Is the pen mightier than the sword? Exploring urban and rural health in Victorian England and Wales using the Registrar General Reports

YesIn AD 1836, the General Register Office (GRO) was established to oversee the national system of civil registration in England and Wales, recording all births, deaths and marriages. Additional data regarding population size, division size and patterns of occupation within each division permit urban and rural areas (and those with both urban and rural characteristics, described here as ‘mixed’) to be directly compared to each other. The annual Reports of the Registrar General summarize the collected data, including cause of and age at death, which is of particular value to historical demographers and bioarcheologists, allowing us to investigate demographic patterns in urban and rural districts in the nineteenth century. Overall, this paper aims to highlight how this documentary evidence can supplement osteological and paleopathological data to investigate how urbanization affected the health of past populations. It examines the data contained within the first Registrar General report (for 1837-8), in order to assess patterns of mortality of diverse rural, urban, and mixed populations within England and Wales at a point in time during a period of rapid urbanization. It shows that urban and mixed districts typically had lower life expectancy and different patterns in cause of death compared to rural areas. The paper briefly compares how the documentary data differs from information regarding health from skeletal populations, focusing on the city of London, highlighting that certain age groups (the very young and very old) are typically underrepresented in archeological assemblages and reminding us that, while the paleopathological record offers much in terms of chronic health, evidence of acute disease and importantly cause of death can rarely be ascertained from skeletal remains.This research was funded by the Royal Society of London (Grant Reference IES\R1\180138) and supported by the University of Bradford and SUNY Plattsburgh

Early life patterns of common infection: a latent class analysis

Early life infection has been implicated in the aetiology of many chronic diseases, most often through proxy measures. Data on ten infectious symptoms were collected by parental questionnaire when children were 6 months old as part of the Avon Longitudinal Study of Parents and Children, United Kingdom. A latent class analysis was used to identify patterns of infection and their relationship to five factors commonly used as proxies: sex, other children in the home, maternal smoking, breastfeeding and maternal education. A total of 10,032 singleton children were included in the analysis. Five classes were identified with differing infectious disease patterns and children were assigned to the class for which they had a highest probability of membership based on their infectious symptom profile: ‘general infection’ (n = 1,252, 12.5%), ‘gastrointestinal’ (n = 1,902, 19.0%), ‘mild respiratory’ (n = 3,560, 35.5%), ‘colds/ear ache’ (n = 462, 4.6%) and ‘healthy’ (n = 2,856, 28.5%). Females had a reduced risk of being in all infectious classes, other children in the home were associated with an increased risk of being in the ‘general infection’, ‘mild respiratory’ or ‘colds/ear ache’ class. Breastfeeding reduced the risk of being in the ‘general infection’ and ‘gastrointestinal’ classes whereas maternal smoking increased the risk of membership. Higher maternal education was associated with an increased risk of being in the ‘mild respiratory’ group. Other children in the home had the greatest association with infectious class membership. Latent class analysis provided a flexible method of investigating the relationship between multiple symptoms and demographic and lifestyle factors

O sexo masculino vulnerável: razão de masculinidade entre os óbitos fetais brasileiros The vulnerable male, or the sex ratio among fetal deaths in Brazil

Alguns estudos apontam para a existência de vulnerabilidades biológicas inatas masculinas, especialmente no período perinatal. Foi realizada uma análise transversal da mortalidade fetal brasileira segundo sexo, entre 2000 e 2009 (inclusive), conforme características maternas (idade, escolaridade e duração da gestação), utilizando-se dados disponibilizados pelos sistema DATASUS do Ministério da Saúde. Todos os óbitos fetais do período foram incluídos na análise, excetuando-se os casos em que o sexo do feto não foi declarado. A razão de masculinidade (RM) encontrada para os óbitos fetais foi de 1,188. As categorias mais relacionadas com maior risco (idade entre 10 e 14 anos, nenhuma escolaridade e gestação com menos de 22 semanas) apresentaram maior RM, sendo esses valores, em todos os casos, estatisticamente maiores do que os observados nas outras categorias analisadas (p < 0,05). Verificou-se RM estatisticamente maior (p < 0,05) ao esperado para 13 causas básicas de óbito e menor para duas. Os resultados encontrados pelo estudo apontam para uma possível vulnerabilidade biológica inata masculina.<br>Some studies indicate the existence of innate male vulnerabilities, especially during the perinatal period. The current study is a cross-sectional analysis of fetal mortality in Brazil according to sex from 2000 to 2009, stratified by maternal characteristics (age, schooling, and gestational age), using Ministry of Health data (DATASUS). The analysis included all fetal deaths from 2000 to 2009, except when the sex of the fetus was not recorded. The male/female sex ratio (SR) for all fetal deaths was 1.188. Analysis of maternal characteristics showed that the SR was statistically higher (p < 0.01) in mothers that were younger (10-14 years), had no formal schooling, and with gestational age < 22 weeks. The study showed a statistically higher-than-expected SR (p < 0.01) for 13 underlying causes of death and a lower SR for two others. The results suggest a potential innate male vulnerability

Risk factors for infant mortality in a municipality in southern Brazil: a comparison of two cohorts using hierarchical analysis Fatores de risco para mortalidade infantil em município do Sul do Brasil: comparação de duas coortes em análise hierarquizada

This study compared risk factors for infant mortality in 2000-2001 and 2007-2008 in Londrina, Paraná State, Brazil. Data on live births and infant deaths were linked in a single database, and a hierarchical regression model was used. Distal risk factors for infant mortality in 2000-2001 were maternal age < 20 or &#8805; 35 years and lower maternal schooling. In 2007-2008, maternal age &#8805; 35 or < 20 years were risk factors, while low schooling appeared as a protective factor. The following intermediate factors were associated with increased infant mortality in 2000-2001: multiple pregnancy, history of stillbirth, and insufficient number of prenatal visits, while cesarean delivery was a protective factor. Multiple pregnancy was the only intermediate risk factor in 2007-2008. All of the proximal factors were associated with higher infant mortality in 2000-2001, but only gestational age and 5-minute Apgar in 2007-2008. The risk factors for infant mortality changed from the first to the second cohort, which may be related to the expansion of social policies and primary care and changes in the reproductive and social patterns of Brazilian women.<br>Compararam-se fatores de risco para mortalidade infantil nos anos 2000/2001 e 2007/2008 em Londrina, Paraná, Brasil. Dados sobre nascidos vivos e óbitos infantis foram vinculados em base de dados única, e usou-se análise de regressão em modelo hierárquico. No nível distal, foram de risco para mortalidade infantil, em 2000/2001, idade materna < 20 e &#8805; 35 anos e escolaridade materna baixa. Em 2007/2008, idades maternas &#8805; 35 e < 20 anos foram de risco, enquanto escolaridade baixa, protetora. Associaram-se à maior mortalidade infantil, no nível intermediário, em 2000/2001: gestação múltipla, filhos mortos e número insuficiente de consultas pré-natal, enquanto cesariana foi fator protetor. Em 2007/2008, apenas gestação múltipla foi de risco. Todos os fatores proximais associaram-se à maior mortalidade infantil em 2000/2001 e, em 2007/2008, apenas idade gestacional e Apgar no quinto minuto. Houve mudanças nos fatores de risco para a mortalidade infantil nos biênios analisados, o que pode estar relacionado à ampliação de políticas sociais e de ações básicas de saúde, e a modificações no padrão reprodutivo e social das mulheres