与坏血病的临床、历史和流行病学文献以及生存分析（一种评估考古记录中疾病存在与生存之间关系的统计分析形式）相结合时，有助于确定疾病的整体负担，无论是发病率还是死亡率。本文探讨了在越南北部新石器时代的 Man Bac 遗址的 26 名成年人（n=26）中，坏血病与生存率之间的关系，同时还探讨了之前在非成年人（n=44）中坏血病的证据。
坏血病的诊断包括鉴别诊断，结合 Snoddy 等人（2018 年）的标准，A. M. E.，Buckley, H. R.，Elliott, G. E.，Standen, V. G.，Arriaza, B. T.，& Halcrow, S. E.。《人类骨骼遗骸坏血病的宏观特征：文献综述和诊断指南》。美国体质人类学杂志，167（4），876-895。https://doi.org/10.1002/ajpa.23699 和 Brickley 和 Morgan（2023 年）的标准，M. B.，& Morgan, B.。《评估人类骨骼坏血病和佝偻病的诊断确定性》。美国生物人类学杂志，181，637-645。使用确定性方法。制作 Kaplan-Meier 生存曲线以评估可能的坏血病与死亡年龄之间的关系。
成年人中可能患有坏血病的比例（35%）明显低于非成年人（80%）。成年人中观察到的几乎所有病变都处于混合愈合阶段。Kaplan-Meier 分析表明，在有无可能患有坏血病的婴儿和儿童（<15 岁）之间，生存率没有差异，但在成年人和青少年（15 岁以上）之间存在显著差异。
研究结果表明，坏血病极大地降低了年龄较大的年龄段的生存率。然而，病变重塑的程度表明，坏血病并不一定是死亡的直接原因，而是导致最终致命的整体疾病负担的一个因素。
