Selectivity of Black Death mortality with respect to preexisting health

Was the mortality associated with the deadliest known epidemic in human history, the Black Death of 1347–1351, selective with respect to preexisting health conditions (“frailty”)? Many researchers have assumed that the Black Death was so virulent, and the European population so immunologically naïve, that the epidemic killed indiscriminately, irrespective of age, sex, or frailty. If this were true, Black Death cemeteries would provide unbiased cross-sections of demographic and epidemiological conditions in 14th-century Europe. Using skeletal remains from medieval England and Denmark, new methods of paleodemographic age estimation, and a recent multistate model of selective mortality, we test the assumption that the mid-14th-century Black Death killed indiscriminately. Skeletons from the East Smithfield Black Death cemetery in London are compared with normal, nonepidemic cemetery samples from two medieval Danish towns (Viborg and Odense). The results suggest that the Black Death did not kill indiscriminately—that it was, in fact, selective with respect to frailty, although probably not as strongly selective as normal mortality.