Health in post-Black Death London (1350-1538): age patterns of periosteal new bone formation in a post-epidemic population.

Previous research has shown that the Black Death targeted older adults and individuals who had been previously exposed to physiological stressors. This project investigates whether this selectivity of the Black Death, combined with post-epidemic rising standards of living, led to significant improvements in patterns of skeletal stress markers, and by inference in health, among survivors and their descendants. Patterns of periosteal lesions (which have been previously shown, using hazard analysis, to be associated with elevated risks of mortality in medieval London) are compared between samples from pre-Black Death (c. 1,000-1,300, n = 464) and post-Black Death (c. 1,350-1,538, n = 133) London cemeteries. To avoid the assumptions that stress markers alone provide a direct measure of health and that a change in frequencies of the stress marker by itself indicates changes in health, this study assesses age-patterns of the stress marker to obtain a more nuanced understanding of the population-level effects of an epidemic disease. Age-at-death in these samples is estimated using transition analysis, which provides point estimates of age even for the oldest adults in these samples and thus allows for an examination of physiological stress across the lifespan. The frequency of lesions is significantly higher in the post-Black Death sample, which, at face value, might indicate a general decline in health. However, a significant positive association between age and periosteal lesions, as well as a significantly higher number of older adults in the post-Black Death sample more likely suggests improvements in health following the epidemic.