Publications by authors named "Jesper Lier Boldsen"

8 Publications

  • Page 1 of 1

A millennium of population change in pre-modern Danish Ribe.

Anthropol Anz 2020 Feb;77(1):13-25

Unit of Anthropology (ADBOU), Department of Forensic Medicine, University of Southern Denmark, Odense, Denmark.

Denmark experienced major socioeconomic changes, including overall population growth, during the Viking, medieval and post-medieval periods from ca. AD 800 to 1800. Archaeological skeletons provide a unique perspective on the population structure of Ribe, a Danish town in Jutland, during the millennium that immediately precedes the industrialization of northern Europe. This skeletal study adds temporal depth to our understanding of an overall trend toward longer life as seen from historical records and in modern studies. Adult male and female mean age at death and mortality profiles during three time periods are based on 943 adult skeletons from three urban cemeteries that collectively represent a cross-section of this urban community. For both males and females, the mean age at death decreased slightly from the Viking (males 38.5 years, females 38.6 years) to the medieval (males 37.4 years, females 36.9 years) periods. This decline was followed by an increase in mean age at death for both sexes from the medieval to post-medieval (males 40.4 years, females 43.2 years) periods, a notable gain of 3.0 and 6.3 years for men and women, respectively.
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http://dx.doi.org/10.1127/anthranz/2019/0952DOI Listing
February 2020

The association between skeletal lesions and tuberculosis diagnosis using a probabilistic approach.

Int J Paleopathol 2019 12 17;27:88-100. Epub 2019 Jan 17.

Unit of Anthropology (ADBOU), Department of Forensic Medicine, University of Southern Denmark, Denmark.

Sensitivity and specificity estimates for 18 skeletal lesions were generated from modern skeletons for future paleoepidemiological analyses of tuberculosis prevalence in archaeological samples. A case-control study was conducted using 480 skeletons from 20 century American skeletal collections. One-half of the skeletons were documented tuberculosis cases (Terry Collection). The remaining age and sex-matched skeletons were controls (Bass Collection). The association between 18 candidate skeletal lesions and tuberculosis was established by comparing lesion distributions in case and control groups. Lesion indicators at six locations - visceral surface of ribs, ventral vertebral bodies, lateral part of ilium, acetabular fossa, iliac auricular surface, and ulna olecranon process - occurred significantly more often among cases than in controls, and were associated with one another. The most useful indicator proved to be a bony reaction on ventral thoracic and lumbar vertebral bodies. Its presence means a 53.3% probability of a true tuberculosis diagnosis. Because of the nature of the reference sample - 20th century American cases - sensitivity and specificity estimates will better estimate disease prevalence in archaeological samples from cultural settings where pulmonary tuberculosis predominated. The general approach of this proof-of-concept study is applicable to other diseases that occur commonly and affect bone.
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http://dx.doi.org/10.1016/j.ijpp.2019.01.001DOI Listing
December 2019

Tuberculosis in medieval and early modern Denmark: A paleoepidemiological perspective.

Int J Paleopathol 2019 12 3;27:101-108. Epub 2018 Dec 3.

Unit of Anthropology (ADBOU), Department of Forensic Medicine, University of Southern Denmark, Denmark.

Millions of people worldwide have sickened and died from tuberculosis in recent centuries. Yet for most of human existence, the impact of tuberculosis on society is largely unknown. It is, indeed, unknowable without methods suitable for estimating disease prevalence in skeletal samples. Here such a procedure is applied to medieval and early modern Danish skeletons, and it shows how disease prevalence varied with differences in socioeconomic conditions. The approach is based on sensitivity and specificity estimates from modern skeletons. To augment our understanding of tuberculosis in Danish history, 713 adult skeletons were examined, all from Ribe. Tuberculosis increased from 17% to 40% in the medieval to early modern periods in Ribe. Low status (29%) people were more likely to contract the disease than those of high status (10%). The general model, derived from the modern expression of tuberculosis, fits the early modern sample better than it does the medieval skeletons. Differences in the model's fit indicate the skeletal expression changed over time. Notably, rib lesions increased in frequency from the medieval to early modern periods. The approach developed here can provide insights into host-pathogen relationships and disease expression in future work with tuberculosis and other diseases that affect the skeleton.
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http://dx.doi.org/10.1016/j.ijpp.2018.11.003DOI Listing
December 2019

Third molar development in a contemporary Danish 13-25year old population.

Forensic Sci Int 2018 Aug 16;289:12-17. Epub 2018 May 16.

Department of Forensic Medicine, University of Copenhagen, Frederik V's Vej 11, 2100 Copenhagen, Denmark. Electronic address:

We present a reference database for third molar development based on a contemporary Danish population. A total of 1302 digital panoramic images were evaluated. The images were taken at a known chronological age, ranging from 13 to 25years. Third molar development was scored according to the Köhler modification of the 10-stage method of Gleiser and Hunt. We found that third molar development was generally advanced in the maxilla compared to the mandible and in males compared to females; in addition, the mandibular third molar mesial roots were generally more advanced in development than were the distal roots. There was no difference in third molar development between the left and right side of the jaws. Establishing global and robust databases on dental development is crucial for further development of forensic methods to evaluate age.
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http://dx.doi.org/10.1016/j.forsciint.2018.05.005DOI Listing
August 2018

On the distribution of trace element concentrations in multiple bone elements in 10 Danish medieval and post-medieval individuals.

Am J Phys Anthropol 2017 01 15;162(1):90-102. Epub 2016 Sep 15.

Department of Forensic Medicine, University of Southern Denmark, Lucernemarken 20, DK-5260 Odense S, Denmark.

Background: The differences in trace element concentrations among 19 different bone elements procured from 10 archaeologically derived human skeletons have been investigated. The 10 individuals are dated archaeologically and some by radiocarbon dating to the medieval and post-medieval period, an interval from ca. AD 1150 to ca. AD 1810. This study is relevant for two reasons. First, most archaeometric studies analyze only one bone sample from each individual; so to what degree are the bones in the human body equal in trace element chemistry? Second, differences in turnover time of the bone elements makes the cortical tissues record the trace element concentrations in equilibrium with the blood stream over a longer time earlier in life than the trabecular. Therefore, any differences in trace element concentrations between the bone elements can yield what can be termed a chemical life history of the individual, revealing changes in diet, provenance, or medication throughout life.

Methods: Thorough decontamination and strict exclusion of non-viable data has secured a dataset of high quality. The measurements were carried out using Inductively Coupled Plasma Mass Spectrometry (for Fe, Mn, Al, Ca, Mg, Na, Ba, Sr, Zn, Pb and As) and Cold Vapor Atomic Absorption Spectroscopy (for Hg) on ca. 20 mg samples.

Results: Twelve major and trace elements have been measured on 19 bone elements from 10 different individuals interred at five cemeteries widely distributed in medieval and renaissance Denmark. The ranges of the concentrations of elements were: Na (2240-5660 µg g ), Mg (440-2490 µg g ), Al (9-2030 µg g ), Ca (22-36 wt. %), Mn (5-11450 µg g ), Fe (32-41850 µg g ), Zn (69-2610 µg g ), As (0.4-120 µg g ), Sr (101-815 µg g ), Ba (8-880 µg g ), Hg (7-78730 ng g ), and Pb (0.8-426 µg g ).

Conclusions: It is found that excess As is mainly of diagenetic origin. The results support that Ba and Sr concentrations are effective provenance or dietary indicators. Migrating behavior or changes in diet have been observed in four individuals; non-migratory or non-changing diet in six out of the 10 individuals studied. From the two most mobile (most changing diet) individuals in the study, it is deduced that the fastest turnover is seen in the trabecular tissues of the long bones and the hands and the feet, and that these bone elements have higher turnover rates than centrally placed trabecular bone tissue, such as from the ilium or the spine. Comparing Sr and published bone turnover times, it is concluded that the differences seen in Sr concentrations are not caused by diagenesis, but by changes of diet or provenance. Finally, it is concluded that there can be two viable interpretations of the Pb concentrations, which can either be seen as an indicator for social class or a temporal development of increased Pb exposure over the centuries.
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http://dx.doi.org/10.1002/ajpa.23099DOI Listing
January 2017

Cost-consequence analysis of cause of death investigation in Finland and in Denmark.

Forensic Sci Int 2014 12 31;245:133-42. Epub 2014 Oct 31.

Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 3-209, 9220 Aalborg, Denmark. Electronic address:

The 1990s 12-16% total autopsy rate in Denmark has until now declined to 4%, while in Finland, it has remained between 25 and 30%. The decision to proceed with a forensic autopsy is based on national legislation, but it can be assumed that the financing of autopsies influences the decision process. Only little is known about the possible differences between health economics of Finnish and Danish cause of death investigation systems. The aims of this article were to analyse costs and consequences of Finnish and Danish cause of death investigations, and to develop an alternative autopsy practice in Denmark with another cost profile. Data on cause of death investigation systems and costs were derived from Departments of Forensic Medicine, Departments of Pathology, and the National Police. Finnish and Danish autopsy rates were calculated in unnatural (accident, suicide, homicide and undetermined intent) and natural (disease) deaths, and used to develop an alternative autopsy practice in Denmark. Consequences for society were analysed. The estimated unit cost (€) for one forensic autopsy is 3.2 times lower in Finland than in Denmark (€1400 versus €4420), but in Finland the salaries for forensic pathologists working at the National Institute for Health and Welfare are not included in the unit cost. The unit cost for one medical autopsy is also lower in Finland than in Denmark; €700 versus €1070. In our alternative practice in Denmark, the forensic autopsy rate was increased from 2.2% to 8.5%, and the medical autopsy rate from 2.4% to 5.8%. Costs per 10,000 deaths were estimated to be 50% (±25%) higher than now; i.e. €3,678,724 (2,759,112-4,598,336), but would result in a lower unit cost for forensic autopsies €3,094 (2,320-3,868) and for medical autopsies €749 (562-936). This practice would produce a higher accuracy of national mortality statistics, which, consequently, would entail higher quality in public health, an accurate basis for decision-making in health politics, and better legislative safety in society. The implementation of this alternative practice in Denmark requires that legislation demands that forensic autopsy be performed if causality between unnatural death and cause of death cannot be clarified or if cause of death remains unknown. The Danish Health and Medicines Authority should provide guidelines that request a medical autopsy in natural deaths where more information about disease as a cause of death is needed. Our study results warrant similar health economic analyses of different cause of death investigations in other countries.
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http://dx.doi.org/10.1016/j.forsciint.2014.10.032DOI Listing
December 2014

Coding ill-defined and unknown cause of death is 13 times more frequent in Denmark than in Finland.

Forensic Sci Int 2014 Nov 28;244:289-94. Epub 2014 Sep 28.

Department of Forensic Medicine, Aarhus University, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark. Electronic address:

Exact cause and manner of death determination improves legislative safety for the individual and for society and guides aspects of national public health. In the International Classification of Diseases, codes R00-R99 are used for "symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified" designated as "ill-defined" or "with unknown etiology". The World Health Organisation recommends avoiding the use of ill-defined and unknown causes of death in the death certificate as this terminology does not give any information concerning the possible conditions that led to the death. Thus, the aim of the study was, firstly, to analyse the frequencies of R00-R99-coded deaths in mortality statistics in Finland and in Denmark and, secondly, to compare these and the methods used to investigate the cause of death. To do so, we extracted a random 90% sample of the Finnish death certificates and 100% of the Danish certificates from the national mortality registries for 2000, 2005 and 2010. Subsequently, we analysed the frequencies of forensic and medical autopsies and external clinical examinations of the bodies in R00-R99-coded deaths. The use of R00-R99 codes was significantly higher in Denmark than in Finland; OR 18.6 (95% CI 15.3-22.4; p<0.001) for 2000, OR 9.5 (95% CI 8.0-11.3; p<0.001) for 2005 and OR 13.2 (95% CI 11.1-15.7; p<0.001) for 2010. More than 80% of Danish deaths with R00-R99 codes were over 70 years of age at the time of death. Forensic autopsy was performed in 88.3% of Finnish R00-R99-coded deaths, whereas only 3.5% of Danish R00-R99-coded deaths were investigated with forensic or medical autopsy. The codes that were most used in both countries were R96-R99, meaning "unknown cause of death". In Finland, all of these deaths were investigated with a forensic autopsy. Our study suggests that if all deaths in all age groups with unclear cause of death were systematically investigated with a forensic autopsy, only 2-3/1000 deaths per year would be coded as an ill-defined and unknown cause of death in national mortality statistics. At the same time the risk to overlook unnatural deaths is decreased to a minimum. To achieve this in Denmark requires that the existing legislation on cause of death investigation would need to be changed to ensure that all deaths with unknown cause of death are investigated with a forensic autopsy.
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http://dx.doi.org/10.1016/j.forsciint.2014.09.016DOI Listing
November 2014

Coding ill-defined and unknown cause of death is 13 times more frequent in Denmark than in Finland.

Forensic Sci Int 2014 Nov 28;244:289-94. Epub 2014 Sep 28.

Department of Forensic Medicine, Aarhus University, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark. Electronic address:

Exact cause and manner of death determination improves legislative safety for the individual and for society and guides aspects of national public health. In the International Classification of Diseases, codes R00-R99 are used for "symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified" designated as "ill-defined" or "with unknown etiology". The World Health Organisation recommends avoiding the use of ill-defined and unknown causes of death in the death certificate as this terminology does not give any information concerning the possible conditions that led to the death. Thus, the aim of the study was, firstly, to analyse the frequencies of R00-R99-coded deaths in mortality statistics in Finland and in Denmark and, secondly, to compare these and the methods used to investigate the cause of death. To do so, we extracted a random 90% sample of the Finnish death certificates and 100% of the Danish certificates from the national mortality registries for 2000, 2005 and 2010. Subsequently, we analysed the frequencies of forensic and medical autopsies and external clinical examinations of the bodies in R00-R99-coded deaths. The use of R00-R99 codes was significantly higher in Denmark than in Finland; OR 18.6 (95% CI 15.3-22.4; p<0.001) for 2000, OR 9.5 (95% CI 8.0-11.3; p<0.001) for 2005 and OR 13.2 (95% CI 11.1-15.7; p<0.001) for 2010. More than 80% of Danish deaths with R00-R99 codes were over 70 years of age at the time of death. Forensic autopsy was performed in 88.3% of Finnish R00-R99-coded deaths, whereas only 3.5% of Danish R00-R99-coded deaths were investigated with forensic or medical autopsy. The codes that were most used in both countries were R96-R99, meaning "unknown cause of death". In Finland, all of these deaths were investigated with a forensic autopsy. Our study suggests that if all deaths in all age groups with unclear cause of death were systematically investigated with a forensic autopsy, only 2-3/1000 deaths per year would be coded as an ill-defined and unknown cause of death in national mortality statistics. At the same time the risk to overlook unnatural deaths is decreased to a minimum. To achieve this in Denmark requires that the existing legislation on cause of death investigation would need to be changed to ensure that all deaths with unknown cause of death are investigated with a forensic autopsy.
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http://dx.doi.org/10.1016/j.forsciint.2014.09.016DOI Listing
November 2014
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