Sex differentials in frailty in medieval England

To Be Frail or Not to Be Frail: This Is the Question-A Critical Narrative Review of Frailty

Many factors have contributed to rendering frailty an emerging, relevant, and very popular concept. First, many pandemics that have affected humanity in history, including COVID-19, most recently, have had more severe effects on frail people compared to non-frail ones. Second, the increase in human life expectancy observed in many developed countries, including Italy has led to a rise in the percentage of the older population that is more likely to be frail, which is why frailty is much a more common concern among geriatricians compared to other the various health-care professionals. Third, the stratification of people according to the occurrence and the degree of frailty allows healthcare decision makers to adequately plan for the allocation of available human professional and economic resources. Since frailty is considered to be fully preventable, there are relevant consequences in terms of potential benefits both in terms of the clinical outcome and healthcare costs. Frailty is becoming a popular, pervasive, and almost omnipresent concept in many different contexts, including clinical medicine, physical health, lifestyle behavior, mental health, health policy, and socio-economic planning sciences. The emergence of the new "science of frailty" has been recently acknowledged. However, there is still debate on the exact definition of frailty, the pathogenic mechanisms involved, the most appropriate method to assess frailty, and consequently, who should be considered frail. This narrative review aims to analyze frailty from many different aspects and points of view, with a special focus on the proposed pathogenic mechanisms, the various factors that have been considered in the assessment of frailty, and the emerging role of biomarkers in the early recognition of frailty, particularly on the role of mitochondria. According to the extensive literature on this topic, it is clear that frailty is a very complex syndrome, involving many different domains and affecting multiple physiological systems. Therefore, its management should be directed towards a comprehensive and multifaceted holistic approach and a personalized intervention strategy to slow down its progression or even to completely reverse the course of this condition.

The Black Death in Hereford, England: A demographic analysis of the Cathedral 14th-century plague mass graves and associated parish cemetery

OBJECTIVES

This study explores the paleoepidemiology of the Black Death (1348-52 AD) mass graves from Hereford, England, via osteological analysis. Hereford plague mortality is evaluated in the local context of the medieval city and examined alongside other Black Death burials.

METHODS

The Hereford Cathedral site includes mass graves relating to the Black Death and a 12th-16th century parish cemetery. In total, 177 adult skeletons were analyzed macroscopically: 73 from the mass graves and 104 from the parish cemetery. Skeletal age-at-death was assessed using transition analysis, and sex and stress markers were analyzed.

RESULTS

The age-at-death distributions for the mass graves and parish cemetery were significantly different (p = 0.0496). Within the mass graves, young adults (15-24 years) were substantially over-represented, and mortality peaked at 25-34 years. From 35 years of age onwards, there was little variation in the mortality profiles for the mass graves and parish cemetery. Males and females had similar representation across burial types. Linear enamel hypoplasia was more prevalent within the mass graves (p = 0.0340) whereas cribra orbitalia and tibial periostitis were underrepresented.

CONCLUSIONS

Mortality within the Hereford mass graves peaked at a slightly older age than is seen within plague burials from London, but the overall profiles are similar. This demonstrates that young adults were disproportionately at risk of dying from plague compared with other age groups. Our findings regarding stress markers may indicate that enamel hypoplasia is more strongly associated with vulnerability to plague than cribra orbitalia or tibial periostitis.

Ancient Yersinia pestis genomes lack the virulence-associated YpfΦ prophage present in modern pandemic strains

Yersinia pestis is the causative agent of at least three major plague pandemics (Justinianic, Medieval and Modern). Previous studies on ancient Y. pestis genomes revealed that several genomic alterations had occurred approximately 5000-3000 years ago and contributed to the remarkable virulence of this pathogen. How a subset of strains evolved to cause the Modern pandemic is less well-understood. Here, we examined the virulence-associated prophage (YpfΦ), which had been postulated to be exclusively present in the genomes of strains associated with the Modern pandemic. The analysis of two new Y. pestis genomes from medieval/early modern Denmark confirmed that the phage is absent from the genome of strains dating to this time period. An extended comparative genome analysis of over 300 strains spanning more than 5000 years showed that the prophage is found in the genomes of modern strains only and suggests an integration into the genome during recent Y. pestis evolution. The phage-encoded Zot protein showed structural homology to a virulence factor of Vibrio cholerae. Similar to modern Y. pestis, we observed phages with a common origin to YpfΦ in individual strains of other bacterial species. Our findings present an updated view on the prevalence of YpfΦ, which might contribute to our understanding of the host spectrum, geographical spread and virulence of Y. pestis responsible for the Modern pandemic.

Pandemics, past and present: The role of biological anthropology in interdisciplinary pandemic studies

Biological anthropologists are ideally suited for the study of pandemics given their strengths in human biology, health, culture, and behavior, yet pandemics have historically not been a major focus of research. The COVID‐19 pandemic has reinforced the need to understand pandemic causes and unequal consequences at multiple levels. Insights from past pandemics can strengthen the knowledge base and inform the study of current and future pandemics through an anthropological lens. In this paper, we discuss the distinctive social and epidemiological features of pandemics, as well as the ways in which biological anthropologists have previously studied infectious diseases, epidemics, and pandemics. We then review interdisciplinary research on three pandemics–1918 influenza, 2009 influenza, and COVID‐19–focusing on persistent social inequalities in morbidity and mortality related to sex and gender; race, ethnicity, and Indigeneity; and pre‐existing health and disability. Following this review of the current state of pandemic research on these topics, we conclude with a discussion of ways biological anthropologists can contribute to this field moving forward. Biological anthropologists can add rich historical and cross‐cultural depth to the study of pandemics, provide insights into the biosocial complexities of pandemics using the theory of syndemics, investigate the social and health impacts of stress and stigma, and address important methodological and ethical issues. As COVID‐19 is unlikely to be the last global pandemic, stronger involvement of biological anthropology in pandemic studies and public health policy and research is vital.

The plague’s impact paleodemographic and genetic measures in 15th to 16th century Gdańsk

Yersinia pestis caused plagues and haunted Gdańsk several times during the 15th and 16th centuries. This study focuses on the following demographic effects: 1/ distributions of deceased by age in a plagued city, 2/ parameters of the life tables, 3/ estimation of the natural increase. To assess genetic effects of the plague, measures of the opportunity for natural selection were considered. Skeletal remains of 283 people from the 15th – 16th century ossuary 3009 from the Dominican Monastery in Gdańsk provided research material. Yersinia pestis DNA in this skeletal material has already been found (Morozowa et al. 2017, 2020). Distributions of the deceased by age in the study sample were compared with those for Gdańsk before the plague and with those for the mass burial of plague victims in the 14th century Lübeck. Neither catastrophic mortality was found in the material studied, nor selective nature of the plague with regard to sex and age had been demonstrated. Using the Weiss method, the rate of natural increase r=–0.005 was reconstructed. With the wide dating range of the ossuary and the fact that it contains results of both the epidemic and “normal” mortality, the natural increase value at this level seems justified. There was a deterioration in the values of life tables parameters, especially life expectancy. Newborn life expectancy dropped to 19.5–22.6 years and for a 20-year-old to 17.7 years. The measures of opportunity for natural selection also deteriorated primarily due to child mortality: the biological state index Ibs values were low (within the 0.3–0.4 range) and values of the Im Crow’s index about 1.0. Natural selection also acted on adults as evidenced by values of the gross potential reproduction rate Rpot below 0.7. Demographically the study sample was at the level of the early Middle Ages rather than the Rennaisance.

Height and health in Roman and Post-Roman Gaul, a life course approach

OBJECTIVE

The present study explores growth and health in Roman (1st-3rd centuries CE) and Post-Roman (4th-7th centuries CE) Gaul, incorporating a life-course approach, to better understand the influence of Roman practices and lifestyles on health, and the impact of cultural change from the Roman to the Post-Roman period.

MATERIALS AND METHODS

The skeletal remains of 844 individuals were analyzed for non-specific signs of physiological stress, including growth disruption (diaphyseal and adult maximum femur length), dental enamel hypoplastic defects (DEH), cribra orbitalia (CO), and periosteal reaction of the tibiae (Tibia PR).

RESULTS

The Gallo-Roman sample demonstrated shorter femoral lengths, and higher rates of DEH and Tibia PR. Post-Roman groups demonstrated longer femoral lengths and higher rates of CO.

CONCLUSIONS

Gallo-Roman individuals may have been more regularly exposed to infectious pathogens throughout childhood, inhibiting opportunities for catch-up growth, resulting in high rates of DEH and shorter femoral lengths ('intermittent stress of low lethality'). This could be the result of overcrowding and insalubrious urban environments. Higher rates of CO in the Post-Roman samples may have been influenced by dietary changes between the periods.

SIGNIFICANCE

The intertwined and often synergistic relationships between early life environment, nutrition and settlement structure is highlighted, helping to further understandings of life experiences during the Roman and Post-Roman periods.

LIMITATIONS

It was not possible to obtain sufficient data from northern regions during the Gallo-Roman period, limiting this analysis.

SUGGESTIONS FOR FURTHER RESEARCH

Further application of life course approaches can reveal subtle patterns in stress indicators.

The biological index of frailty: A new index for the assessment of frailty in human skeletal remains

OBJECTIVE

Frailty is the physiological stress that individuals suffer during their life. In past populations, frailty is conventionally assessed through the occurrence of different biomarkers of biological stress. Some efforts have been made to propose indexes that combine all biomarkers. However, these indices have some critical limitations: they cannot be used on incomplete skeletons, do not consider the severity and/or healing of lesions, and assign equal importance to different biomarkers. To address these limitations, we propose a new index to assess frailty in skeletal individuals.

MATERIAL AND METHODS

By statistically analyzing a large amount of osteological data available from the Museum of London, and using a Logit model, we were able to define a different weight for each reported biomarker of frailty, based on their importance in increasing the risk of premature death for the individuals.

RESULTS

The biological index of frailty (BIF) is the weighted mean of all biomarkers scored on the individuals, according to a different degree of importance assigned to each one. It also considers the severity and healing of the biomarkers when this is relevant to diagnose frailty. We applied BIF on a sample of Monastics and Non-Monastics from medieval England and compared it with the skeletal index of frailty (SFI).

DISCUSSION

BIF is the first frailty index that gives a different weight to each skeletal biomarker of stress, considers both severity and healing of the lesions, and can be applied on partial skeletal remains. The comparison with SFI showed that BIF is applicable to a larger number of skeletal individuals, revealing new differences between the Monastic and the Non-Monastic groups.

Heterogeneous frailty and the expression of linear enamel hypoplasia in a genealogical population

OBJECTIVES

Linear enamel hypoplasia (LEH) is a common skeletal marker of physiological stress (e.g., malnutrition or illness) that is studied within and across populations, without reference to familial risk. We examine LEH prevalence in a population with known genealogical relationships to determine the potential influence of genetic heritability and shared environment.

METHODS

LEH data of 239 individuals from a single population were recorded from the Ohio State University Menegaz-Bock collection dental casts. All individuals were of known age, sex, and genealogy. Narrow-sense heritability estimates were obtained for LEH presence and count data from all unworn, fully erupted teeth (excluding third molars) using SOLAR (v.8.1.1). Age, sex, and age-sex interaction were included as covariates. Models were re-run with a household effect variable.

RESULTS

LEH persists across generations in this study population with moderate, significant heritability estimates for presence in four teeth, and count in four teeth (three teeth were significant for both). When a household effect variable was added, no residual heritability remained for LEH count on any tooth. There was no significant household effect for three of the four teeth that had significant heritability estimates for LEH presence. Age was a significant covariate. Further analyses with birth year data revealed a secular trend toward less LEH.

CONCLUSIONS

This study provides evidence for familial risk of LEH (genetic and environmental) that has consequences for the broad use of this skeletal marker of stress. These results have repercussions for archaeological assemblages, or population health studies, where genetic relatives and household groups might be heavily represented.

Using a multimethod life history approach to navigate the osteological paradox: A case study from Prehispanic Nasca, Peru

OBJECTIVES

We leverage recent bioarchaeological approaches and life history theory to address the implications of the osteological paradox in a study population. The goal of this article is to evaluate morbidity and mortality patterns as well as variability in the risk of disease and death during the Late Intermediate period (LIP; 950-1450 C.E.) in the Nasca highlands of Peru. We demonstrate how the concurrent use of multiple analytical techniques and life history theory can engage the osteological paradox and provide salient insights into the study of stress, frailty, and resilience in past populations.

MATERIALS AND METHODS

Crania from LIP burial contexts in the Nasca highlands were examined for cribra orbitalia (n = 325) and porotic hyperostosis (n = 270). All age groups and both sexes are represented in the sample. Survivor/nonsurvivor analysis assessed demographic differences in lesion frequency and severity. Hazard models were generated to assess differences in survivorship. The relationship between dietary diversity and heterogeneity in morbidity was assessed using stable δ¹⁵ N and δ¹³ C isotope values for bone collagen and carbonate. One hundred and twenty-four crania were directly AMS radiocarbon dated, allowing for a diachronic analysis of morbidity and mortality.

RESULTS

The frequency and expression of both orbital and vault lesions increases significantly during the LIP. Survivor/nonsurvivor analysis indicates cranial lesions co-vary with frailty rather than robusticity or longevity. Hazard models show (1) decreasing survivorship with the transition into the LIP, (2) significantly lower adult life expectancy for females compared to males, and (3) individuals with cranial lesions have lower survivorship across the life course. Stable isotope results show very little dietary diversity. Mortality risk and frequency of pathological skeletal lesions were highest during Phase III (1300-1450 C.E.) of the LIP.

CONCLUSION

Results provide compelling evidence of increasing physiological stress and mortality in the Nasca highlands during the LIP, but also reveal substantial heterogeneity in frailty and the risk of death. Certain members of society experienced a heavier disease burden and higher mortality compared to their contemporaries. Elevated levels of disease and lethal trauma among females account for some of the sex differences in survivorship but cannot explain the large degree of female-biased mortality. We hypothesize that parental investment in males or increased female fertility rates may explain these differences.

A paleodemographic assessment of mortality and fertility rates during the second demographic transition in rural central Indiana

OBJECTIVES

Since its inception, skeletally based paleodemographic research has emphasized the utility of biocultural models for interpreting the dynamic relationship between the sociocultural and ecological forces accompanying demographic transitions and shaping populations' health and well-being. While the demographic transition associated with the Neolithic Revolution has been a common focus in bioarcheology, the present study analyzes human skeletal remains from a large 19th century cemetery in central Indiana to examine population dynamics during the second demographic transition, a period generally characterized by decreasing fertility rates and improvements in life expectancy. This study demonstrates the potential to methodologically identify regional variations in the timing and interactions between broad-scale socioeconomic changes and technological advancements that characterized the time period through observed changes in survivorship and fertility based on age-at-death distributions.

MATERIALS AND METHODS

This study uses three temporally distinct samples (AD 1827-1869; 1870-1889; 1890-1935) from the Bethel Cemetery (n = 503). Kaplan-Meier survival analyses with a log- rank tests are utilized to evaluate survivorship and mortality over time. Next, Cox proportional hazard analyses are employed to examine the interaction between sex and time as covariates. Finally, the D0-14/D ratio is applied to estimate fertility for each of the three temporally bounded cohorts.

RESULTS

The Kaplan-Meier survival analyses and Cox proportional hazard modeling revealed statistically significant differences in survivorship between the three time periods. Age-specific mortality rates are reduced among adult female and male age classes in this rural community over the course of the 19th and early 20th centuries, resulting in the increasing life expectancies associated with the second demographic transition. While mortality in early adulthood was common during the first time period and decreases thereafter, sex was not identified as a meaningful covariate. The proportion of juveniles in the three temporal samples indicate that fertility rates were higher than national averages for the better part of the 19th century and subsequently declined around the turn of 20th century for this community.

CONCLUSIONS

The results indicate temporal differences between the three periods, demonstrating increased survivorship and decreased mortality and fertility over time. These findings corroborate two key features of the second demographic transition characterized by the move from high rates of both fertility and mortality to reduced rates and a general easing of demographic pressures. The observed trends likely reflect improvements in health, coinciding the industrial advance and economic development within and around Indianapolis. While the socioeconomic factors characterizing the Industrial Revolution drove demographic shifts that parallel an equally important epidemiological transition, potential regional differences are discussed to highlight variability in the timing of demographic transitions. The paleodemographic methods utilized in this study demonstrate improved accuracy and efficacy, which ultimately advances researchers' potential to disentangle population-specific socioeconomic factors that may contribute to asymmetrical experiences of health and mortality.

Increased dental fluctuating asymmetry is associated with active skeletal lesions, but not mortality hazards in the precontact Southwest United States

OBJECTIVE

This study examines whether individuals with higher dental fluctuating asymmetry (DFA) are frailer than those with lower DFA, by examining whether increased DFA is associated with skeletal lesion formation.

SUBJECTS AND METHODS

150 individuals with permanent teeth and 64 individuals with deciduous teeth. All individuals are Ancestral Puebloans from archaeological sites in modern-day New Mexico. We estimate DFA in three ways: (a) deciduous DFA only, (b) permanent DFA only, and (c) a composite of permanent and deciduous DFA. We analyzed DFA alongside lesion status for cribra orbitalia (CO) and porotic hyperostosis (PH), as well as the presence/absence of enamel hypoplasia (EH). All stress indicators were further analyzed for their impact on mortality hazards.

RESULTS

We find that individuals with active CO and PH lesions have increased DFA, while those with healed lesions have lower DFA. We found no relationship between EH and DFA. Further, DFA alone does not predict individual mortality but CO does.

CONCLUSIONS

Individuals with increased DFA are frailer and therefore, less capable of buffering themselves against perturbations to their health than those with lower DFA. All results indicate that individuals in this study with lower DFA were more successful in buffering themselves against random environmental impacts during childhood. While DFA alone does not predict mortality hazard, its relationship to lesion status (lower DFA in individuals with healed lesions) indicates that it would be a valuable addition to studies of health and stress.

Dental health in adults and subadults from the 16th-century plague cemetery of Alghero (Sardinia, Italy)

OBJECTIVE

The aim of this study is to examine a set of dental health indicators, including caries, periodontal disease, abscesses, ante-mortem tooth loss, calculus, and tooth wear of a 16^th-century population from the city of Alghero, Sardinia (Italy), in order to evaluate the state of dental health and the diet.

DESIGN

The cemetery is referable to the plague outbreak that ravaged the city in 1582-1583. A total of 160 individuals (81 adults and 79 subadults) were suitable for dental examination.

RESULTS

The oral conditions of the urban population of Alghero are characterised by high frequency of carious lesions, periodontal disease, ante mortem tooth loss, and calculus, but a low prevalence of abscesses and moderate tooth wear are recorded. In general, no statistically significant sexual differences are observed, suggesting a uniform scenario for diet access and oral health. The subadult subsample shows moderate rates of caries and is affected by calculus. The results suggest that the diet was rich in soft and refined food, with a prevalence of carbohydrates and cariogenic aliments; the effects of the diet are associated with a lack of oral hygiene.

CONCLUSIONS

The patterns of dental health observed in the Alghero population fit with the data observed in other Modern Age samples, reflecting increased prevalence of dentoalveolar diseases resulting from a less abrasive diet and an increase in carbohydrate consumption, as documented during the transition from the Middle Ages to the Modern period.

Leopoli-Cencelle (9th-15th centuries CE), a centre of Papal foundation: bioarchaeological analysis of the skeletal remains of its inhabitants

BACKGROUND

The medieval city of Leopoli-Cencelle (9th-15th centuries CE) represents an exceptional study-model for extending our knowledge of the Italian Medieval period due not only to the large sample size available but also to the widespread presence of material data and a well preserved archaeological context.

AIM

This research aims to reconstruct the osteobiography of the inhabitants of this centre of Papal foundation.

SUBJECTS AND METHODS

The analysed sample counts 877 individuals. Scientifically established anthropological morphological methods were used for assessing their biological profile as well as for reconstructing lifestyle and health status.

RESULTS

The sample consists of 62.49% adults and 37.51% non-adults. The mortality pattern shows the highest peak prior to 1 year and between 1 and 6 years of age and a reduced longevity of female individuals as commonly observed in pre-antibiotic era populations. Metric and musculoskeletal stress markers revealed different biomechanical stress between sexes probably carrying out different working activities. The palaeopathological analysis supports a general good health status with the exception of a few specific cases.

CONCLUSIONS

The present research helps shed light on the lifestyle of the inhabitants of Leopoli-Cencelle, enhancing a better understanding of the Italian Middle Ages.

Survival analysis of the Black Death: Social inequality of women and the perils of life and death in Medieval London

OBJECTIVES

Described as an indiscriminate killer by many chroniclers, the Black Death descended on London during the 14th century. To best understand the pattern of transmission among demographic groups, models should include multiple demographic and health covariates concurrently, something rarely done when examining Black Death, but implemented in this study to identify which demographic groups had a higher susceptibility. Female predisposition to the Black Death was also explored, focusing on whether social inequality added to vulnerability.

MATERIALS AND METHODS

Three attritional cemeteries from the Wellcome Osteological Research Database were compared with the Black Death cemetery, East Smithfield. A Cox proportional hazards regression estimated hazards ratios of dying of the Black Death, using transition analysis ages-at-death as the time variable, and sex and frailty as covariates. Additionally, a binomial logistic regression generated odds ratios for age-at-death, sex, and frailty.

RESULTS

The Cox model produced a significant hazards ratio for individuals deemed frail. Similarly, the logit model calculated significantly increased odds ratios for frail individuals, and decreased odds for individuals aged 65+.

DISCUSSION

The older individuals were not undergoing growth during times of great stress in London pre-dating the Black Death epidemic, which may explain the decreased odds of contracting the Black Death. Further, although women dealt with social inequality, which partially led to the demographic puzzle of the Medieval "missing" women, women's susceptibility to infection by the Black Death was not increased. The phenomenon of the missing women may be due to a combination of factors, including infant and child mortality and preservation.

Ankylosis of a knee joint from Medieval London: Trauma, congenital anomaly or osteoarthritis?

OBJECTIVE

To explore the differential diagnoses of a fused left knee joint and the subsequent impairment.

MATERIALS

An adult female skeleton from the Medieval cemetery of St Mary Spital (London, England).

METHODS

We employed digital radiography and macroscopic observation to record the changes observed throughout the skeleton. We also used the Index of Care to explore the subsequent impairment.

RESULTS

A range of congenital and developmental conditions were identified throughout the axial skeleton, with changes to the spine, pelvis, arms and leg bones reflecting adaptation to the mobility impairment.

CONCLUSIONS

In all probability, the left knee reflects a case of congenital ankylosis with a differential diagnosis of subadult trauma. The female's skeleton had adapted to the impairment. Their risk is likely to have been elevated because of climatic and pandemic events during this period.

SIGNIFICANCE

First reported case of congenital knee ankylosis.

LIMITATIONS

The left knee joint was damaged during excavation.

SUGGESTIONS FOR FURTHER RESEARCH

Additional imaging is advised.

Implications of accumulative stress burdens during critical periods of early postnatal life for mortality risk among Guale interred in a colonial era cemetery in Spanish Florida (ca. AD 1605-1680)

OBJECTIVE

Research situated within the Developmental Origins of Health and Disease demonstrates that stressors are correlated with future mortality risk, especially if experienced frequently and during early periods of postnatal life. This study examines if the developmental timing and frequency of early life stressors influenced mortality risk for Indigenous Guale in Spanish Florida during the 17th century.

MATERIALS AND METHODS

The present study examines internal enamel microgrowth disruptions (accentuated lines-AL) from Guale individuals (n = 52) interred at Mission Santa Catalina de Guale on St. Catherines Island, Georgia (AD 1605-1680). Teeth were thin-sectioned and microscopically analyzed to document AL variables as predictors of age-at-death.

RESULTS

Individuals with AL died earlier than those without AL. This difference, however, was not significant. Individuals who exhibit AL formed during their first year of life died on average three times earlier than those who did not. The frequency of AL and age-at-first-AL are significantly correlated with age-at-death, and Cox hazard analyses indicates that individuals with early forming and frequent AL had increased risks of early death.

DISCUSSION

This study emphasizes how the lived experiences of Guale children shaped demographic patterns during the 17th century. The survival of early life stressors resulted in life history trade-offs and increased risks for early death. Mortality risks were exacerbated for individuals who experienced frequent stressors during the earliest periods of life. This underscores a role for bioarchaeology in understanding of how accumulative stress burdens during the earliest years of postnatal life may influence mortality risk.

The ice age with little effect? Exploring stress in the Danish Black Friars cemetery before and after the turn of the 14th century

The Little Ice Age, beginning in Europe in the 14th century, saw a period of climatic cooling and increased precipitation where food sources dwindled and famine became rampant, particularly in urban city centers. This study focuses on the Black Friars population (13th-17th centuries) to explore changes in stress in Denmark at the onset of the Little Ice Age. This study specifically explores the periods before and after the turn of the 14th century. Forty-five adult individuals were analyzed for cribra orbitalia, porotic hyperostosis, and enamel hypoplastic lesions. Results showed no statistically significant differences between the prevalence of these stress indicators between either time period; however, reduced age at death and increased lesion frequency was more prevalent post-1300. It was expected that increased stress would be evident in those buried after the turn of the 14th century due to the many challenges associated with wide spread climatic cooling; however, the reliance on nutrient rich marine resources and alms provisions may have helped lessen the burden of these stressors during this period of climatic hardship. Additionally, while famine characterized the beginning of the 14^th century, agricultural rebound shortly after this period may have also influenced the stress levels observed.

Calculus and survivorship in medieval London: The association between dental disease and a demographic measure of general health

OBJECTIVES

Dental plaque is associated with a variety of systemic diseases and mortality risks in living populations. However, bioarchaeologists have not fully investigated the mortality risks associated with plaque (or its mineralized form, calculus) in the past. This study examines the relationship between survivorship and calculus in a medieval skeletal sample.

MATERIALS AND METHODS

Our sample (n = 1,098) from four medieval London cemeteries, c. 1000-1540 CE, includes people who died under attritional (normal) and catastrophic (famine and plague) conditions. The associations between age and the presence of dental calculus on the permanent left first mandibular molar are assessed using binary logistic regression and Kaplan-Meier survival analysis.

RESULTS

The regression results indicate a significant negative relationship between age and calculus presence for individuals of all ages who died under normal mortality conditions and for adults who died under both normal and catastrophic conditions. Survival analysis reveals decreased survivorship for people of all ages with calculus under normal mortality conditions. Similarly, during conditions of catastrophic mortality, adult males with calculus suffered reduced survivorship compared to males without it, though there was no difference in survivorship between adult females with and without calculus.

CONCLUSIONS

These results suggest that, as in modern populations, calculus accumulation in the inhabitants of medieval London reflects a greater risk of premature death. The evaluation of calculus, a potential measure of underlying frailty, in the context of a demographic measure of general health suggests that it might provide insights into health in past populations.

A critical review of anthropological studies on skeletons from European plague pits of different epochs

In historical times, plague epidemics intermittently ravaged Europe for more than 1,400 years, and still represent a threat in many countries all over the world. A debate is ongoing about the past plague, if it killed randomly in a population or discriminated among persons on the basis of their biological features. To address questions of plague lethality, we reviewed a large number of anthropological studies published in the last twenty years on victims of the past pestilences in Europe. In particular, we focused on data concerning demography (age at death and sex determination), and health status (skeletal biomarkers). We applied to these data a model system based on Multiple Linear Regression, which aimed to discern among possible predictors of sex-selective plague lethality in entire populations, in different periods and regions. Based on available data, we lack evidence for general trends of association between biological features. Differences in sex ratio are more likely due to the original population compositions or to distinct cultural behaviours of the two genders. We concluded that generalizations on biological evidence are not feasible for ancient plagues if we exclude that the infection possibly killed primarily persons between 5-10 and 20-35 years of age.

A survival analysis of the last great European plagues: The case of Nonantola (Northern Italy) in 1630

This paper develops the first survival analysis of a large-scale mortality crisis caused by plague. For the time-to-event analyses we used the Cox proportional hazards regression model. Our case study is the town of Nonantola during the 1630 plague, which was probably the worst to affect Italy since the Black Death. Individual risk of death did not depend on sex, grew with age (peaking at ages 40-60 and then declining), was not affected by socio-economic status, and was positively associated with household size. We discuss these findings in light of the historical-demographic and palaeo-demographic literature on medieval and early modern plagues. Our results are compatible with the debated idea that ancient plague was able to spread directly from human to human. Our methods could be replicated in other studies of European plagues to nuance and integrate the findings of recent palaeo-biological and palaeo-demographic research on plague.

Evaluating the relationship between lesion burden and aging among the skeletons of an 18th-19th century London cemetery using osteological and radiological analysis

Study of disease in the past can help illuminate patterns of human health, disease, and aging in the present. As average human life expectancy and incidence of chronic disease have increased in the last century, efforts to understand this epidemiologic shift have led to more investigation of healthy aging. Using osteological and radiological methods of analysis, this study examined 212 mostly nineteenth century adult skeletons from the crypt of St. Bride’s in London, in order to investigate the relationship between age-at-death, sex, and number of lesions observed in bone. Lesions were classified into macro-level categories according to the Rapid Method for Recording Human Skeletal Data, and the correlation between age group and number of lesions in each category, as well as the total number of lesions, were analyzed. Correlations between age-at-death and the number and type of lesions were compared across both methods of analysis. A greater total number of lesions and a greater number of types of lesions was observed for the osteologically analyzed data, compared to the radiologically analyzed data. Correlations between age-at-death and specific pathology groups were in general weak, though stronger for the osteologically analyzed data. For each method of analysis, there were statistically significant differences between the total number of lesions and age group, with total number of lesions increasing with age, regardless of method of analysis. Joint and metabolic lesions were the most significant predictors of age-at-death. The correlations between total lesions observed and age-at-death were similar for radiologically and osteologically analyzed data, for the same set of bones. This suggests that, for the bones analyzed, while the number of lesions recorded differed according to method of analysis, the relationship between overall observed lesion burden and age-at-death was similar for both osteological and radiological analysis.

Influence of physiological stress on the presence of hypoplasia and fluctuating asymmetry in a medieval population from the village of Sypniewo

This study aims to estimate the levels of physiological stress in the medieval rural population of Sypniewo by evaluating patterns of fluctuating asymmetry (FA) and enamel hypoplasia (EH), and provide information on the influence of physiological stress during the prenatal and perinatal period on early childhood development. Stress is defined as any external or internal condition that challenges homeostasis of an organism. FA is associated with physiological stress occurring mainly during prenatal development and early childhood. The level of FA is thought to reflect the intensity of the stressor(s). EH is caused by physiological stress such as nutritional instability during the first years of life. The studied material consisted of 126 skulls from the village of Sypniewo (Poland). Cranial radiographs were taken in postero-anterior (P-A) and basal views. The images were scanned and calibrated. Measurements of the cranium were used to estimate FA. The presence of EH was assessed using standard anthropological methods The highest levels of FA were observed in the region of the cranial base. EH was observed in 29% of individuals from the rural skeletal series. There was no statistically significant correlation between FA and EH occurrence or between sex and the studied stress indicators.

The effect of leprotic infection on the risk of death in medieval rural Denmark

INTRODUCTION

Paleopathological studies of leprosy in Danish skeletal collections show that many individuals suffered from this stigmatized disease during the Middle Ages. This study examines the risk of death associated with leprotic infection in individuals from the Danish rural cemetery of Øm Kloster (AD 1172-1536). Specifically, we modeled the influence of leprotic infection on age-specific mortality accounting also for sex and social status (lay person / monastic).

MATERIALS AND METHODS

The sample consisted of 311 adult individuals from the Øm Kloster skeletal collection housed at the Institute of Forensic Medicine, University of Southern Denmark (ADBOU). We modeled morbidity and mortality using a three-state illness-death model with the following parameterizations for the three transition hazards: (1) nonlesioned to lesioned: constant; (2) nonlesioned to dead: Gompertz-Makeham; and (3) lesioned to dead: Gompertz-Makeham, directly proportional to the hazard of the well to dead transition.

RESULTS

The mortality hazard of lesioned individuals exceeded that of nonlesioned individuals by a factor of 1.4 (40%) across all individuals, 1.7 for females, 1.0 for males, 1.3 for lay persons, and 1.7 for monastics. Overall, 15% of the sample died with skeletal manifestations of leprosy, though it is likely that a higher percentage of the population carried the bacterium.

DISCUSSION

This study improves understanding of past health and population dynamics focusing on a chronic infectious disease. The methods employed could informatively be applied to larger analyses of community health from skeletal collections by incorporating more than one disease into the multistate model and inferring individual frailty using various skeletal markers.

The sex-selective impact of the Black Death and recurring plagues in the Southern Netherlands, 1349-1450

Although recent work has begun to establish that early modern plagues had selective mortality effects, it was generally accepted that the initial outbreak of Black Death in 1347‐52 was a “universal killer.” Recent bioarchaeological work, however, has argued that the Black Death was also selective with regard to age and pre‐plague health status. The issue of the Black Death's potential sex selectivity is less clear. Bioarchaeological research hypothesizes that sex‐selection in mortality was possible during the initial Black Death outbreak, and we present evidence from historical sources to test this notion.

Objective

To determine whether the Black Death and recurring plagues in the period 1349–1450 had a sex‐selective mortality effect.

Materials and Methods

We present a newly compiled database of mortality information taken from mortmain records in Hainaut, Belgium, in the period 1349–1450, which not only is an important new source of information on medieval mortality, but also allows for sex‐disaggregation.

Results

We find that the Black Death period of 1349–51, as well as recurring plagues in the 100 years up to 1450, often had a sex‐selective effect—killing more women than in “non‐plague years.”

Discussion

Although much research tends to suggest that men are more susceptible to a variety of diseases caused by bacteria, viruses and parasites, we cannot assume that the same direction of sex‐selection in mortality applied to diseases in the distant past such as Second Pandemic plagues. While the exact reasons for the sex‐selective effect of late‐medieval plague are unclear in the absence of further data, we suggest that simple inequities between the sexes in exposure to the disease may not have been a key driver.

Stressing out in medieval Denmark: An investigation of dental enamel defects and age at death in two medieval Danish cemeteries

The influence of early life stress on later life experiences has become a major focus of research in medicine and more recently in bioarchaeology. Dental enamel, which preserves a record of childhood stress events, represents an important resource for this investigation when paired with the information from adult skeletal remains, such as age at death. The purpose of this research was to use a life history approach to the exploration of sex differences in the relationship between childhood stress and adult longevity by examining accentuated striae of Retzius (AS). A medieval Danish sample (n=70) drawn from the rural cemetery of Sejet and the urban cemetery of Ole Wormsgade was considered for AS and age at death. The results suggest sex differences in survivorship, with more stress being associated with reduced survivorship in males and increased survivorship in females. A consideration of AS formation time also suggests a difference in the impact of developmental timing between males and females. These results are interpreted in terms of differential frailty and selective mortality, drawing in both biomedical and cultural perspectives.

Frailty in older women

It is a truth universally acknowledged that although men tend to have better health in old age, women live longer lives. Here, we briefly review the biological, social and behavioural factors that may contribute to women's greater longevity. We consider in particular factors that might result in a greater frailty burden in women, focusing on frailty being measured by a Frailty Index. The Frailty Index represents the burden of health deficits, expressed for an individual as the proportion of deficits present - from 0 (no deficits) to 1.0 (the theoretical maximum, if all deficits were expressed). A greater frailty burden in women might first represent a male "fitness-frailty pleiotropy", resulting in men having lower physiological reserves in old age so that health deficits are more lethal. In short, the price of more optimal physiological functioning during youth is a lower threshold for system failure in old age. Conversely, a female "fertility-frailty pleiotropy" might result in greater physiological reserves in women. Child birth and child rearing necessitate high levels of energetic and nutritional investment: women who have children live shorter lives. Women currently are limiting the number of children they bear and their life expectancies may be longer than predicted by evolutionary design. Third, though the Frailty Index captures physical, cognitive and psychological vulnerability, it may not include all factors that impact life expectancy in older people; these factors may be present more in men than in women. While these hypotheses seek to explain how frailty impacts men and women in different ways, there is clearly much to be done to understand frailty in older people.

Analysis of cribra orbitalia in the earliest inhabitants of medieval Vilnius

The purpose of this work is to present an analysis of cribra orbitalia (CO) from the population of a medieval cemetery in Vilnius, Lithuania, dated between the end of the 13th to the beginning of the 15th centuries. The sample consisted of 208 individuals with sufficiently preserved orbits: 82 subadults and 122 adults. CO was correlated with sex, age-at-death, and three skeletal indicators of biological health: linear enamel hypoplasia, periostitis, and adult femur length as a proxy value for stature. Siler's and Gompertz-Makeham's parametric models of mortality as well as χ2 statistics were used to evaluate these relationships. Almost one-third of all analyzed individuals had signs of CO, including approximately 60% of the subadults. There was a very strong relationship between the age-at-death and incidence of CO, i.e., individuals with the lesion were dying much younger. The frequency of CO among the sexes was not statistically significant. On the other hand, CO had a negative effect only on adult males, i.e., males who had the lesion died at a younger age. Furthermore, CO and linear enamel hypoplasia were positively related for subadults, whereas no significant relationships were found among adults of corresponding sex. Incidence of periostitis and adult stature were not related to CO.