Life not death: Epidemiology from skeletons

What's luck got to do with it? A generative model for examining the role of stochasticity in age-at-death, with implications for bioarchaeology

INTRODUCTION

The role of "luck" in determining individual exposure to health insults is a critical component of the processes that shape age-at-death distributions in mortality samples but is difficult to address using traditional bioarcheological analysis of skeletal materials. The present study introduces a computer simulation approach to modeling stochasticity's contribution to the mortality schedule of a simulated cohort.

METHODS

The present study employs an agent-based model of 15,100 individuals across a 120 year period to examine the predictive value of birth frailty on age-at-death when varying the likelihood of exposure to health insults.

RESULTS

Birth frailty, when accounting for varying exposure likelihood scenarios, was found to account for 18.7% of the observed variation in individual age-at-death. Analysis stratified by exposure likelihood demonstrated that birth frailty alone explains 10.2%-12.1% of the variation observed across exposure likelihood scenarios, with the stochasticity associated with exposure to health insults (i.e., severity of health insult) and mortality likelihood driving the majority of variation observed.

CONCLUSIONS

Stochasticity of stressor exposure and intrinsic stressor severity are underappreciated but powerful drivers of mortality in this simulation. This study demonstrates the potential value of simulation modeling for bioarchaeological research.

Ancient human dental calculus metadata collection and sampling strategies: Recommendations for best practices

OBJECTIVES

Ancient human dental calculus is a unique, nonrenewable biological resource encapsulating key information about the diets, lifestyles, and health conditions of past individuals and populations. With compounding calls its destructive analysis, it is imperative to refine the ways in which the scientific community documents, samples, and analyzes dental calculus so as to maximize its utility to the public and scientific community.

MATERIALS AND METHODS

Our research team conducted an IRB-approved survey of dental calculus researchers with diverse academic backgrounds, research foci, and analytical specializations.

RESULTS

This survey reveals variation in how metadata is collected and utilized across different subdisciplines and highlights how these differences have profound implications for dental calculus research. Moreover, the survey suggests the need for more communication between those who excavate, curate, and analyze biomolecular data from dental calculus.

DISCUSSION

Challenges in cross-disciplinary communication limit researchers' ability to effectively utilize samples in rigorous and reproducible ways. Specifically, the lack of standardized skeletal and dental metadata recording and contamination avoidance procedures hinder downstream anthropological applications, as well as the pursuit of broader paleodemographic and paleoepidemiological inquiries that rely on more complete information about the individuals sampled. To provide a path forward toward more ethical and standardized dental calculus sampling and documentation approaches, we review the current methods by which skeletal and dental metadata are recorded. We also describe trends in sampling and contamination-control approaches. Finally, we use that information to suggest new guidelines for ancient dental calculus documentation and sampling strategies that will improve research practices in the future.

Ageing and disease risk factors: A new paleoepidemiological methodology for understanding disease in the past

OBJECTIVES

To outline a methodology that enables the reconstruction of age-related disease risk in past societies.

MATERIALS

Modern epidemiological evidence considering risk factors for age-related disease is combined with contextual information about an archaeological society of interest.

METHODS

Data gathered is used to create a qualitative population-specific risk model for the disease of interest. To provide a case study, a risk model is constructed for Chronic Obstructive Pulmonary Disease (COPD) in the Eastern English Bronze Age.

RESULTS

This enables the first rigorous approach to reconstructing age-related disease risk in the past. A risk model shows a high degree of COPD risk in the Eastern English Bronze Age, with a major contribution from indoor airborne pollution and agricultural practices.

SIGNIFICANCE

This represents a significant new approach in human paleopathology, facilitating understanding of the occurrence of a wide variety of diseases in the past, without the need for well-preserved skeletons of identified elderly individuals.

LIMITATIONS

The risk models generated are, of necessity, qualitative rather than quantitative, since we are unable to calculate the size of risk factors in the past with certainty.

SUGGESTIONS FOR FURTHER RESEARCH

The methodology could be applied to a wide variety of diseases and for many past societies.

A, Kis L, Király K, Varga S, Marcsik A, Schütz O, Török T, Hunt DR, Tihanyi B. White plague among the "forgotten people" from the Barbaricum of the Carpathian Basin-Cases with tuberculosis from the Sarmatian-period (3rd-4th centuries CE) archaeological site of Hódmezővásárhely-Kenyere-ér, Bereczki-tanya (Hungary)

Tuberculosis (TB) is a bacterial infection that is well-known in the palaeopathological record because it can affect the skeleton and consequently leaves readily identifiable macroscopic alterations. Palaeopathological case studies provide invaluable information about the spatio-temporal distribution of TB in the past. This is true for those archaeological periods and geographical regions from when and where no or very few TB cases have been published until now-as in the Sarmatian period (1st-5th centuries CE) in the Barbaricum of the Carpathian Basin. The aim of our paper is to discuss five newly discovered TB cases (HK199, HK201, HK225, HK253, and HK309) from the Sarmatian-period archaeological site of Hódmezővásárhely-Kenyere-ér, Bereczki-tanya (Csongrád-Csanád county, Hungary). Detailed macromorphological evaluation of the skeletons focused on the detection of bony changes likely associated with different forms of TB. In all five cases, the presence of endocranial alterations (especially TB-specific granular impressions) suggests that these individuals suffered from TB meningitis. Furthermore, the skeletal lesions observed in the spine and both hip joints of HK225 indicate that this juvenile also had multifocal osteoarticular TB. Thanks to the discovery of HK199, HK201, HK225, HK253, and HK309, the number of TB cases known from the Sarmatian-period Carpathian Basin doubled, implying that the disease was likely more frequent in the Barbaricum than previously thought. Without the application of granular impressions, the diagnosis of TB could not have been established in these five cases. Thus, the identification of TB in these individuals highlights the importance of diagnostics development, especially the refinement of diagnostic criteria. Based on the above, the systematic macromorphological (re-)evaluation of osteoarchaeological series from the Sarmatian-period Carpathian Basin would be advantageous to provide a more accurate picture of how TB may have impacted the ancestral human communities of the Barbaricum.

The palaeopathology of industry, a perspective from Britain

OBJECTIVES

This article considers the position of palaeopathology of ca. 1750AD onward within the subdiscipline of Industrial Archaeology, and reflects upon the relationship between skeletal palaeopathology and textual sources on disease prevalences.

METHODS

It draws upon the author's experience in engaging with threat-led archaeology. It synthesises key elements of palaeopathological literature, emphasising contributions to the IJPP VSI 'Changes in Health with the Rise of Industry', and also the broader literature regarding Industrial Archaeology.

RESULTS

Industrial Archaeology has seen a recent refocus to include not only a concentration upon technological aspects of industry but also increased emphasis the social context of industrialisation. This movement toward a placement of people as well as machines centre stage has resulted in an environment conducive for paleopathology to make a greater impact upon studies of the period.

CONCLUSIONS

Palaeopathologists need to ensure that their biocultural work is orientated toward research goals of broader relevance if the impact of their work is to be maximised. We cannot directly align prevalence data generated from skeletal and and written sources; roles played by these two sources of evidence will depend, inter alia, upon the problems being investigated.

SIGNIFICANCE

The success of 'Industrial Palaeopathology' will be measured by the extent to which human remains studies move toward centre stage within the broader discipline of Industrial Archaeology.

LIMITATIONS

Multiple perspectives on disciplinary development are possible. Academic traditions, relationships between university- and threat led-sectors, and the opportunities and challenges engendered by working with human remains, differ in different countries.

The first probable case with tuberculous meningitis from the Hun period of the Carpathian Basin - How diagnostics development can contribute to increase knowledge and understanding of the spatio-temporal distribution of tuberculosis in the past

The aim of our paper is to demonstrate and discuss in detail the endocranial bony changes suggestive of tuberculous meningitis (TBM) that were recorded in an adult female's (SPF15) skeleton. The bone remains were uncovered from a solitary grave from the Hun period (5th-century-CE) archaeological site of Solt-Polya-fok (Bács-Kiskun county, Hungary). During the macromorphological examination of the very incomplete and poorly preserved skeleton of SPF15, the inner surface of the skull displayed abnormally pronounced digital impressions (APDIs) and granular impressions (GIs). Recently, it was confirmed that endocranial GIs can be considered as specific signs of TBM; and thus, they are sufficient enough on their own to make a definitive diagnosis of the disease in the palaeopathological practice. On the other hand, APDIs are not specific to TBM but can be tuberculous in origin; their concomitant presence with GIs in SPF15 makes their tuberculous origin very likely. Based on the above, it seems that the adult female from the 5th-century-CE archaeological site of Solt-Polya-fok suffered from TBM. SPF15 is the first reported probable case with tuberculosis (TB) from the Hun period of the present-day territory of Hungary, who gives us invaluable information about the spatio-temporal distribution of the disease in the past. Furthermore, it highlights the paramount importance of diagnostics development, especially the identification and refinement of diagnostic criteria, as without the application of APDIs and GIs, the diagnosis of TB could not have been established in SPF15.

Leprosy: The age-old companion of humans - Re-evaluation and comparative analysis of Avar-period cases with Hansen's disease from the Danube-Tisza Interfluve, Hungary

In recent years, our knowledge of leprosy in the past has substantially been enriched. Nonetheless, much still remains to be discovered, especially in regions and periods from where no written sources are available. To fill in some research gaps, we provide the comparative analysis of eight Avar-period leprosy cases from the Danube-Tisza Interfluve (Hungary). In every case, to reconstruct the biological consequences of leprosy, the detected bony changes were linked with palaeopathological and modern medical information. To reconstruct the social consequences of being affected by leprosy, conceptualisation of the examined individuals' treatment in death was conducted. In every case, the disease resulted in deformation and disfigurement of the involved anatomical areas (rhinomaxillary region, feet, and/or hands) with difficulties in conducting certain physical activities. These would have been disadvantageous for the examined individuals and limited or changed their possibilities to participate in social situations. The most severe cases would have required continuous support from others to survive. Our findings indicate that, despite their very visible disease and associated debility, the examined communities did not segregate leprosy sufferers but provided and cared for them, and maintained a strong enough social network that made their survival possible even after becoming incapable of self-sufficiency.

Sex, gender, and sexuality in paleopathology: Select current developments and pathways forward

OBJECTIVE

Overall, paleopathology trails behind related fields in exploring sex, gender, and sexuality in past societies. Here, we interrogatively synthesize scholarship on topics not included in similar reviews, focusing on sex estimation methods, and considering the social determinants of health; trauma; reproduction and family; and childhood - to highlight novel, social epidemiology- and social theory-informed frameworks and interpretive devices.

CONCLUSIONS

Many paleopathological interpretations focus on sex-gender differences relative to health, with increasing use of intersectionality. Others consistently project present-day ideologies about sex, gender, and sexuality (e.g., binary sex-gender systems) into paleopathological interpretations (i.e., presentism).

SIGNIFICANCE

Paleopathologists have an ethical imperative to generate scholarship that contributes to social justice initiatives focused on dismantling structural inequalities, especially relative to sex, gender, and sexuality (e.g., homophobia), such as through denaturalizing presentist binary systems. They also have a responsibility towards greater inclusivity relative to researcher identity and diversification of method and theory.

LIMITATIONS

In addition to material limitations complicating reconstructions of sex, gender, and sexuality relative to health and disease in the past, this review wasn't comprehensive. The review was also limited by the relative paucity of paleopathological work on these topics.

SUGGESTIONS FOR FUTURE RESEARCH

The outlook for paleopathological research on sex, gender, and sexuality is, however, positive; paleopathology is well situated to tackle these aspects of social identity. Future work should consider critical, self-reflective movement away from presentism; more robust contextualization; and further engagement with social theory and social epidemiology theory and approaches, including the Developmental Origins of Health and Disease (DOHaD), social determinants of health, and intersectionality.

Lumbosacral tuberculosis, a rare manifestation of Pott's disease - How identified human skeletons from the pre-antibiotic era can be used as reference cases to establish a palaeopathological diagnosis of tuberculosis

The macromorphological examination of identified human osteological collections from the pre-antibiotic era (e.g., Terry Collection) can provide invaluable information about the skeletal manifestations of tuberculosis (TB) in individuals who did not receive pharmaceutical therapy. With analysis of such collections, new diagnostic criteria for TB can be recognised which can be used in palaeopathological interpretation. The aim of our paper is to provide a reference and aid for the identification of TB in past populations by demonstrating and discussing in detail the vertebral alterations indicative of one of its rare skeletal manifestations, lumbosacral TB. These changes were detected in two individuals from the Terry Collection (Terry No. 760 and Terry No. 1093). These two case studies furnish palaeopathologists with a stronger basis for diagnosing lumbosacral TB in skeletons which exhibit similar vertebral lesions from osteoarchaeological series. To illustrate this, an archaeological case from Hungary (KK146) is also presented, displaying vertebral alterations resembling that of the two cases from the Terry Collection. Through the demonstrated case studies, we can derive a better insight into the disease experience of people who lived in the past and suffered from TB.

Biocultural perspectives of infectious diseases and demographic evolution: Tuberculosis and its comorbidities through history

Anthropologists recognize the importance of conceptualizing health in the context of the mutually evolving nature of biology and culture through the biocultural approach, but biocultural anthropological perspectives of infectious diseases and their impacts on humans (and vice versa) through time are relatively underrepresented. Tuberculosis (TB) has been a constant companion of humans for thousands of years and has heavily influenced population health in almost every phase of cultural and demographic evolution. TB in human populations has been dramatically influenced by behavior, demographic and epidemiological shifts, and other comorbidities through history. This paper critically discusses TB and some of its major comorbidities through history within a biocultural framework to show how transitions in human demography and culture affected the disease-scape of TB. In doing so, I address the potential synthesis of biocultural and epidemiological transition theory to better comprehend the mutual evolution of infectious diseases and humans.

The role of case studies in recent paleopathological literature: An argument for continuing relevance

OBJECTIVE

To critically examine the role that case studies play in recent paleopathological literature, by evaluating their frequency of publication, academic impact, and the public engagement they generate.

MATERIALS

Articles published in International Journal of Paleopathology between 2011 and 2018 (N = 377).

METHODS

Articles were coded as case studies, population studies, methodological studies, or reviews. Case studies were coded as cultural practices, differential diagnosis, historical, or methodological/theoretical. We utilized bibliometric analysis to assess academic impact and altmetric analysis to evaluate public engagement.

RESULTS

Case studies continue to be the most frequently published, but least frequently cited, article type. There are no significant differences in public engagement data between article types. Methodological/theoretical case studies have the most academic impact. Differential diagnosis case studies have the least academic impact and generate the least public engagement.

CONCLUSIONS

The case study genre includes a variety of approaches, some of which hold significant potential for contributing to the discipline of paleopathology and beyond.

SIGNIFICANCE

This study updates Mays' (2012b) citation analysis, pioneers the use of altmetric data to analyze public engagement with paleopathological publications, and identifies less productive approaches and areas of heightened relevance in the case study genre.

LIMITATIONS

Publications in only one journal were analyzed. Only one source was utilized for citation data (Google Scholar) and one source for altmetric data (PlumX).

SUGGESTIONS FOR FUTURE RESEARCH

Expanding the granular analysis of case studies piloted here to additional journals and/or citation indexes to enlarge the sample size and provide keener insights.

The impact of industrialization on malignant neoplastic disease of bone in England: A study of medieval and industrial samples

OBJECTIVE

The increasing prevalence of malignant disease has been associated with shifts in environmental, socioeconomic, and lifestyle risk factors as well as increased adult lifespan. We examine the relationship between malignant neoplasms affecting bone, age and industrialization.

MATERIALS

Pre-existing skeletal data from 11 medieval (1066-1547, n = 8973) and 14 industrial (1700-1890, n = 4748) cemeteries (N = 13,721) from England.

METHODS

Context number, sex, age-at-death, evidence of skeletal malignancy, and diagnosis were collated. The data were compared using chi square, Kolmogorov-Smirnov tests and logistic regression (α = 0.01).

RESULTS

There was a statistically significant increase in skeletal malignancy from 0.06 % in the medieval sample to 0.36 in the industrial sample (p < 0.001). Age had a strong relationship with malignancy (p = 0.003), sex did not (p = 0.464). Logistic regression revealed that time-period (p < 0.001) was a stronger predictor of skeletal malignancy than age-at-death (p = 0.002).

CONCLUSION

Our results confirm that even with the temporal increase in adult human lifespan the increase of malignant neoplasms of bone between the medieval and industrial time periods is still statistically significant.

SIGNIFICANCE

The augmented exposure to carcinogens and pollution during the Industrial Revolution had a strong effect on an individual's susceptibility to developing malignant disease of bone.

LIMITATIONS

This meta-analysis relies upon previously gathered data and diagnosis from a large number of researchers and did not include radiographic or CT screening. Only malignant neoplasms that affected bone could be included.

SUGGESTIONS FOR FURTHER RESEARCH

Increasing excavation and analysis of post-medieval cemeteries will provide more data. Multimethod approaches (radiography, CT, Micro-CT and histology) are encouraged.

Twenty-first century bioarchaeology: Taking stock and moving forward

This article presents outcomes from a Workshop entitled "Bioarchaeology: Taking Stock and Moving Forward," which was held at Arizona State University (ASU) on March 6-8, 2020. Funded by the National Science Foundation (NSF), the School of Human Evolution and Social Change (ASU), and the Center for Bioarchaeological Research (CBR, ASU), the Workshop's overall goal was to explore reasons why research proposals submitted by bioarchaeologists, both graduate students and established scholars, fared disproportionately poorly within recent NSF Anthropology Program competitions and to offer advice for increasing success. Therefore, this Workshop comprised 43 international scholars and four advanced graduate students with a history of successful grant acquisition, primarily from the United States. Ultimately, we focused on two related aims: (1) best practices for improving research designs and training and (2) evaluating topics of contemporary significance that reverberate through history and beyond as promising trajectories for bioarchaeological research. Among the former were contextual grounding, research question/hypothesis generation, statistical procedures appropriate for small samples and mixed qualitative/quantitative data, the salience of Bayesian methods, and training program content. Topical foci included ethics, social inequality, identity (including intersectionality), climate change, migration, violence, epidemic disease, adaptability/plasticity, the osteological paradox, and the developmental origins of health and disease. Given the profound changes required globally to address decolonization in the 21st century, this concern also entered many formal and informal discussions.

Paleodemography: From archaeology and skeletal age estimation to life in the past

Much of paleodemography, an interdisciplinary field with strong ties to archaeology, among other disciplines, is oriented toward clarifying the life experiences of past people and why they changed over time. We focus on how human skeletons contribute to our understanding of preindustrial demographic regimes, including when changes took place that led to the world as we know it today. Problems with existing paleodemographic practices are highlighted, as are promising directions for future work. The latter requires both better age estimates and innovative methods to handle data appropriately. Age-at-death estimates for adult skeletons are a particular problem, especially for adults over 50 years that undoubtedly are mistakenly underrepresented in published studies of archaeological skeletons. Better age estimates for the entirety of the lifespan are essential to generate realistic distributions of age at death. There are currently encouraging signs that after about a half-century of intensive, and sometimes contentious, research, paleodemography is poised to contribute much to understandings of evolutionary processes, the structure of past populations, and human-disease interaction, among other topics.

A rare case of calvarial tuberculosis from the Avar Age (8th century CE) cemetery of Kaba-Bitózug (Hajdú-Bihar county, Hungary) - Pathogenesis and differential diagnostic aspects

The aim of our paper is to present and discuss in detail the bony changes indicative of tuberculosis (TB) that were identified in a skeleton (KB67), unearthed from grave 67 of the 8th-century-CE cemetery of Kaba-Bitózug (Hungary). Furthermore, to provide the differential diagnoses of the observed alterations, with special attention to the cranial osteolytic lesions. During the macro- and micromorphological examinations of KB67, the skull revealed three small, well-circumscribed, punched-out osteolytic lesions accompanied by endocranial granular impressions, abnormal blood vessel impressions, periosteal appositions, and cortical erosion. The postcranial skeleton exhibited osteolytic lesions, cortical remodelling and erosion, and signs of hypervascularisation in the spine. Based on the differential diagnosis of the cranial osteolytic lesions and their co-occurrence with endocranial and vertebral bony changes indicative of TB, they most likely resulted from tuberculous involvement of the frontal and left parietal bones. The morphologically established diagnosis was confirmed by a PCR analysis that provided evidence for the presence of Mycobacterium tuberculosis DNA in KB67. KB67, the first reported archaeological case with calvarial TB from the present-day territory of Hungary, gives us a unique insight into the occurrence of a rare manifestation of TB in the Avar Age of the Great Plain.

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.

Towards a definition of Ancient Rare Diseases (ARD): Presenting a complex case of probable Legg-Calvé-Perthes Disease from the North Caucasian Bronze Age (2200-1650 cal BCE)

OBJECTIVE

This study discusses the challenges and possibilities of establishing a definition for Ancient Rare Diseases (ARD) in a probable case of Legg-Calvé-Perthes Disease (LCPD) from the Bronze Age cemetery Kudachurt 14, situated in the Northern Caucasus.

MATERIALS

We investigated the skeletal remains of a male aged 35-45 years at death. For comparison we examined other males buried at Kudachurt 14 (n = 24) and reviewed 22 LCPD cases from the paleopathological literature.

METHODS

We use macroscopic as well as osteometric examination methods and imaging techniques.

RESULTS

The morphology of the left hip joint corresponds to skeletal characteristics for LCPD. Co-occurring osteochondrosis dissecans, femoral anteversion, and atrophy of the left femoral shaft suggest a complex disease course.

CONCLUSIONS

Modern criteria of rare diseases applied on ancient skeletal remains are either non-transferable or require completion. We conclude that rarity is dynamic, etiological uncertainty has to be accepted, and the respective socioeconomic context is crucial. Degree of disability and level of sociomedical investment are not defining criteria for ARD.

SIGNIFICANCE

Dating 2200-1650 cal BCE, this study currently presents the earliest case of probable LCPD. This is the first attempt to transform modern characteristics of rare diseases for establishing a paleopathological concept of ARD.

LIMITATIONS

As this study is limited to LCPD, our conclusions are not directly applicable to other ARD in question.

SUGGESTIONS FOR FURTHER RESEARCH

More focused paleopathological research on skeletal populations from different cultures and time periods is needed, enabling an evolutionary perspective on the comparability of ancient, modern and future rare diseases.

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.

Prevalence of cranial trauma in Eurasian Upper Paleolithic humans

OBJECTIVES

This study characterizes patterns of cranial trauma prevalence in a large sample of Upper Paleolithic (UP) fossil specimens (40,000-10,000 BP).

MATERIALS AND METHODS

Our sample comprised 234 individual crania (specimens), representing 1,285 cranial bones (skeletal elements), from 101 Eurasian UP sites. We used generalized linear mixed models (GLMMs) to assess trauma prevalence in relation to age-at-death, sex, anatomical distribution, and between pre- and post-Last Glacial Maximum (LGM) samples, while accounting for skeletal preservation.

RESULTS

Models predicted a mean cranial trauma prevalence of 0.07 (95% CI 0.003-0.19) at the level of skeletal elements, and of 0.26 (95% CI 0.08-0.48) at the level of specimens, each when 76-100% complete. Trauma prevalence increased with skeletal preservation. Across specimen and skeletal element datasets, trauma prevalence tended to be higher for males, and was consistently higher in the old age group. We found no time-specific trauma prevalence patterns for the two sexes or age cohorts when comparing samples from before and after the LGM. Samples showed higher trauma prevalence in the vault than in the face, with vault remains being affected predominantly in males.

DISCUSSION

Cranial trauma prevalence in UP humans falls within the variation described for Mesolithic and Neolithic samples. According to our current dataset, UP males and females were exposed to slightly different injury risks and trauma distributions, potentially due to different activities or behaviors, yet both sexes exhibit more trauma among the old. Environmental stressors associated with climatic changes of the LGM are not reflected in cranial trauma prevalence. To analyze trauma in incomplete skeletal remains we propose GLMMs as an informative alternative to crude frequency calculations.

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.

Advancing the understanding of treponemal disease in the past and present

Syphilis was perceived to be a new disease in Europe in the late 15th century, igniting a debate about its origin that continues today in anthropological, historical, and medical circles. We move beyond this age-old debate using an interdisciplinary approach that tackles broader questions to advance the understanding of treponemal infection (syphilis, yaws, bejel, and pinta). How did the causative organism(s) and humans co-evolve? How did the related diseases caused by Treponema pallidum emerge in different parts of the world and affect people across both time and space? How are T. pallidum subspecies related to the treponeme causing pinta? The current state of scholarship in specific areas is reviewed with recommendations made to stimulate future work. Understanding treponemal biology, genetic relationships, epidemiology, and clinical manifestations is crucial for vaccine development today and for investigating the distribution of infection in both modern and past populations. Paleopathologists must improve diagnostic criteria and use a standard approach for recording skeletal lesions on archaeological human remains. Adequate contextualization of cultural and environmental conditions is necessary, including site dating and justification for any corrections made for marine or freshwater reservoir effects. Biogeochemical analyses may assess aquatic contributions to diet, physiological changes arising from treponemal disease and its treatments (e.g., mercury), or residential mobility of those affected. Shifting the focus from point of origin to investigating who is affected (e.g., by age/sex or socioeconomic status) and disease distribution (e.g., coastal/ inland, rural/urban) will advance our understanding of the treponemal disease and its impact on people through time.

Tuberculosis in medieval and early modern Denmark: A paleoepidemiological perspective

Millions of people worldwide have sickened and died from tuberculosis in recent centuries. Yet for most of human existence, the impact of tuberculosis on society is largely unknown. It is, indeed, unknowable without methods suitable for estimating disease prevalence in skeletal samples. Here such a procedure is applied to medieval and early modern Danish skeletons, and it shows how disease prevalence varied with differences in socioeconomic conditions. The approach is based on sensitivity and specificity estimates from modern skeletons. To augment our understanding of tuberculosis in Danish history, 713 adult skeletons were examined, all from Ribe. Tuberculosis increased from 17% to 40% in the medieval to early modern periods in Ribe. Low status (29%) people were more likely to contract the disease than those of high status (10%). The general model, derived from the modern expression of tuberculosis, fits the early modern sample better than it does the medieval skeletons. Differences in the model's fit indicate the skeletal expression changed over time. Notably, rib lesions increased in frequency from the medieval to early modern periods. The approach developed here can provide insights into host-pathogen relationships and disease expression in future work with tuberculosis and other diseases that affect the skeleton.

The association between skeletal lesions and tuberculosis diagnosis using a probabilistic approach

Sensitivity and specificity estimates for 18 skeletal lesions were generated from modern skeletons for future paleoepidemiological analyses of tuberculosis prevalence in archaeological samples. A case-control study was conducted using 480 skeletons from 20^th century American skeletal collections. One-half of the skeletons were documented tuberculosis cases (Terry Collection). The remaining age and sex-matched skeletons were controls (Bass Collection). The association between 18 candidate skeletal lesions and tuberculosis was established by comparing lesion distributions in case and control groups. Lesion indicators at six locations - visceral surface of ribs, ventral vertebral bodies, lateral part of ilium, acetabular fossa, iliac auricular surface, and ulna olecranon process - occurred significantly more often among cases than in controls, and were associated with one another. The most useful indicator proved to be a bony reaction on ventral thoracic and lumbar vertebral bodies. Its presence means a 53.3% probability of a true tuberculosis diagnosis. Because of the nature of the reference sample - 20th century American cases - sensitivity and specificity estimates will better estimate disease prevalence in archaeological samples from cultural settings where pulmonary tuberculosis predominated. The general approach of this proof-of-concept study is applicable to other diseases that occur commonly and affect bone.

Mummy studies and the bioarchaeology of care

The bioarchaeology of care is a framework through which researchers can begin to infer the level of care an individual may have required based on the presence of paleopathological evidence. To date, all of the research that has employed the framework has been based on evidence derived from skeletal material. This special issue was organized in order to highlight how the analysis of mummified soft tissue, as well as other sources of data commonly associated with mummified remains, such as coprolites and intestinal contents, has the potential to provide valuable insight into the reconstruction of care in the past.

A tale of two cities: A comparison of urban and rural trauma in Medieval Denmark

OBJECTIVE

This study explores the differences in frequency and type of trauma found in two Medieval cemeteries in Denmark, as well as the cultural and community implications of those differences.

MATERIALS

We examined 235 skeletons from the cemetery at Tjærby (rural) and 170 skeletons from the cemetery at Randers (urban) for trauma from the Medieval period in Denmark, 1050 to 1536 CE.

METHODS

Trauma was assessed through macroscopic examination and odds ratio and relative risk assessments were run to assess the difference in trauma.

RESULTS

There was no significant difference in the presence of trauma between the rural and urban cemeteries or between males and females. There were some significant differences in relative risk for trauma between the two cemeteries.

CONCLUSIONS

The division and variation in trauma between the two cemeteries is most likely related to differences in economy and occupation.

SIGNIFICANCE

There are relatively few studies that examine the difference in inherent risk of trauma between rural and urban Medieval communities, especially in Denmark. This research also adds to the growing body of literature in paleopathology that uses epidemiology to explore the parallels between patterns of trauma and community lifeways.

LIMITATIONS

The cemeteries are approximately 5 km distance from each other so similarities in the sample could be a result of location.

SUGGESTIONS FOR FURTHER RESEARCH

A wider sample of Medieval cemeteries in Denmark needs be added to this analysis to provide a more complete picture of trauma patterns during this time period.

The Bioarchaeology of Health Crisis: Infectious Disease in the Past

Beginning some 10,000 years ago, humans began a dramatic alteration in living conditions relating especially to the shift in lifeway from foraging to farming. In addition to the initiation of and increasing focus on the production and consumption of domesticated plant carbohydrates, this revolutionary transformation in diet occasioned a decline in mobility and an increased size and agglomeration of populations in semipermanent or permanent settlements. These changes in life conditions presented an opportunity for increased transmission of pathogenic microbes from host to host, such as those that cause major health threats affecting most of the 7.5 billion members of our species today. This article discusses the bioarchaeology of infectious disease, focusing on tuberculosis, treponematosis, dental caries, and periodontitis, all of which continue to contribute to high levels of morbidity and mortality among the world's populations today.

Selective mortality in middle-aged American women with Diffuse Idiopathic Skeletal Hyperostosis (DISH)

OBJECTIVE

A mortality sample of white American male and female skeletons was examined to illustrate a simple means of identifying skeletal conditions associated with an increased risk of dying relatively early in adulthood and to determine if males and females with Diffuse Idiopathic Skeletal Hyperostosis (DISH) displayed the same general age-specific pattern of mortality.

METHODS

Age-specific probability distributions for DISH were generated from 416 white Americans who died from the 1980s to the present, and whose remains were donated to the University of Tennessee Forensic Anthropology Center. The age-specific frequency of DISH is analyzed using an empirical smoothing algorithm. Doing so allows for the identification of deviations (i.e., local maxima) from monotonically increasing age-specific probabilities.

RESULTS

In females (N = 199), there is a peak in the frequency of individuals with DISH around 60 years of age where 37.0% of the individuals have DISH. It is matched only by the frequency (38.7%) in the oldest females, those over 85 years old. In contrast, DISH frequencies for males (N = 217) increase monotonically with advancing age, reaching 62.5% in the ≥86 years age group. There was an association between DISH and high body weight in women, particularly those who died before they reached the age of 75.

CONCLUSIONS

Early-onset DISH in white American women is associated with an increased risk of dying indicated by a local maximum in the probability curve. Should this finding be replicated in additional mortality samples and the reason DISH is associated with early death is established, beyond being heavy, this radiologically visible ossification of the spine could be a potential component of health-monitoring programs for middle-aged women.

Paleo-oncology: Taking stock and moving forward

This article serves as an introduction to the International Journal of Paleopathology's special issue, Paleo-oncology: Taking Stock and Moving Forward. Reflecting the goals of the special issue, this paper has been designed to provide an overview of the current state of paleo-oncology, to introduce new and innovative paleo-oncological research and ideas, and to serve as a catalyst for future discussions and progress. This paper begins with an overview of the paleo-oncological evidence that can be found in ancient remains, followed by a summary of significant paleo-oncological findings and methodological advances to date. Thereafter, challenges in estimating past prevalence of cancer are highlighted and recommendations are made for future advancements in paleo-oncological research. The ground-breaking studies included in the special issue and referenced throughout this introduction embody the many ways in which progress can be made in the field of paleo-oncology.