The person‐years construct: ageing and the prevalence of health related phenomena from skeletal samples

Age has the ability to confound prevalence data. Yet, the effects of length of exposure and age‐structure on such prevalence data are seldom directly measured in osteological studies. Here we describe a simple method that addresses both issues through the use of person‐years, and treatment of data in the case of rare events as Poisson counts. We advocate use of person‐years as a denominator when comparing skeletal data that involves the cumulative insults of ageing (e.g. fractures, dental caries, and other chronic diseases such as osteoarthritis). Copyright © 2003 John Wiley & Sons, Ltd.     

Osteoarthritis in a Black Death cemetery in London

Age-specific prevalence rates were determined in a group of skeletons recovered from a Black Death plague pit in London. The disease showed the expected increase in prevalence with age but these rates were lower than those in the contemporary population and the disease was more frequent in men than in women. In the majority of cases the disease affected one joint only and there were no cases of generalized osteoarthritis. The sites most commonly affected were the facet joints of the spine, the acromioclavicular joint and the hands; there were relatively few cases in which the large joints were affected but the knee was slightly more frequently affected than the hip.     

Changes in the distribution of osteoarthritis over historical time

A total of 2635 skeletons recovered from different sites in England was examined for the presence of osteoarthritis (OA); 206 were from pre-medieval sites, 1453 from medieval sites and 976 from post-medieval sites. Where OA was considered to be present in a joint, the site was noted and for each time period the total number of anatomical sites with the condition was determined and the number of major sites with OA (10 in number) was expressed as a proportion of this total. There were no differences in the distribution of osteoarthritis between the pre-medieval and medieval periods but there were between the medieval and post-medieval periods. In the post-medieval period the proportion of osteoarthritis of the knee increased whereas that of the hip decreased; the proportion of osteoarthritis of the hands also increased whereas that of the wrist decreased. Other data presented indicate that patellofemoral disease is about twice as common as tibio-femoral disease in both medieval and post-medieval periods and that lateral compartment disease is almost as common as medial compartment disease.     

Schmorl's nodes in a post‐medieval skeletal sample from Klostermarienberg,Austria

The prevalence and distribution pattern of Schmorl's nodes (SNs) were studied in a post‐medieval skeletal sample (n = 473) from the 16^th–18^th century cemetery of Klostermarienberg, Austria. The reasons for the prevalence and distribution pattern of SNs in this sample are discussed with regard to their aetiology. SNs were correlated with age and sex as well as with degenerative spinal joint disease such as vertebral osteophytosis (VO) and apophyseal osteoarthritis (OA). SNs were most commonly found in the lower thoracic region, in agreement with other studies. Males were more affected than females by SNs, especially in the lower thoracic region. SNs show a completely different distribution pattern to VO and OA. Additionally, there was no relationship found between SNs and ageing. Observed differences in the prevalence of SNs in the vertebral column and between the sexes suggest that mechanical factors may be responsible. Copyright © 2008 John Wiley & Sons, Ltd.     

Bioarchaeological Analysis of Iron Age Human Skeletons from Zambia

The Ingombe Ilede and Isamu Pati Iron Age sites in Zambia provide 47 human burials for analyses. Our new study provides demographic information (sex and age), evidence of trauma, infectious diseases as well as physiological and mechanical indicators of stress. We found a high mortality rate for infants and children. Most of the sample (65%) lacked indications of stress or infectious diseases, but a few had cribra orbitalia, osteoarthritis, osteophytosis and various dental pathologies. These conditions are known to be caused by diet, food processing, nutritional intake and cultural systems. In addition, there were low levels of degenerative joint disease and no evidence of trauma. The stature and body mass estimates show that these Iron Age people were similar in size and shape compared with contemporary South Africans. These data indicate a relatively healthy population with a well‐balanced diet and low afflictions of infectious and parasitic diseases. Copyright © 2012 John Wiley & Sons, Ltd.     

The Cost of a Commute: A Multidisciplinary Approach to Osteoarthritis in New Kingdom Egypt

This article evaluates rates of osteoarthritis of the lower limb in human remains from Deir el‐Medina in order to compare the health of the residents of Deir el‐Medina with previous studies on other ancient Egyptian and Nubian populations. This study focuses on osteological observations from the commingled New Kingdom human remains documented during the 2012–2014 field seasons of the Institut Français d'Archéologie Orientale. This is the first publication of osteoarthritis for the human remains at Deir el‐Medina, a dataset which complements comparable populations at sites such as Amarna, Giza, and Tombos. It demonstrates that men in the village of Deir el‐Medina experienced significantly higher rates of osteoarthritis in the ankle and knee in comparison to women at Deir el‐Medina. Rates of osteoarthritis in the lower limb at Deir el‐Medina generally fall between workers' cemeteries and middle‐class or elite cemeteries. This study also includes data from Deir el‐Medina's detailed textual record and intact landscape in order to determine how occupation influenced these higher rates of osteoarthritis. The duration, intensity, and frequency of the workmen's hikes are reconstructed based on the surrounding landscape and 42 texts recording work days. This study compares rates of osteoarthritis with these datasets in order to document how the strain, duration, and frequency of the workmen's hikes may have impacted overall rates of osteoarthritis. Consequently, data from the texts and landscape surrounding Deir el‐Medina not only corroborate osteoarthritis patterns, but offer detailed daily life activity which can be used as a comparison for broader studies on osteoarthritis in ancient and modern populations. Copyright © 2016 John Wiley & Sons, Ltd.     

Health Patterns of the Etruscan Population (6th–3rd Centuries bc) in Northern Italy: The Case of Spina

A sample of 303 skeletons from the Etruscan necropolis of Spina (Ferrara, Italy, 6th–3rd centuries bc ) was examined for paleopathological lesions in order to assess the general health, diseases and quality of life of this Iron Age population. The observed pathologies included porotic hyperostosis, specific and aspecific infections, metabolic and endocrine disorders, tumours and osteoarthritis. A total of 46.7% of adults and 7.7% of subadults showed at least one pathological lesion. Statistical comparisons were made between sexes and adult‐age classes (20–35 years and >35 years) to analyse the prevalence of the lesions. The analysis of porotic hyperostosis and osteoperiostitis allowed to determine the general health status of this group, and the analysis of osteoarthritis allowed to hypothesise a gender division of labour. The results suggest a relatively high‐life expectancy for the time as well as good health and quality of life. The few specific infections and metabolic disorders indicate fairly good nutrition, while the high frequency of porotic hyperostosis can be partly linked to some type of hereditary anaemia. Copyright © 2015 John Wiley & Sons, Ltd.     

The prevalence of,and the relationship between some spinal diseases in a human skeletal population from London

The prevalence of osteoarthritis, osteophytosis, intervertebral disc disease and diffuse idiopathic skeletal hyperostosis (DISH) was determined in a group of skeletons excavated from the crypt of Christ Church, Spitalfields. Age-specific prevalence rates were calculated from the group of skeletons for which age at death was known from intact coffin plates. Osteoarthritis of the facet joints occurred most frequently in the cervical and upper thoracic regions and was also common in the lower lumbar spine. The disease was more frequently bilateral in the lumbar spine than in upper regions. Osteophytes were common in the thoracic and lumbar spines, whereas intervertebral disc disease was confined almost completely to the cervical region. Diffuse idiopathic skeletal hyperostosis seemed to be underrepresented in this group, but was more common in males than in females. Age correlated significantly with all the conditions except DISH. Multiple regression analysis was carried out using each of the conditions as the dependent variable in turn. Age accounted for more of the variance than any of the other conditions added as independent variables.     

Erosive osteoarthritis in a medieval skeleton

In human skeletons from archaeological sites, osteoarthritis is by far the most common disease found, but no case of erosive osteoarthritis has been described and we present here what we believe to be the first such case.     

Variation in health and socioeconomic status within the W. Montague Cobb skeletal collection: Degenerative joint disease,trauma and cause of death

This paper examines health differences between two distinct samples within an African American skeletal population by investigating variation in osteoarthritis (OA) patterns, the presence of enthesopathies, fractures and cause of death. Surveys and statistical treatments tested the hypothesis that two samples within a population that have different socioeconomic contexts will present associated differences in health. Binomial statistics were used to examine differences in OA patterns and prevalence within and between groups, and according to age and sex. These data were paired with information on the presence of enthesopathies at select muscle attachment and insertion sites to add another dimension to the assessment of mechanical strain. Finally causes of death, when available, were recorded to compare leading causes within and between samples, as well as with the larger population. Data reveal significant differences in the prevalence of OA between groups. Significant differences also presented when comparing the prevalence of unilateral and bilateral affect. Although a number of differences in health status observed can be attributed to age, relationships between the presence of OA and enthesopathies in a portion of the sample indicates that degenerative change and hypertrophy in the samples reflect both systemic and non‐systemic change. The presence and pattern of fractures and causes of death are also suggestive of differences in social context between the two samples. Copyright © 2010 John Wiley & Sons, Ltd.     

Spinal degenerative lesions and spinal ligamentous ossifications in ancient Chinese populations of the Yellow River Civilization

Rheumatological diseases, whether inflammatory or degenerative, are ubiquitous among modern Asian people but very few palaeopathological studies have been performed in Asia on this subject. Since 1996, we have been carrying out a palaeoepidemiological survey of rheumatic diseases in ancient Chinese and Japanese skeletal populations. Findings on the spinal column in ancient Chinese populations (ca. 5000 bc –ad 1644) in Henan Province (centre of the Yellow River Civilization) are reported in this study. The examined number of the people over 20 years old was 365 (185 males, 169 females and 11 unsexed). Of these, 248 were young adults, 98 were middle adults and 19 were old adults. Crude prevalence (number/100) in total population of vertebral osteophytosis/facet osteoarthritis was 17.5/7.7, 17/3.7 and 44.6/21.1 at the cervical, thoracic and lumbar spine, respectively. That of ossified anterior longitudinal ligament (OALL) or Forestier's disease was around 3 at each of the cervical, thoracic and lumbar spine. Ossification of the posterior longitudinal ligament (OPLL) of the cervical spine was observed in five out of 114 skeletons with cervical spine preserved, while it did not exist in any thoracic and lumbar segment. Ossification of the ligamentum flavum (OLF) was predominantly observed in the thoracic spine, the crude prevalence of which was 36.7. Overall spinal degenerative lesions seemed to have been more prevalent and spinal ligament ossifications less prevalent in ancient Chinese populations than in modern people. None of the inflammatory lesions like rheumatoid spondylitis, as well as seronegative spondyloarthropathies, were detected. This is the first palaeopathological study in which the prevalence of OPLL and OLF, the two clinically important spinal ligamentous ossifications causing myelopathy in modern mankind, was surveyed in ancient skeletons. Copyright © 2000 John Wiley & Sons, Ltd.     

The distribution of osteoarthritis of the hands in a skeletal population

The distribution of osteoarthritis of the hands was studied in 101 skeletons from archaeological sites in England. The results are similar to those found in epidemiological studies of modern populations. Osteoarthritis of the hands was more common in females than in males, and in females tended to involve a greater number of joints. The distal and proximal interphalangeal joints were commonly affected, the former more frequently than the latter, but otherwise the disease was largely confined to the first ray of the hand, centred on the trapezium. It is concluded that the pattern of osteoarthritis in the hand has probably not changed greatly over several hundred years.     

Understanding the Southern African ‘Anomaly’: Poverty,Endemic Disease and HIV

The epicentre of the global HIV epidemic is southern Africa. Previous explanations point to migration patterns and highly skewed income distribution, both thought to promote risky sexual behaviour. This study emphasizes the importance of common infectious and parasitic diseases that increase the likelihood of HIV transmission by increasing contagiousness and vulnerability to infection. Using multiple regression analysis on country‐level data, the authors find that socio‐economic variables explain statistically only one‐tenth of the difference in HIV prevalence between southern Africa and other low‐ and middle‐income countries. Measures of five cofactor infections together with the socio‐economic variables, however, explain statistically about two‐thirds of the southern Africa difference in HIV prevalence. They conclude that the relative affluence of countries in southern Africa and historical migration patterns have tended to mask the vulnerability of the majority of their populations who are poor and who have very high prevalence of infectious and parasitic diseases. Those diseases replicate a cycle of poverty that produces biological vulnerability through coinfections. An important implication of this research is that integrating treatment of endemic diseases with other HIV‐prevention policies may be necessary to slow the spread of HIV.     

Inter-observer variation in coding osteoarthritis in human skeletal remains

Thirty-eight participants at the VIIIth European Meeting of the Paleopathology Association took part in a study of inter-observer variation in scoring osteoarthritis in human skeletal remains. Ten specimens representing different joints were used and five criteria of osteoarthritis were scored. Eleven of the 38 participants ranked themselves as beginners, 13 as experienced and six as very experienced; the data were subsequently examined using the results from these 30, comparing beginners with experts. Agreement as to whether or not changes were present on the specimens and on the degree of change was seldom complete but was greater when scoring eburnation and the presence of new bone on the joint surface than for the three other criteria. There was little difference between beginners and experts. Although all the specimens were chosen to meet our published criteria for osteoarthritis, the experts were unanimous is agreeing the diagnosis in only three cases and the beginners in only one. These results suggest that more work needs to be done to develop operational definitions for the classification of disease in palaeopathology and that great care must be taken when comparing disease frequencies between studies.     

Application of Health Expectancy Research on Working Male Population in Bangladesh

Lower quality of life and more work-loss days for the workforce are barriers for economic development in Bangladesh. Using nationally representative data—the Bangladesh Demographic and Health Surveys for the 2004–2007 period, we examined the prevalence of diseases (asthma, diabetes, heart problems, high blood pressure, jaundice/hepatitis, malaria/fever, tuberculosis, and other) that prevented ever-married male workers from doing their regular activities in Bangladesh, and we examined changes in partial work-loss free life expectancy (WLFLE). The study found improvements in the mean number of work-loss days as well as in WLFLE; male workers at age 30 in 2007 expected 212 days more WLFLE than male workers of the same age in 2004. Other diseases prevented 17.8 per cent of male workers in 2004 and 9.1 per cent of male workers in 2007 from doing their normal work. Malaria/fever prevented 14.4 per cent and 11.5 per cent of male workers in 2004 and 2007, respectively, from doing their normal work. In both years, of all the diseases, the other diseases category and malaria/fever were found to be the major causes preventing Bangladeshi male workers from doing their normal work. This study recommends taking action against malaria/fever so that people can continue working without health problems or illness, and it recommends identifying other diseases which cause work-loss days. It suggests collecting data for both the males and females in a consistent manner by keeping the same questions with the same wording, order, and age groups consistent over time.     

Diet and Oral Health of Populations that Inhabited Central Argentina (Córdoba Province) during Late Holocene

The aim of this work is to study, from a bioarchaeological perspective, the diet and oral health of the populations that inhabited Central Argentina in two periods which would reflect changes in subsistence strategies: earlier late Holocene (ca. 2500–1500 years BP) and later late Holocene (ca.1500–400 years BP). The sample is composed by 83 adult individuals from 47 archaeological sites. We considered five non‐specific indicators of stress, infectious and degenerative diseases: hypoplasia of dental enamel, dental caries, abscesses, antemortem teeth loss, and calculus. We also considered hypercementosis, dens in dens, and agenesis. We test intraobserver error by means of intraclass correlation coefficient and analysis of variance of repeated measures. We calculated prevalence by sex, age, geographic subregion, and chronological period. We applied Chi‐square (X²) to test statistical significance of observed differences. Considering the sample as a whole, low prevalence of dental caries (10.27%), abscesses (16.52%), and hypoplasia (10.84%) are coincident with values observed for populations with mixed or hunter‐gathering subsistence strategy. In later late Holocene, high incidence of caries should be considered as indicator of consumption of C4 vegetables or other carbohydrate‐rich vegetables, such as legumes of Prosopis sp. Also, moderate values of dental enamel hypoplasia should be related with metabolic‐systemic stress episodes. Summarizing, these results are coincident with isotopic, archaeological, and ethnohistorical evidences which suggest climatic, social, and demographic pressures that might have affected the lifestyle of these populations before the Spanish conquest. Copyright © 2012 John Wiley & Sons, Ltd.     

Osteoarthritis revisited: a contemporary review of aetiology

Osteoarthritis is among the most common pathological conditions in skeletal collections and is the most frequent musculoskeletal disorder in contemporary populations. Jurmain ( 1991 ) has previously published in this journal a brief review of skeletal perspectives on osteoarthritis. Subsequent studies by osteologists and medical researchers have added considerably to understanding of the aetiology and patterning of osteoarthritis. Thus, it is timely to present an updated review that expands and supports conclusions discussed in the earlier review. In short, osteoarthritis aetiology is multifactorial, with age being the main influence on the onset and severity of osteoarthritis. Genetic influences also play a large role in the severity of osteoarthritis, especially in the lower limbs. Weight, although playing a significant role for modern populations, seems to have had very minimal effects on prehistoric populations. Sex differences may often be a consequence of hormones, body size and anatomy, rather than activity related. Finally, intense activity starting at a young age still may influence osteoarthritis, especially in the upper limbs. Future directions discussed include within‐body comparisons, animal studies, and examining patterns in large populations. Copyright © 2007 John Wiley & Sons, Ltd.     

In sickness or in health? Assessment of Early Iron Age human skeletons from Toutswe sites,east central Botswana

The general health of Early Iron Age (AD 700 to 1300) mixed farmers in east central Botswana has not been studied before. In this study the bones and teeth of 84 individuals from ten Toutswe sites were analysed for osteological manifestations of disease, with the aim of assessing the general health of the Toutswe communities. These individuals were aged between newborn and 75 years old, and include both sexes. Results indicate the presence of diseases commonly found in archaeological populations such as osteoarthritis, spina bifida occulta, cribra orbitalia, porotic hyperostosis and enamel hypoplasias. One possible case of DISH was found. The frequency of lesions was comparable with or even lower than at other similar sites, such as K2 and Mapungubwe and other parts of southern Africa. The samples represent communities with relatively low levels of stress and infections. This seems to support the results of the palaeodemographic analysis, which indicated that the Toutswe people were better off than those of neighbouring K2 and Mapungubwe. Copyright © 2008 John Wiley & Sons, Ltd.     

Paleodiet of domestic turkey,Shields Pueblo (5MT3807), Colorado: isotopic analysis and its implications for care of a household domesticate

Isotopic analysis of domestic turkey (Meleagris gallopavo) bones from Shields Pueblo, southwest Colorado, USA, suggests that these birds consumed a diet high in C4 plants. This contrasts with the diet of local herbivores, where much lower percentages of C4 plants were recorded. In view of the prevalence of maize (Zea mays) in the human diet of Ancestral Puebloan people, we suggest that turkeys were fed food scraps and surplus maize, rather than being allowed to forage for themselves. This suggests that turkeys were carefully tended in the household. Analysis of specimens from other sites in the northern Southwest shows that this pattern of turkey feeding characterizes all of the sampled horticultural communities.     

Diffuse idiopathic skeletal hyperostosis cases found in Joseon Dynasty Human Sample Collection of Korea

Diffuse idiopathic skeletal hyperostosis (DISH) is a disorder showing hyperostosis of the spinal column and ossification of extraspinal ligaments or tendons. The prevalence of DISH has been found to be higher in historic peoples of the upper‐ and ruling classes, and in fact was closely correlative with nutritional and high‐caloric diets. DISH is also known to be a function of genetic factors; as such, there have been very few cases of DISH found among the specimens of Asian skeletal collections. In our osteoarchaeological study on the Joseon Dynasty Human Sample Collection (JDHSC), we found four DISH instances among the 96 cases (4.17%) we examined. This prevalence is not so different from those discovered in already‐published studies on collections in Europe and other regions. However, as already stated, it must be considered that most of the JDHSC individuals we examined were remains of people from the highest social classes of 16th–18th century Joseon society. Therefore, when collections from medieval European monastic sites, the appropriate control from well‐fed populations, were used for comparison, the prevalence of DISH was found to be far lower among the JDHSC. Reports on DISH from examinations of collections in Asian countries have been spotty, leaving gaps in the social‐strata spectrum. Further researches into the prevalence of DISH among the different social strata of ancient or medieval Asian peoples are still required. Copyright © 2010 John Wiley & Sons, Ltd.