Skeletal indicators of disease are frequently used in bioarcheological research as a proxy for the frailty of an individual preceding death. Whilst certain indicators have been established as being associated with excess mortality in adults, these relationships are not necessarily replicated in sub-adults, nor are they consistent in strength of association across sites or time periods. Further, the influence of co-morbid indicators of disease have rarely been assessed in a bioarcheological context. This study addresses this research gap by examining the relationship between skeletal indicators of disease and mortality in sub-adults whilst controlling for observable co-morbidities in a medieval Irish population from Ballyhanna (Co. Donegal). Multivariable logistic regression on a subset of the Ballyhanna population reveals significant associations between linear enamel hypoplasia and stunting with increased likelihood of mortality in sub-adult years, therefore representing reliable indicators of frailty in this population. However, other examined skeletal indicators either had no association, or were more likely to occur in individuals who died in adulthood. Complex relationships between cribra orbitalia, porotic hyperostosis, and reactive periosteal lesions by severity or state of healing were observed via univariable analysis, suggesting that presence of these skeletal indicators are not reliably representative of frailty. More broadly, these combined findings suggest that skeletal indicators of disease, especially non-specific indicators such as periosteal lesions, may be more informative of population-level exposure to stressors than of variation in individual frailty. These findings reiterate the need to quantify the relationship between skeletal indicators and measurable outcomes if they are to be used as generalised indicators of frailty in a population.

疾病的骨骼指标经常用于生物考古研究，作为个体死亡前体弱的代表。虽然某些指标已被确定为与成人死亡率过高有关，但这些关系不一定在亚成人中复制，它们在不同地点或时间段的关联强度也不一致。此外，很少在生物考古学背景下评估疾病共病指标的影响。这项研究通过检查疾病骨骼指标与亚成人死亡率之间的关系来解决这一研究空白，同时控制来自 Ballyhanna (Co. Donegal) 的中世纪爱尔兰人口中可观察到的合并症。对 Ballyhanna 人群子集的多变量逻辑回归揭示了线性牙釉质发育不全和发育迟缓与亚成年死亡率可能性增加之间的显着关联，因此代表了该人群虚弱的可靠指标。然而，其他检查的骨骼指标要么没有关联，要么更可能发生在成年后死亡的个体中。通过单变量分析观察到眼眶、多孔性骨质增生和反应性骨膜病变之间的复杂关系（按严重程度或愈合状态），这表明这些骨骼指标的存在并不能可靠地代表虚弱。更广泛地说，这些综合发现表明疾病的骨骼指标，尤其是非特异性指标，如骨膜病变，可能比个体脆弱性的变化更能提供人口水平暴露于压力源的信息。这些发现重申了量化骨骼指标和可测量结果之间的关系的必要性，如果它们被用作人群中虚弱的一般指标。