Who the Plague Chose: Exploring Intersecting Social Risk in Black Death Mortality.

OBJECTIVES: This study investigates how demographic factors influenced mortality risk during the Black Death. Uniquely, we examine how specific ages-at-death given sex (e.g., 18-26 years old, female) experienced the Black Death and whether the intersection of those identities further compounded vulnerability. We hypothesize that individuals who were at the intersection of being younger and male faced higher mortality risk.

MATERIALS AND METHODS: We analyzed skeletal data from seven medieval London cemeteries using the Wellcome Osteological Research Database (WORD). The variables analyzed were the interaction of sex and age-at-death, and we controlled for heterogeneity in the attritional burials with a variable identifying cemeteries as being composed of laypersons/religious clergy/combination, urban/rural context, and frailty markers. Logistic regression assessed plague mortality risk, with survivorship compared via Kaplan-Meier curves. Missing data were imputed with missForest.

RESULTS: Only one category in the interaction term, males aged 52-64, was statistically significant and protective, showing lower odds of being buried in the plague cemetery. Urban/rural context and layperson/religious/combination were not statistically significant, but the presence of frailty was.

DISCUSSION: Our findings indicate that the Black Death amplified biological and social vulnerabilities: supporting our hypothesis, middle-aged males had higher mortality risk in the Black Death cemetery, possibly due to differences in social buffering and biological resilience. These results demonstrate the complex intersection of social and biological factors in shaping plague mortality, where biological susceptibility may have outweighed social disadvantage. These findings show how pandemics are shaped by existing social inequalities, offering important insight for understanding health disparities.