Sex differences in periodontal disease in catastrophic and attritional assemblages from medieval london

Periodontal disease is one of the most common chronic diseases in living populations, and most studies that have examined sex differences in periodontal disease have found higher frequencies in men compared to women. This study examines sex differences in periodontal disease in two cemeteries from medieval London: the East Smithfield cemetery (c. 1349–1350), an exclusively Black Death cemetery that represents catastrophic mortality (n = 161), and the St. Mary Graces cemetery (c. 1350–1538), a post‐Black Death attritional assemblage that represents normal medieval mortality (n = 100). The results reveal a significantly higher frequency of periodontal disease, independent of age, among males compared with females in St. Mary Graces, but no significant difference between the sexes in East Smithfield. The sex differences in the attritional assemblage might reflect heightened susceptibility to periodontal disease in the living population or sex differences in frailty. The differences in the sex patterns of periodontal disease between the two cemeteries might be the result of disproportionately negative effects of the Great Bovine Pestilence and consequent decreases in dairy availability on female oral health among victims of the Black Death. Am J Phys Anthropol, 2012. © 2012 Wiley Periodicals, Inc.     

The effect of sex on risk of mortality during the Black Death in London,A.D. 1349–1350

The Black Death of 1347–1351 was one of the most devastating epidemics in human history, and though it is frequently assumed that the epidemic killed indiscriminately, recent research suggests that the disease was selective, at least with respect to frailty. The purpose of this study is to determine whether the Black Death was similarly selective with respect to biological sex—that is, did either sex face an elevated risk during the epidemic or were men and women at equal risk of dying? A sample of 298 victims of the Black Death, from the East Smithfield cemetery in London, is compared to a pre‐Black Death normal mortality sample of 194 individuals from two Danish urban cemeteries, St Mikkel Church (Viborg) and St Albani Church (Odense). To assess the effect of sex on risk of death, sex is modeled as a covariate affecting the Gompertz–Makeham model of adult mortality. The results suggest that sex did not strongly affect risk of death in either the normal mortality or Black Death samples. These results are important for improving our understanding of Black Death mortality patterns. This is essential for understanding the effects the Black Death had on European populations, and the methods used here can potentially be informatively applied to investigations of other episodes of epidemic diseases in past populations. Am J Phys Anthropol 2009. © 2009 Wiley‐Liss, Inc.     

The Black Death in Hereford,England: A demographic analysis of the Cathedral 14th-century plague mass graves and associated parish cemetery

Objectives

This study explores the paleoepidemiology of the Black Death (1348–52 AD) mass graves from Hereford, England, via osteological analysis. Hereford plague mortality is evaluated in the local context of the medieval city and examined alongside other Black Death burials.

Methods

The Hereford Cathedral site includes mass graves relating to the Black Death and a 12th-16th century parish cemetery. In total, 177 adult skeletons were analyzed macroscopically: 73 from the mass graves and 104 from the parish cemetery. Skeletal age-at-death was assessed using transition analysis, and sex and stress markers were analyzed.

Results

The age-at-death distributions for the mass graves and parish cemetery were significantly different (p = 0.0496). Within the mass graves, young adults (15–24 years) were substantially over-represented, and mortality peaked at 25–34 years. From 35 years of age onwards, there was little variation in the mortality profiles for the mass graves and parish cemetery. Males and females had similar representation across burial types. Linear enamel hypoplasia was more prevalent within the mass graves (p = 0.0340) whereas cribra orbitalia and tibial periostitis were underrepresented.

Conclusions

Mortality within the Hereford mass graves peaked at a slightly older age than is seen within plague burials from London, but the overall profiles are similar. This demonstrates that young adults were disproportionately at risk of dying from plague compared with other age groups. Our findings regarding stress markers may indicate that enamel hypoplasia is more strongly associated with vulnerability to plague than cribra orbitalia or tibial periostitis.     

Mortality Risk and Survival in the Aftermath of the Medieval Black Death

The medieval Black Death (c. 1347-1351) was one of the most devastating epidemics in human history. It killed tens of millions of Europeans, and recent analyses have shown that the disease targeted elderly adults and individuals who had been previously exposed to physiological stressors. Following the epidemic, there were improvements in standards of living, particularly in dietary quality for all socioeconomic strata. This study investigates whether the combination of the selective mortality of the Black Death and post-epidemic improvements in standards of living had detectable effects on survival and mortality in London. Samples are drawn from several pre- and post-Black Death London cemeteries. The pre-Black Death sample comes from the Guildhall Yard (n = 75) and St. Nicholas Shambles (n = 246) cemeteries, which date to the 11^th–12^th centuries, and from two phases within the St. Mary Spital cemetery, which date to between 1120-1300 (n = 143). The St. Mary Graces cemetery (n = 133) was in use from 1350–1538 and thus represents post-epidemic demographic conditions. By applying Kaplan-Meier analysis and the Gompertz hazard model to transition analysis age estimates, and controlling for changes in birth rates, this study examines differences in survivorship and mortality risk between the pre- and post-Black Death populations of London. The results indicate that there are significant differences in survival and mortality risk, but not birth rates, between the two time periods, which suggest improvements in health following the Black Death, despite repeated outbreaks of plague in the centuries after the Black Death.     

Leprosy in the early medieval Lauchheim community

Leprosy was a well-recognized and dreaded disease in medieval Europe (5th-15th century AD). It is reported to have reached Germany with the Roman invasion. A much larger fraction than previously assumed appears to have been affected by leprosy in the medieval period. This article estimates the frequency (i.e., the prevalence at death) of leprosy among adult people buried in the Lauchheim early medieval cemetery. Seven different dichotomous osteological lesions indicative of leprosy are analyzed, and it is possible to score at least one of these conditions on 110 adult skeletons (aged 15 or more). The scores were transformed to a statistic--lambda (lambda)--indicating the likelihood that the person to whom the skeleton belonged suffered from leprosy. The analyses indicate that 16% (95% confidence interval: 9-23%) of adult people in Lauchheim died with osteological signs of leprosy. Leprosy was significantly more prevalent among men than women. The lambda statistic indicates that people who died with signs of leprosy did not differ in the distribution of age at death from those who did not have such signs. Some of the leprosy-related lesions had a statistically significant nonrandom dispersal on the cemetery; but there is no clear pattern to this and the significant results could be easily attributed to a type-1 error in the statistical analysis.     

Oral health and frailty in the medieval English cemetery of St Mary Graces

The analysis of oral pathologies is routinely a part of bioarcheological and paleopathological investigations. Oral health, while certainly interesting by itself, is also potentially informative about general or systemic health. Numerous studies within modern populations have shown associations between oral pathologies and other diseases, such as cardiovascular disease, certain types of cancer, and pulmonary infections. This article addresses the question of how oral health was associated with general health in past populations by examining the relationship between two oral pathologies (periodontal disease and dental caries) and the risk of mortality in a cemetery sample from medieval England. The effects of periodontitis and dental caries on risk of death were assessed using a sample of 190 individuals from the St Mary Graces cemetery, London, dating to ～AD 1350–1538. The results suggest that the oral pathologies are associated with elevated risks of mortality in the St Mary Graces cemetery such that individuals with periodontitis and dental caries were more likely to die than their peers without such pathologies. The results shown here suggest that these oral pathologies can be used as informative indicators of general health in past populations. Am J Phys Anthropol, 2010. © 2009 Wiley‐Liss, Inc.     

The association between periodontal disease and periosteal lesions in the St. Mary Graces cemetery, London, England A.D. 1350-1538

Numerous studies have demonstrated significant associations between periodontal disease and many other diseases in living populations, and some studies have shown that individuals with periodontal disease are at elevated risks of mortality. Recent analysis of a medieval skeletal sample from London has also shown that periodontal disease was associated with increased risks of mortality in the past. This study examines whether periodontal disease is associated with periosteal lesions in a skeletal sample from the urban St. Mary Graces cemetery (n = 265) from medieval London. The results reveal a significant association between periodontal disease and periosteal lesions in the St. Mary Graces sample (i.e., individuals with periodontal disease were also likely to have periosteal lesions), and the association between the two is independent of age. The association between the two pathological conditions might reflect underlying reduced immune competence and thus heightened susceptibility to pathogens that cause periodontal disease or periosteal lesions, exposure to an environmental factor, or underlying heightened inflammatory responses.     

Medieval monastic mortality: Hazard analysis of mortality differences between monastic and nonmonastic cemeteries in England

Scholarship on life in medieval European monasteries has revealed a variety of factors that potentially affected mortality in these communities. Though there is some evidence based on age‐at‐death distributions from England that monastic males lived longer than members of the general public, what is missing from the literature is an explicit examination of how the risks of mortality within medieval monastic settings differed from those within contemporaneous lay populations. This study examines differences in the hazard of mortality for adult males between monastic cemeteries (n = 528) and non‐monastic cemeteries (n = 368) from London, all of which date to between AD 1050 and 1540. Age‐at‐death data from all cemeteries are pooled to estimate the Gompertz hazard of mortality, and “monastic” (i.e., buried in a monastic cemetery) is modeled as a covariate affecting this baseline hazard. The estimated effect of the monastic covariate is negative, suggesting that individuals in the monastic communities faced reduced risks of dying compared to their peers in the lay communities. These results suggest better diets, the positive health benefits of religious behavior, better living conditions in general in monasteries, or selective recruitment of healthy or higher socioeconomic status individuals. Am J Phys Anthropol 152:322–332, 2013. © 2013 Wiley Periodicals, Inc.     

Vertebral morphology influences the development of Schmorl's nodes in the lower thoracic vertebrae

Schmorl's nodes are the result of herniations of the nucleus pulposus into the adjacent vertebral body and are commonly identified in both clinical and archaeological contexts. The current study aims to identify aspects of vertebral shape that correlate with Schmorl's nodes. Two‐dimensional statistical shape analysis was performed on digital images of the lower thoracic spine (T10–T12) of adult skeletons from the late medieval skeletal assemblages from Fishergate House, York, St. Mary Graces and East Smithfield Black Death cemeteries, London, and postmedieval Chelsea Old Church, London. Schmorl's nodes were scored on the basis of their location, depth, and size. Results indicate that there is a correlation between the shape of the posterior margin of the vertebral body and pedicles and the presence of Schmorl's nodes in the lower thoracic spine. The size of the vertebral body in males was also found to correlate with the lesions. Vertebral shape differences associated with the macroscopic characteristics of Schmorl's nodes, indicating severity of the lesion, were also analyzed. The shape of the pedicles and the posterior margin of the vertebral body, along with a larger vertebral body size in males, have a strong association with both the presence and severity of Schmorl's nodes. This suggests that shape and/or size of these vertebral components are predisposing to, or resulting in, vertically directed disc herniation. Am J Phys Anthropol, 2012. © 2012 Wiley Periodicals, Inc.     

Paleodemographic comparison of a catastrophic and an attritional death assemblage

The aim of this contribution is to examine the effect of an indiscriminate epidemic on a population to assess whether or not a catastrophic event can be identified from examination of paleodemographic data. Using paleodemographic techniques, the death assemblage from the Royal Mint site, London, a Black Death cemetery dated 1349 AD, is compared with that from St. Helen-on-the-Walls, York, which dates from the twelfth to the sixteenth centuries AD. The Royal Mint site represents a catastrophic cemetery, while that of St. Helen-on-the-Walls is of an attritional type. Certain features of the paleodemographic profile of the plague victims suggest that the population had been affected by factors other than natural wastage. Three factors are proposed which may define an indiscriminate catastrophic event in preindustrial populations.     

Mobility,mortality, and the middle ages: Identification of migrant individuals in a 14th century black death cemetery population

Mobility and migration patterns of groups and individuals have long been a topic of interest to archaeologists, used for broad explanatory models of cultural change as well as illustrations of historical particularism. The 14th century AD was a tumultuous period of history in Britain, with severely erratic weather patterns, the Great Famine of 1315–1322, the Scottish Wars of Independence, and the Hundred Years' War providing additional migration pressures to the ordinary economic issues drawing individuals to their capital under more stable conditions. East Smithfield Black Death Cemetery (Royal Mint) had a documented use period of only 2 years (AD 1348–1350), providing a precise historical context (～50 years) for data. Adults (n = 30) from the East Smithfield site were sampled for strontium and oxygen stable isotope analyses of tooth enamel. Five individuals were demonstrated to be statistical outliers through the combined strontium and oxygen isotope data. Potential origins for migrants ranged from London's surrounding hinterlands to distant portions of northern and western Britain. Historic food sourcing practices for London were found to be an important factor for consideration in a broader than expected ⁸⁷Sr/⁸⁶Sr range reflected in a comparison of enamel samples from three London datasets. The pooled dataset demonstrated a high level of consistency between site data, divergent from the geologically predicted range. We argue that this supports the premise that isotope data in human populations must be approached as a complex interaction between behavior and environment and thus should be interpreted cautiously with the aid of alternate lines of evidence. Am J Phys Anthropol, 2013. © 2012 Wiley Periodicals, Inc.     

Brief and precarious lives: infant mortality in contrasting sites from medieval and post-medieval England (AD 850-1859)

This study compares the infant mortality profiles of 128 infants from two urban and two rural cemetery sites in medieval England. The aim of this paper is to assess the impact of urbanization and industrialization in terms of endogenous or exogenous causes of death. In order to undertake this analysis, two different methods of estimating gestational age from long bone lengths were used: a traditional regression method and a Bayesian method. The regression method tended to produce more marked peaks at 38 weeks, while the Bayesian method produced a broader range of ages and were more comparable with the expected "natural" mortality profiles.At all the sites, neonatal mortality (28-40 weeks) outweighed post-neonatal mortality (41-48 weeks) with rural Raunds Furnells in Northamptonshire, showing the highest number of neonatal deaths and post-medieval Spitalfields, London, showing a greater proportion of deaths due to exogenous or environmental factors. Of the four sites under study, Wharram Percy in Yorkshire showed the most convincing "natural" infant mortality profile, suggesting the inclusion of all births at the site (i.e., stillbirths and unbaptised infants).     

Validation of Inverse Seasonal Peak Mortality in Medieval Plagues,Including the Black Death,in Comparison to Modern Yersinia pestis-Variant Diseases

Background

Recent studies have noted myriad qualitative and quantitative inconsistencies between the medieval Black Death (and subsequent “plagues”) and modern empirical Y. pestis plague data, most of which is derived from the Indian and Chinese plague outbreaks of A.D. 1900±15 years. Previous works have noted apparent differences in seasonal mortality peaks during Black Death outbreaks versus peaks of bubonic and pneumonic plagues attributed to Y. pestis infection, but have not provided spatiotemporal statistical support. Our objective here was to validate individual observations of this seasonal discrepancy in peak mortality between historical epidemics and modern empirical data.

Methodology/Principal Findings

We compiled and aggregated multiple daily, weekly and monthly datasets of both Y. pestis plague epidemics and suspected Black Death epidemics to compare seasonal differences in mortality peaks at a monthly resolution. Statistical and time series analyses of the epidemic data indicate that a seasonal inversion in peak mortality does exist between known Y. pestis plague and suspected Black Death epidemics. We provide possible explanations for this seasonal inversion.

Conclusions/Significance

These results add further evidence of inconsistency between historical plagues, including the Black Death, and our current understanding of Y. pestis-variant disease. We expect that the line of inquiry into the disputed cause of the greatest recorded epidemic will continue to intensify. Given the rapid pace of environmental change in the modern world, it is crucial that we understand past lethal outbreaks as fully as possible in order to prepare for future deadly pandemics.     

Body Mass Index and All-Cause Mortality in a Large Prospective Cohort of White and Black U.S. Adults

Remaining controversies on the association between body mass index (BMI) and mortality include the effects of smoking and prevalent disease on the association, whether overweight is associated with higher mortality rates, differences in associations by race and the optimal age at which BMI predicts mortality. To assess the relative risk (RR) of mortality by BMI in Whites and Blacks among subgroups defined by smoking, prevalent disease, and age, 891,572 White and 38,119 Black men and women provided height, weight and other information when enrolled in the Cancer Prevention Study II in 1982. Over 28 years of follow-up, there were 434,400 deaths in Whites and 18,702 deaths in Blacks. Cox proportional-hazards regression was used to estimate multivariable-adjusted relative risks (RR) and 95% confidence intervals (CI). Smoking and prevalent disease status significantly modified the BMI-mortality relationship in Whites and Blacks; higher BMI was most strongly associated with higher risk of mortality among never smokers without prevalent disease. All levels of overweight and obesity were associated with a statistically significantly higher risk of mortality compared to the reference category (BMI 22.5–24.9 kg/m²), except among Black women where risk was elevated but not statistically significant in the lower end of overweight. Although absolute mortality rates were higher in Blacks than Whites within each BMI category, relative risks (RRs) were similar between race groups for both men and women (p-heterogeneity by race  = 0.20 for men and 0.23 for women). BMI was most strongly associated with mortality when reported before age 70 years. Results from this study demonstrate for the first time that the BMI-mortality relationship differs for men and women who smoke or have prevalent disease compared to healthy never-smokers. These findings further support recommendations for maintaining a BMI between 20–25 kg/m² for optimal health and longevity.     

Body Mass Index and Mortality in Non-Hispanic Black Adults in the NIH-AARP Diet and Health Study

Background

Although the prevalence of obesity (body mass index, kg/m², BMI ≥30) is higher in non-Hispanic blacks than in non-Hispanic whites, the relation of BMI to total mortality in non-Hispanic blacks is not well defined.

Purpose

We investigated the association between BMI and total mortality in 16,471 non-Hispanic blacks in the NIH-AARP Diet and Health Study, a prospective cohort of adults aged 50–71 years.

Methods

During an average of 13 years of follow-up, 2,609 deaths were identified using the Social Security Administration Death Master File and the National Death Index. Cox proportional hazard models were used to estimate relative risks and two-sided 95% confidence intervals (CI), adjusting for potential confounders.

Results

Among individuals with no history of cancer or heart disease at baseline and had a BMI of 20 or greater, the relative risk for total death was 1.12 (95% CI:1.05, 1.19, for a 5-unit increase in BMI) in men and 1.09 (95% CI:1.03, 1.15) in women. Among never smokers with no history of cancer or heart disease at baseline, relative risks for total death for BMI 25–<30, 30–<35, 35–<40, and 40–50, compared with BMI 20–<25, were 1.27 (95% CI: 0.91, 1.78), 1.56 (95% CI: 1.07, 2.28), 2.48 (95% CI: 1.53, 4.05), and 2.80 (95% CI: 1.46, 5.39), respectively, in men and 0.78 (95% CI: 0.59, 1.04), 1.17 (95% CI: 0.88, 1.57), 1.35 (95% CI: 0.96, 1.90), and 1.93 (95% CI: 1.33, 2.81), respectively, in women.

Conclusions

Our findings suggest that overweight is related to an increased risk of death in black men, but not in black women, while obesity is related to an increased risk of death in both black men and women. A large pooled analysis of existing studies is needed to systematically evaluate the association between a wide range of BMIs and total mortality in blacks.     

Abandonment of farmland and vegetation succession following the Eurasian plague pandemic of ad 1347–52

Aim This paper reviews the available documentary, archaeological and palaeoecological evidence for the abandonment of agricultural land and consequent regeneration of the forest in Europe after the Black Death. Location Western and northern Europe. Methods This review is the result of an exhaustive search of the historical, archaeological and palaeoecological literature for evidence indicating agricultural decline and forest regeneration in Eurasia during the 14th century. The available evidence for landscape change can be divided into two categories: (1) documentary and archaeological sources, and (2) palaeoecological reconstructions of past vegetation. In the past few years, several pollen diagrams from north‐west Europe have been reported with precise chronologies (decadal and even annual scale) showing the abandonment of farmland and consequent ecological change in the late medieval period. Results and main conclusions There is strong evidence of agricultural continuity at several sites in Western Europe at the time of the Black Death. The effects of the Black Death on the European rural landscape varied geographically, with major factors probably including the impact of the plague on the local population, and soil quality. At two sites in western and northern Ireland, the late medieval decline in cereal agriculture was probably a direct result of population reduction following the Black Death. In contrast, the decline in cereal production began at sites in Britain and France before the Black Death pandemic of ad 1347–52, and was probably due to the crisis in the agricultural economy, exacerbated by political instability and climate deterioration. Much of the abandoned arable land was probably exploited for grazing during the period between the decline in cereal farming and the Black Death. In the aftermath of the Black Death, grazing pressure was greatly reduced owing to reductions in the grazing animal population and a shortage of farmers. Vegetation succession on the abandoned grazing land resulted in increased cover of woody tree species, particularly Betula and Corylus, by the late 14th century. The cover of woodland was greatest at c.ad 1400, before forest clearance and agriculture increased in intensity.     

Mortality in young offenders: retrospective cohort study

Objectives To estimate overall and cause specific standardised mortality ratios in young offenders.Design Comparison of mortality data in cohort of young offenders.Settings State of Victoria, Australia.Subjects Cohort of young offenders aged 10-20 years with a first custodial sentence from 1 January 1988 to 31 December 1999.Main outcome measures Deaths ascertained by matching with the national death index, a database containing records of all deaths in Australia since 1980. Death rates in the reference Victorian population used to calculate standardised mortality ratios.Results The offender cohort comprised 2621 men and 228 women with 11 333 person years of observation. The median age of first detention was 17.9 years for men and 18.4 years for women. Median follow up was 3.3 years for men and 1.4 years for women. Overall standardised mortality ratio adjusted for age (expressed as a ratio) was 9.4 (95% confidence interval 7.4 to 11.9) for men and 41.3 (20.2 to 84.7) for women. Cause specific standardised mortality ratios for men were 25.7 (17.9 to 36.9) for drug related causes, 9.2 (5.8 to 15) for suicide, and 5.7 (3.6 to 9.2) for non-intentional injury. A quarter of drug related deaths in men aged 15-19 years were in offenders.Conclusions Social policies for young offenders should address both the prevalent drug and mental health problems as well the high levels of social disadvantage.     

The distribution of selenium and mortality owing to acquired immune deficiency syndrome in the continental United States

A hypothesis has been proposed that Selenium (Se) concentration in the environment as measured by its uptake by alfalfa, which sorbs Se from the soil in proportion to what is present, exerted an apparent effect on incidence of (acquired immune deficiency syndrome) AIDS such that AIDS’ mortality within the conterminous United States was lower where the Se quantity in the soil was high than where the amount was low. The object of this study was to test this hypothesis for statistical significance and to discover whether the apparent pattern of AIDS mortality in relation to Se distribution holds true with respect to all ages, both races (Black and White), and both genders. The statistical analysis employed was analysis of variance. Age-specific data as well as age-adjusted data were subject to statistical analysis. Ages where AIDS mortality rates per 100,000 were greatest were in the range from 25–54 yr for low-, medium-, and high-Se areas of the US. Black mortality owing to AIDS showed highly statistically significant results for the three Se regions, both genders, and six age groups, whereas white mortality was not as significantly affected by Se. A hypothesis is proposed that the Black population during the last decade or so has been less migratory than the White population. Thus, their food supply and hence its Se content have been more stable than that of the White population, which is more prone to consume imported foods of unknown Se content and be more migratory. A second hypothesis is advanced that suggests that medical care is not equally available to the poor and especially poor Blacks. Black men and women die at a greater death rate than do Whites. This implies that a lack of medical care is the true cause. This article suggests that a pattern exists between the geographical distribution of Se using alfalfa as a dietary guide and AIDS’ mortality such that an inverse relationship persists between Se quantity in an area and AIDS’ mortality in the same area.     

If a population crashes in prehistory, and there is no paleodemographer there to hear it, does it make a sound?

Catastrophic episodes (e.g., epidemics, natural disasters) strike with only limited regard for age. A large percentage of catastrophic mortality in a population can lead to a death distribution that resembles the living distribution, which includes greater numbers of older children, adolescents, and young adults than typical mortality profiles. This paper examines both the population implications of a large catastrophic mortality event, based on the Black Death as it ravaged medieval Europe, and its long-term effects on age-at-death distributions. An increased prevalence of epidemic disease is a common feature of reconstructions of the shift to agriculture and the rise of urban centers. The model begins with a hypothetical Medieval living population. This population is stable and characterized by slow growth. It has fertility and mortality rates consistent with a natural-fertility, agrarian population. The effects of catastrophic episodes are simulated by projecting the model population and subjecting it to one large (30% mortality) catastrophic episode as part of a 100-year population projection. A pair of Leslie matrices forms the basis of the projection. The catastrophic episode has important, long-term effects on both the living population and the cumulative distribution of death. The living population fails to recover from plague losses; at the end of the projection, population is still less than 75% its pre-plague level. The age-at-death distribution takes on the juvenile-young adult-heavy profile characteristic of many archaeological samples. The cumulative death profile based on the projection differs from that produced by the stable model significantly (P < 0.05) for 25-50 years after the plague episode, depending on sample size.     

The CroHort study: cardiovascular behavioral risk factors in adults, school children and adolescents, hospitalized coronary heart disease patients, and cardio rehabilitation groups in Croatia

Based on repeated measurement of health behaviors the CroHort Study showed that health behavior explains a great deal more of class inequalities in mortality than observed in previous studies. These include decreasing prevalence of smoking and increase in obesity, hypertension and diabetes mellitus. The lowest prevalence of health risks was recorded among children and adolescents, followed by general adult population from the CroHort Study. Hospitalized coronary heart disease patients had higher risks prevalence than general population, while the highest prevalence of risks was recorded among patients in cardiac rehabilitation program. The higher levels of stress were associated to lower financial conditions, poorer social functioning and poorer mental health for both men and women. Higher levels of stress were also associated with heart problems, higher alcohol consumption in men while in women stress was associated to poorer general health, higher age and lower levels of education.