Closer to godliness: a contextual study of osteoarchaeological and spatial patterns of diseased individuals in medieval Danish cemeteries

Introduction: Medieval Danish populations (c. 1050-1536 AD) faced numerous
infectious diseases, including leprosy and tuberculosis, that shaped modern
perceptions of medieval health crises. While previous studies explored disease
spread andmitigating factors like leprosaria, it remains unclear how health status influenced burial treatment and placement within church cemeteries. Cemetery analyses may also clarify whether urban-rural mortality differences were affected by proximity to care institutions. This study integrates paleoepidemiology and spatial archaeology to examine health and death treatments in 939 adults from three urban and two rural medieval Danish collections.
Methods: Bone involving disease prevalence was estimated using probabilistic
estimates of sensitivity and specificity from skeletal indicators of leprosy
and tuberculosis, enabling spatial comparisons of infected and non-infected
individuals across cemeteries. Differential survivorship and mortality hazards
were evaluated using Kaplan-Meier and Cox regression analyses.
Results: Results showed no distinct patterns of clustering of skeletons with
positive disease states that suggest specific treatment of disease sufferers
in death, but notable variation was found in burial status distribution and
survivorship between cemeteries with high status individuals having lower
mortality. No significant survivorship differences existed between those with
and without leprosy, whereas tuberculosis-positive individuals had significantly
higher survivorship than non-lesioned peers (p < 0.001).
Discussion: The absence of leprosy sufferers in urban cemeteries reinforces
leprosaria’s selective effect on burial placement, while tuberculosis prevalence
was high across all cemeteries, indicating no differential treatment. This study
demonstrates medieval Danes’ complex relationship with disease, status, and
burial practices.