title: Cranial vault trauma and selective mortality in medieval to early modern Denmark.
abstract: To date, no estimates of the long-term effect of cranial vault fractures on the risk of dying have been generated from historical or prehistoric skeletons. Excess mortality provides a perspective on the efficacy of modern treatment, as well as the human cost of cranial injuries largely related to interpersonal violence in past populations. Three medieval to early modern Danish skeletal samples are used to estimate the effect of selective mortality on males with cranial vault injuries who survived long enough for bones to heal. The risk of dying for these men was 6.2 times higher than it was for their uninjured counterparts, estimated through a simulation study based on skeletal observations. That is about twice the increased risk of dying experienced by modern people with traumatic brain injuries. The mortality data indicate the initial trauma was probably often accompanied by brain injury. Although the latter cannot be directly observed in skeletal remains, it can be inferred through the relative risks of dying. The ability to identify the effects of selective mortality in this skeletal sample indicates it must be taken into account in paleopathological research. The problem is analogous to extrapolating from death register data to modern communities, so epidemiological studies based on mortality data have the same inherent possibility of biases as analyses of ancient skeletons.
authors.affiliation: Department of Anthropology, Institute of Forensic Medicine, University of Southern Denmark, DK 5260 Odense S, Denmark; ost@psu.edu jboldsen@health.sdu.dk.
authors.forename: Jesper L
authors.initials: JL
authors.lastname: Boldsen
authors.affiliation: Department of Anthropology, Pennsylvania State University, University Park, PA 16802; ost@psu.edu jboldsen@health.sdu.dk.
authors.forename: George R
authors.initials: GR
authors.lastname: Milner
authors.affiliation: Max Planck Institute for Demographic Research, 18057 Rostock, Germany.
authors.forename: Svenja
authors.initials: S
authors.lastname: Weise
mesh_terms: D000367:Age Factors; D001106:Archaeology; D003198:Computer Simulation; D003718:Denmark / Q000453:epidemiology; D049668:History, 15th Century; D049669:History, 16th Century; D049670:History, 17th Century; D049691:History, Medieval; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008954:Models, Biological; D010164:Paleopathology; D012887:Skull Fractures / Q000266:history* / Q000401:mortality* / Q000473:pathology*
keywords: cranial trauma survival; premodern Denmark; selective mortality; violence