Structural Inequity and Socioeconomic Status Link to Osteoporosis Diagnosis in a Population-Based Cohort of Middle-Older-Age Americans.

Socioeconomic status (SES) is an important social determinant of health inequities that has been linked to chronic conditions, including osteoporosis, but research tends to focus on socioeconomic disadvantage rather than how socioeconomic advantage may facilitate these inequities. This study accounts for structural inequities and assesses the relationship between early-life and later-life SES, and risk of osteoporosis diagnosis. Data come from the nationally representative, population-based cohort Health and Retirement Study and include individuals ages 50 to 90. The outcome variable is osteoporosis diagnosis. Logistic regression models of the relationship between SES and osteoporosis diagnosis are estimated, accounting for demographic, health, and childhood variables. Higher levels of childhood and adult SES link to lower odds of osteoporosis diagnosis. Structural inequities in income and underdiagnosis of osteoporosis among persons identifying as Black/African American were detected. Accounting for bone density scan access, inequities in osteoporosis diagnosis appear to stem from barriers to accessing health care due to financial constraints. The important role of SES and evidence of structural inequities leading to underdiagnosis suggest the critical importance of clinicians receiving Diversity, Equity, and Inclusion training to reduce health inequities.

Health Insurance Coverage as a Social Determinant of Osteoporosis Diagnosis in a Population-Based Cohort Study of Older American Adults.

Social determinants of health theoretical frameworks identify health insurance coverage as a determinant of older adults' osteoporosis diagnoses, which results in health inequities. In this research, we used the longitudinal Health and Retirement Study dataset of older United States adults, sampled biennially from 2012 to 2016. Logistic regressions estimated odds of osteoporosis diagnosis with and without a bone scan and/or hip fracture, holding insurance type, and health and demographic factors constant. Results were validated using the National Health and Nutrition Examination Survey. Probable underdiagnosing is present in older adults identifying as Black/African American and as males without a bone scan, regardless of fracture status, potentially as products of structural racism and sexism. Models including a bone scan show a reduction in disparities. These findings suggest having a bone scan is still crucial for addressing health inequities in older adults, and remedying barriers to accessing a scan is paramount.

How social/environmental determinants and inflammation affect salivary telomere length among middle-older adults in the health and retirement study.

Social epidemiology posits that chronic stress from social determinants will lead to a prolonged inflammatory response that may induce accelerated aging as measured, for example, through telomere length (TL). In this paper, we hypothesize variables across demographic, health-related, and contextual/environmental domains influence the body's stress response, increase inflammation (as measured through high-sensitivity C-reactive protein (hs-CRP)), and thereby lead to shortening of telomeres. This population-based research uses data from the 2008 Health and Retirement Study on participants ages ≤ 54-95 + years, estimating logistic regression and Cox proportional hazards models of variables (with and without confounders) across the domains on shortened TL. A mediation analysis is also conducted. Contrary to expectations, hs-CRP is not associated with risk of shortened TL. Rather, factors related to accessing health care, underlying conditions of frailty, and social inequality appear to predict risk of shorter TL, and models demonstrate considerable confounding. Further, hs-CRP is not a mediator for TL. Therefore, the social determinants of health examined do not appear to follow an inflammatory pathway for shortened TL. The finding of a relationship to social determinants affecting access to health care and medical conditions underscores the need to address social determinants alongside primary care when examining health inequities.

An epidemiological approach to the analysis of cribra orbitalia as an indicator of health status and mortality in medieval and post-medieval London under a model of parasitic infection.

OBJECTIVES: Many individuals living in medieval and post-medieval London suffered issues with sanitation, food insecurity, infectious disease, and widespread exposure to parasites from a multitude of sources, causing increased risk of death for many inhabitants. We examine this stressful environment and its relationship with various demographic and temporal dimensions, using cribra orbitalia (CO) as an indicator of stress, to model an increased risk of dying under the expectations of our proposed parasitic model of infection. MATERIALS AND METHODS: We analyze the relationship between CO and mortality across seven medieval and post-medieval cemeteries from London by the covariates of sex, status, and age-at-death. A survival analysis (Cox regression) and a binomial logit estimated hazard and odds ratios of dying with CO across age-at-death, sex, status, and time-period within single statistical models. In addition, we provide new Bayesian age-at-death estimates for post-medieval samples. RESULTS: The models show the rate of CO decreased over time and age-at-death, regardless of sex or status; post-medieval individuals were ~72% less likely to die with lesions than their medieval counterparts. Further, individuals with CO had ~1% decrease in risk of dying with CO per year of age. DISCUSSION: These results suggest increased mortality risk for those with lesions indicative of anemia (CO), and selective mortality of younger individuals during the medieval period. Despite sex-specific nutritional and occupational hazards, and status-based access to resources, the prevalence of CO was similar across sex and status, which suggests living with parasitic infection that caused anemia was an everyday reality for medieval and post-medieval Londoners.

New Approaches to Age Estimation Using Palatal Suture Fusion.

Palatal suture fusion has seen little testing and/or application due in part to an inadequately described relationship to formal age ranges. This study presents a modified scoring method that examines fusion on samples of modern documented adult males and compares two Bayesian approaches to age estimation. In the first analysis, American and Portuguese collections were used to derive univariate and multivariate transition analysis (TA) parameters, which combined with an informative prior, estimated age in a sample of modern Americans and Portuguese. For the second analysis, a Bayesian multiple linear regression (BMLR) used indicator statuses as the independent variables with age as the dependent variable. Highest posterior density regions (HPDRs) and highest posterior density intervals (HDI) were calculated for a holdout sample. Final age estimates for the methods were tested for accuracy using cumulative binomial tests at 75% and 90% coverages. The HPDRs from multivariate TA captured age better for younger individuals, but consistently underaged. The cumulative binomial tests on the BMLR results indicated the prediction intervals performed as expected, and we show they are narrower (more precise) and/or more accurate than the corresponding HPDR. The modified method presented here formally links palatal suture obliteration to age using two different approaches, one of which (BMLR) is new to the aging literature. The BMLR provided results free from bias and more reasonable age ranges while maintaining accuracy. We present a look-up table and a free, simple R file for users to download and run their own estimates with BMLR.

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.

Ancient Egyptian health: the prevalence of anemia at the origins of agriculture and state level society.

Ancient Egyptians experienced a vast increase in population size following the Neolithic Revolution. Nomadic hunter-gatherer groups gradually adopted agriculture as their primary food subsistence strategy. Analyses of human societies shifting from foragers to farmers have provided evidence which suggests this transition is linked with an increase in disease and allostatic load. This paper presents an examination of cribra orbitalia and porotic hyperostosis prevalence in Predynastic and Dynastic Egyptians using public health evidence as a means to interpret the skeletal findings. The sample included 219 individuals from the regions of Naga-ed-Dêr, Mesheikh, Giza, and potentially El-Ahaiwah. The aim of this study was to identify significant differences of cribra orbitalia and porotic hyperostosis across time and sex. Application of a Fisher-Freeman-Halton's test indicated there were no differences in prevalence of cribra orbitalia or porotic hyperostosis between the Predynastic and Dynastic, nor were there differences between the sexes. The results of this study did not produce any evidence for an epidemiological shift to have occurred in post-agricultural Egypt. Further, the most likely explanation of the pattern of disease stems from a parasitic model of infection.

Correction: Iron deficiency anemia, population health and frailty in a modern Portuguese skeletal sample.

[This corrects the article DOI: 10.1371/journal.pone.0213369.].

Iron deficiency anemia, population health and frailty in a modern Portuguese skeletal sample.

INTRODUCTION: Portugal underwent significant political, demographic and epidemiological transitions during the 20th century resulting in migration to urban areas with subsequent overcrowding and issues with water sanitation. This study investigates population health during these transitions and interprets results within a framework of recent history and present-day public health information. We investigate skeletal evidence for anemia (cribra orbitalia and porotic hyperostosis) as indicators of stress and frailty-i.e., whether the lesions contribute to susceptibility for disease or increased risk of death. METHODS: The presence and severity of skeletal lesions were compared against known sex and cause of death data to investigate potential heterogeneity in frailty and the relationship between lesions and risk of dying over time. Additionally, we tested for the presence of selective mortality in our data (i.e., whether or not the sample is biased for individuals with higher frailty). Our sample derives from a large, documented, modern Portuguese collection from Lisbon and is the first study of its kind using a documented collection. The collection represents primarily middle-class individuals. RESULTS AND CONCLUSIONS: Analyses indicated that porotic hyperostosis became more common and severe over time, while cribra orbitalia severity increased over time. Neither process was linked to cause of death. However, there was a significant relationship to sex; males exhibited a higher prevalence and severity of lesions and increased mortality. A Gompertz function showed decreased survivorship in early life but increased survivorship over age 60. Using comorbidities of anemia, we were unable to detect selective mortality-i.e., in our sample, lesions do not represent a sign of poor health or increased frailty and are not significantly linked with a decreased mean age-at-death. However, lesion prevalence and severity do reflect the socioeconomic processes in urban Lisbon during the 1800s and 1900s and the possibility of water-borne parasites as the contributing factor for iron deficiency anemia.

Accelerated Aging: The Role of Socioeconomic, Social, Demographic, and Biological Factors on Bone Mineral Density.

We investigate socioeconomic, social, demographic, and biological variables that are associated with chronic stress in the body to assess whether they have an effect on bone mineral density (BMD) as an indicator of accelerated aging. Multiple regression models were derived from data in the Midlife in the United States: A National Longitudinal Study of Health and Well-Being, Waves 1 (1995-1996) and 2 (2004-2006). Three BMD variables were used as outcomes: femoral, femoral neck, and spine T scores. The sample included 333 men and women aged 34-80. Poverty and C-reactive protein were related to BMD for spine T scores, partially consistent with hypotheses. But, marital status, perceived support of a partner, and education were not associated. Friend strain was discovered to have a relationship with BMD. More variables, and from a broader context, need to be examined together to understand what affects reduced BMD, given the high costs of accelerated aging.

A multifaceted analysis of social stressors and chronic inflammation.

Chronic stress has been linked to negative health outcomes, including increased inflammation, which can be measured by high-sensitivity C-reactive protein (CRP). Prior research has focused almost exclusively on relationships between individual social and demographic stressors and CRP. The objective of this study is to assess the role of multiple potential stressors simultaneously to determine which key stressors are related to risk of high CRP, given that sustained stress and resulting inflammation may have long-term health implications. We hypothesized that negative social and environmental factors would be associated with high CRP. Data from two waves of Midlife in the United States were used to predict high CRP with variable selection procedures and logistic regression. Results indicated females, those with greater BMI, those with improvements in family strain, and those with higher A1c had a greater risk of high CRP. There was limited evidence that negative social factors were associated with CRP to the extent seen in prior literature. A key advantage of the study was testing multiple potential determinants of chronic stress and inflammation simultaneously, advancing the existing literature. Results demonstrate the potential usefulness of a multifaceted approach to evaluating the risk of chronic inflammation and high CRP.

Methoxychlor metabolite HPTE alters viability and differentiation of embryonic thymocytes from C57BL/6 mice.

Endocrine-disrupting chemicals (EDC) are widespread in the built and natural environments. Heightened public awareness of their potential danger has led to concern about whether EDC and their metabolites have significant negative biological effects. Studies have shown that EDC like DDT and other organochlorine pesticides, such as methoxychlor (MXC), have adverse effects on immune cells, but no studies have addressed the impact of HPTE, the primary metabolite of MXC. To elucidate the presence and significance of HPTE adverse effects, this study explored the impact of HPTE on a critical window and component of immune system development, embryonic T-cell development. Lesions at this phase of development can lead to lifelong immune dysfunction and increased incidence of immune disease, such as autoimmunity. Embry-onic thymocytes (GD 16-18) from C57BL/6 mice were subjected to an in vitro differentiation culture that mimicked early steps in thymocyte development in the presence of 0.005, 0.05, 0.5, 5, or 50 µM HPTE, or a model endocrine disruptor, DES. The results indicated that compared to the vehicle control, HPTE- and DES-induced death of thymocytes. Annexin-V staining and Caspase 8, markers of programed cell death, revealed that the loss of cells was due at least in part to induction of apoptosis. Moreover, HPTE-induced cell death not only resulted in selective loss of double positive thymocytes, but also loss of developing CD4 intermediate cells (post-double positive partially differentiated thymocyte population). Phenotypic analysis of thymocyte maturation (T-cell receptor, TCR) and TCR ligation (CD5) surface markers revealed that surviving embryonic thymocytes expressed low levels of both. Taken together these data demonstrate that immature embryonic thymocytes are sensitive to HPTE exposure and that HPTE exposure targets thymocyte populations undergoing critical differentiation steps. These findings suggest HPTE may play a pivotal role in MXC exposure-induced immune dysfunction.

Evaluating Nubian Population Structure from Cranial Nonmetric Traits: Gene Flow, Genetic Drift, and Population History of the Nubian Nile Valley.

Paleolithic archaeological and skeletal remains from the Nile Valley have yielded a complex picture of life along the river. Sociocultural and sociopolitical events during this time frame shaped population structure, while gene flow and genetic drift further developed it. In this study, we took a population genetics approach to modeling Nubian biological relationships in an effort to describe how an accumulation of events formed Nubian population structure. A variety of Nubian samples were utilized, spanning the Mesolithic-Christian time periods and geographically from just above the first through the third cataracts. Population genetics statistics were employed to estimate and depict biological affinities (Mahalanobis D2 with a tetrachoric matrix, principal coordinates analysis, FST, and Relethford-Blangero residuals), supplemented by spatial-temporal modeling (Mantel tests and PROTESTs). Variation was high among these groups, indicating an intricate pattern of relationships in their population history where similar levels of gene flow probably stemmed from extensive cultural contact with Egypt and other populations in a variety of contexts. Genetic drift was also apparent in some of these sites, which is consistent with social and political histories of these groups. Traditional modeling of spatial-temporal patterning was not successful, which may be attributed to the nonlinear, loose clustering of Nubian groups by site. Collectively, the archaeological, biological, and environmental evidence supports the ideas of multiple populations living in Lower Nubia during the Paleolithic and/or a new population entering the area and shaping Nubian population structure.

The Use of Informative Priors in Bayesian Modeling Age-at-death; a Quick Look at Chronological and Biological Age Changes in the Sacroiliac Joint in American Males.

The aim of this study is to examine how well different informative priors model age-at-death in Bayesian statistics, which will shed light on how the skeleton ages, particularly at the sacroiliac joint. Data from four samples were compared for their performance as informative priors for auricular surface age-at-death estimation: (1) American population from US Census data; (2) county data from the US Census data; (3) a local cemetery; and (4) a skeletal collection. The skeletal collection and cemetery are located within the county that was sampled. A Gompertz model was applied to compare survivorship across the four samples. Transition analysis parameters, coupled with the generated Gompertz parameters, were input into Bayes' theorem to generate highest posterior density ranges from posterior density functions. Transition analysis describes the age at which an individual transitions from one age phase to another. The result is age ranges that should describe the chronological age of 90% of the individuals who fall in a particular phase. Cumulative binomial tests indicate the method performed lower than 90% at capturing chronological age as assigned to a biological phase, despite wide age ranges at older ages. The samples performed similarly overall, despite small differences in survivorship. Collectively, these results show that as we age, the senescence pattern becomes more variable. More local samples performed better at describing the aging process than more general samples, which implies practitioners need to consider sample selection when using the literature to diagnose and work with patients with sacroiliac joint pain.

Auricular Surface Aging: Comparing Two Methods that Assess Morphological Change in the Ilium with Bayesian Analyses.

Modern standards in forensic anthropology require rigorous testing and evaluation of methods used for aging skeletal remains. Age estimation has been criticized for bias, inaccuracy, and population specificity; issues which are minimized by the application of Bayesian methodology. Using Bayesian statistics, we compare the Lovejoy et al. (Am J Phys Anthropol, 68, 1985, 15) (original) and Buckberry and Chamberlain (Am J Phys Anthropol, 119, 2002, 231) (revised) auricular surface aging methods. Transition analysis parameters derived from American males (n = 372), in combination with a Thai male (N = 37) informative prior, statistically model age in Portuguese males (n = 221). Cumulative binomial tests assess the accuracy of the generated age ranges. Overall, the application of transition analysis and Bayesian statistics significantly improved age estimation with both methods (also outperforming Suchey-Brooks pubic symphysis aging). Moreover, the accuracy of the original method was low without statistical modeling, whereas the revised method can be applied accurately without further statistical analysis. Additionally, reference tables for aging Portuguese males are provided.

A Longitudinal Study on Human Outdoor Decomposition in Central Texas.

The development of a methodology that estimates the postmortem interval (PMI) from stages of decomposition is a goal for which forensic practitioners strive. A proposed equation (Megyesi et al. 2005) that utilizes total body score (TBS) and accumulated degree days (ADD) was tested using longitudinal data collected from human remains donated to the Forensic Anthropology Research Facility (FARF) at Texas State University-San Marcos. Exact binomial tests examined the rate of the equation to successfully predict ADD. Statistically significant differences were found between ADD estimated by the equation and the observed value for decomposition stage. Differences remained significant after carnivore scavenged donations were removed from analysis. Low success rates for the equation to predict ADD from TBS and the wide standard errors demonstrate the need to re-evaluate the use of this equation and methodology for PMI estimation in different environments; rather, multivariate methods and equations should be derived that are environmentally specific.

Modeling senescence changes of the pubic symphysis in historic Italian populations: a comparison of the Rostock and forensic approaches to aging using transition analysis.

Age-related anatomical changes to the surface of the pubic symphysis are well-documented in the literature. However, aligning these morphological changes with chronological age has proven problematic, often resulting in biased age estimates. Statistical modeling provides an avenue for forensic anthropologists and bioarchaeologists to increase the accuracy of traditional aging methods. Locating appropriate samples to use as a basis for modeling age estimations can be challenging due to differing sample age distributions and potentially varying patterns of senescence. We compared two approaches, Rostock and Forensic, coupled with a Bayesian methodology, to address these issues. Transition analysis was run specific to each method (which differ by sample selection). A Gompertz model was derived from an informative prior that yielded the mortality and senescence parameters for constructing highest posterior density ranges, i.e., coverages, which are analogous to age ranges. These age ranges were generated from both approaches and are presented as reference tables useful for historic male and female Italian samples. The age ranges produced from each approach were tested on an historic Italian sample, using cumulative binomial tests. These two approaches performed similarly, with the Forensic approach showing a slight advantage. However, the Forensic approach is unable to identify varying senescence patterns between populations, thus preference for one approach over the other will depend on research design. Finally, we demonstrate that while populations exhibit similar morphological changes with advancing age, there are no significant sex differences in these samples, and the timing of these changes varies from population to population.

Secular trends in cranial morphological traits: a socioeconomic perspective of change and sexual dimorphism in North Americans 1849-1960.

BACKGROUND: The human body has undergone significant changes in stature and other areas, which reflect secular trends associated with socioeconomics. AIM: To analyse cranial morphological traits for deciphering if they are subject to secular trends. SUBJECTS AND METHODS: Two documented skeletal collections were sampled for a total of 525 individuals from 1849-1960. Cranial morphological traits were scored and input into time series statistics (logistic regression). RESULTS: In females, nuchal crests have enlarged, while glabella has decreased. In males, supraorbital margins have dulled, while glabella decreased. Sexual dimorphism increased in supraorbital margins. CONCLUSION: The patterns in the data here reflect those found in other areas of the skeleton, namely height, as regards to secular trends. These findings can be extended to stature and cranial changes that parallel socioeconomic trends during the Industrial Revolution, antebellum period and after.

Comparability of multiple data types from the Bering Strait region: cranial and dental metrics and nonmetrics, mtDNA, and Y-chromosome DNA.

Different data types have previously been shown to have the same microevolutionary patterns in worldwide data sets. However, peopling of the New World studies have shown a difference in migration paths and timings using multiple types of data, spurring research to understand why this is the case. This study was designed to test the degree of similarity in evolutionary patterns by using cranial and dental metric and nonmetric data, along with Y-chromosome DNA and mtDNA. The populations used included Inuits from Alaska, Canada, Siberia, Greenland, and the Aleutian Islands. For comparability, the populations used for the cranial and molecular data were from similar geographic regions or had a shared population history. Distance, R and kinship matrices were generated for use in running Mantel tests, PROTEST analyses, and Procrustes analyses. A clear patterning was seen, with the craniometric data being most highly correlated to the mtDNA data and the cranial nonmetric data being most highly correlated with the Y-chromosome data, while the phenotypic data were also linked. This patterning is suggestive of a possible male or female inheritance, or the correlated data types are affected by the same or similar evolutionary forces. The results of this study indicate cranial traits have some degree of heritability. Moreover, combining data types leads to a richer knowledge of biological affinity. This understanding is important for bioarchaeological contexts, in particular, peopling of the New World studies where focusing on reconciling the results from comparing multiple data types is necessary to move forward.