Assessing the existence of the male–female health-survival paradox in the past: Dental caries in medieval London

Abstract

Objectives

This study seeks to identify signals of the male–female health-survival paradox in medieval London.

Materials and Methods

This study uses skeletal data on age, sex, dental caries (n = 592) and antemortem tooth loss (n = 819) from adult individuals from medieval London cemeteries (c. 1200–1540 CE). The association between age and dental caries was assessed using binary logistic regression. The associations among age, time period (pre- vs. post-Black Death), oral biomarker (dental caries or antemortem tooth loss), and sex were tested using hierarchical log-linear analysis.

Results

The analyses reveal significantly higher odds of dental caries with increasing adult ages, more older adults after the Black Death, different age distributions of dental caries between the sexes, and a greater decrease in the prevalence of dental caries for females after the Black Death. These results appear not to be an artifact of trends in AMTL. However, this study does not yield evidence suggesting that females experienced both a survival advantage and a decline in oral health at late adult ages after the Black Death relative to males.

Conclusions

These results do not provide evidence of the existence of a male–female health-survival paradox, but they do corroborate existing evidence of improvements in health in general in the aftermath of the Black Death. The decreased prevalence of dental caries after the Black Death may reflect dietary improvements or the effects of selective mortality during the epidemic.