Skeletal manifestations of disease experience: Length of illness and porous cranial lesion formation in a contemporary juvenile mortality sample

Abstract

ObjectivesPorous lesions of the orbit (cribra orbitalia [CO]) and cranial vault (porotic hyperostosis [PH]) are used as skeletal indicators of childhood stress. Because they are understudied in contemporary populations, their relationship to disease experience is poorly understood. This paper examines the relationship between length of childhood illness and CO/PH formation in a clinically documented sample. “Turning points,” which identify the window for lesion formation for CO/PH, are defined, implications for hidden heterogeneity in frailty are considered.MethodsData are from 333 (199 males; 134 females) pediatric postmortem computed tomography scans. Individuals died in New Mexico (2011–2019) and are 0.5 to 15.99 years (mean = 7.1). Length of illness was estimated using information from autopsy and field reports. Logistic regression was used to estimate predicted probabilities, odds ratios, and the temporal window for lesion formation.ResultsIllness, single bouts, or cumulative episodes lasting over 1 month is associated with higher odds of CO; individuals who were never sick have lower odds of having PH. This relationship was consistent for fatal and incidental illnesses that did not cause death. The developmental window for CO formation appears to close at 8 years.ConclusionsThose ill for over 1 month are more likely to have CO/PH than those with acute illnesses. Some individuals lived sufficiently long to form CO/PH but died of illness. Others with lesions died of circumstances unrelated to disease. This indicates hidden variation in robusticity even among ill individuals with CO/PH, which is vital in interpreting lesion frequencies in the archeological record.

Perinatal Disorders and Small Birthweight Are Significantly Associated With Small Vertebral Neural Canal Size in a Contemporary Pediatric Autopsy Sample

“…68 Furthermore, those with natural MOD may be frailer than those who died in accidents. 66,69 Here, individuals with natural MOD have smaller VNC size overall and smaller T12-TR metrics in particular than those who died of other causes (Figure 5, Table 2). This speaks to the relative frailty of children who experienced ELS or illness that compromised VNC growth during that particular DSW.…”

“…Individuals who die of natural causes may have increased “frailty” or heightened risk of death/illness compared with others in the population from which they derived 68. Furthermore, those with natural MOD may be frailer than those who died in accidents 66,69. Here, individuals with natural MOD have smaller VNC size overall and smaller T12-TR metrics in particular than those who died of other causes (Figure 5, Table 2).…”

“…Natural deaths are likely representative of individuals who are the most at risk of illness/death in a population. These individuals exhibit evidence of physiological scarring: 66 ELS leads to increased susceptibility to death from illness and skeletal evidence of ELS (reduced VNC size). Reduced VNC size stems from early life experiences and indicates risks for, at the least, morbidity and, at worst, premature mortality.…”

“…43,44 Few studies focus on reference pediatric osteological/ clinical samples to understand the biological, developmental, pathological, and/or socioeconomic factors that might lead to the development of skeletal stress indicators (see also Corron et al 45 and O'Donnell et al in prep. [46][47][48] ) This is primarily because of the lack of sizeable pediatric reference samples. [1][2][3] Most published studies inferring early childhood stress from small VNC focus on adults from archeological contexts with unverified or estimated demographic information (e.g.…”

“…This speaks to the relative frailty of children who experienced ELS or illness that compromised VNC growth during that particular DSW. 31,45 Children who died from natural causes may have suffered health insults that slowed or stopped VNC growth either in utero or during the first few years of childhood and potentially permanently "scarred" their physiology, 66 leaving them susceptible to severe illness and earlier mortality compared with other children.…”