Lower respiratory tract disease as an indicator of childhood health in the post-medieval Low Countries

Objective To examine the prevalence of lower respiratory tract diseases (LRTDs) in post-medieval non-adult skeletal assemblages from the Low Countries and to assess whether their occurrence was influenced by socioeconomic status. Materials We analyzed 146 non-adult individuals from eight urban sites dating between 1492 and 1850 CE, representing populations from diverse socioeconomic groups. Methods New bone formation on visceral surfaces of ribs was assessed macroscopically as a proxy for LRTDs. Firth logistic regression and Fisher’s Exact test were used to analyze associations between lesions, socioeconomic status, and age-at-death. Results 15.8% (23/146) of the analyzed individuals showed evidence of new bone formation. Lesions were distributed evenly across age groups and socioeconomic strata (low: 15.6%, 12/77; middle: 15.6%, 5/32; high: 16.2%, 6/37) with no significant associations observed. Conclusions Despite well-documented historical inequalities in living conditions and access to healthcare, no socioeconomic gradient was observed in rib lesion frequency. This may reflect a widespread exposure of children to risk factors for respiratory disease. Significance This study adds to the growing body of literature on historical health in the Low Countries and provides important insights into the challenges of using new bone formation on visceral surfaces of ribs as an indicator of past health. Limitations Small sample sizes, only moderate inter-observer agreement, and the inherent complexity of new bone formation on ribs as a diagnostic marker for respiratory health. Suggestions for further research Broader comparative studies are needed to clarify the role of LRTDs in shaping childhood health outcomes in past populations.