Survivorship and the second epidemiological transition in industrial-era London.

OBJECTIVES: The second epidemiological transition describes a shift in predominant causes of death from infectious to degenerative (non-communicable) diseases associated with the demographic transition from high to low levels of mortality and fertility. In England, the epidemiological transition followed the Industrial Revolution, but there is little reliable historical data on cause of death beforehand. Because of the association between the demographic and epidemiological transitions, skeletal data can potentially be used to examine demographic trends as a proxy for the latter. This study uses skeletal data to examine differences in survivorship in London, England in the decades preceding and following initial industrialization and the second epidemiological transition. MATERIALS AND METHODS: We use data (from n = 924 adults) from London cemeteries (New Churchyard, New Bunhill Fields, St. Bride's Lower Churchyard, and St. Bride's Church Fleet Street) in use prior to and during industrialization (c. 1569-1853 CE). We assess associations between estimated adult age at death and time period (pre-industrial vs. industrial) using Kaplan-Meier survival analysis. RESULTS: We find evidence of significantly lower adult survivorship prior to industrialization (c. 1569-1669 and 1670-1739 CE) compared to the industrial period (c. 1740-1853 CE) (p < 0.001). DISCUSSION: Our results are consistent with historical evidence that, in London, survivorship was improving in the later 18th century, prior to the recognized beginning of the second epidemiological transition. These findings support the use of skeletal demographic data to examine the context of the second epidemiological transition in past populations.

Interpreting adult stature in industrial London.

OBJECTIVES: This study examines adult stature and its association with risk of mortality in two skeletal collections from industrializing London, taking sex and socioeconomic status into account as potential sources of heterogeneity in frailty. METHODS: Mean femur and tibia lengths and the distributions of short femora and tibiae were examined in adult skeletons from the cemeteries at Lower Saint Bride's (low status) and Chelsea Old Church (high status). Cox proportional hazards models were used to determine if stature was associated with risk of mortality and how that relationship varied with sex and socioeconomic status. RESULTS: High-status females had significantly longer femora, but not tibiae, on average, than low-status females. There were no status-based differences in mean element lengths among males. There were sex and status based differences in the distribution of short femora and tibiae, and there was a significant negative association between tibia length and risk of mortality in high-status females. DISCUSSION: The results may be explained by differences in subadult mortality, potentially due to variation in infant feeding practices. Low-status infants were more likely to live in pathogenic environments and less likely to be breastfed, leading to both stature and immunological deficits, thus minimizing the association between adult stature and mortality, as the shortest individuals did not survive into adulthood. The ways in which migration and repeated epidemics of plague may have shaped stature variation during industrialization are also discussed, highlighting the importance of context in understanding the association between stature and mortality.

Wealth, health and frailty in industrial-era London.

BACKGROUND: Socioeconomic status is a powerful predictor of mortality in living populations, as status affects exposure or access to a variety of factors that impact health and survival, such as diet, healthcare, infectious disease and pollution. AIM: This study examines the effect of socioeconomic status on mortality and survival in London during a period spanning the early 18th through mid-19th centuries. During this period, London experienced rapid industrialization and heightened class distinctions. This study examines whether low-socioeconomic status was associated with reduced survival at a time when the distinctions between social strata were peaking. SUBJECTS AND METHODS: The samples for this study are drawn from three skeletal assemblages in London that represent lower and higher social strata. The upper socioeconomic status sample (n = 394) is from Chelsea Old Church and St Bride's Fleet Street (crypt assemblage). The low socioeconomic status sample (n = 474) is from St. Bride's Lower Churchyard (also known as St Bride's Farringdon Street). The effect of status on mortality and survival is assessed using hazard analysis and Kaplan-Meier analysis. RESULTS: The results reveal elevated mortality and reduced survival for lower socioeconomic status children, but no strong effect of status on adult mortality or survival. CONCLUSION: These results might indicate strong selective mortality operating during childhood or the effects of migration in the industrial-era population of London.

Stature and frailty during the Black Death: the effect of stature on risks of epidemic mortality in London, A.D. 1348-1350.

Recent research has shown that preexisting health condition affected an individual's risk of dying during the 14th-century Black Death. However, a previous study of the effect of adult stature on risk of mortality during the epidemic failed to find a relationship between the two; this result is perhaps surprising given the well-documented inverse association between stature and mortality in human populations. We suggest that the previous study used an analytical approach that was more complex than was necessary for an assessment of the effect of adult stature on risk of mortality. This study presents a reanalysis of data on adult stature and age-at-death during the Black Death in London, 1348-1350 AD. The results indicate that short stature increased risks of mortality during the medieval epidemic, consistent with previous work that revealed a negative effect of poor health on risk of mortality during the Black Death. However, the results from a normal, non-epidemic mortality comparison sample do not show an association between stature and risks of mortality among adults under conditions of normal mortality. Fisher's exact tests, used to determine whether individuals who were growing during the Great Famine of 1315-1322 were more likely to be of short stature than those who did not endure the famine, revealed no differences between the two groups, suggesting that the famine was not a source of variation in stature among those who died during the Black Death.