Mortality from pulmonary tuberculosis in Madrid in the early 20th century social factors and urban living conditions

Pulmonary tuberculosis was an iconic disease of the industrialization and urbanization era, and a key part of the epidemiological landscape of the 19th and early 20th centuries. This article looks at the impact of sex, age, socio-economic status, and urban living conditions on the risk of dying from pulmonary tuberculosis in a context that is rarely studied with individual-level data including causes of death: a large Southern European city, Madrid. Using a large sample of over 112,000 inhabitants, complemented with mortality follow-up data, we use multinomial logistic regressions to compare pulmonary tuberculosis with infectious respiratory diseases and other causes of death. The results shed light on a debate that, at the end of the 19th and beginning of the 20th century, pitted supporters of social inequality, poverty, and malnutrition against those who pointed to the unsanitary conditions of cities as the main cause of the havoc of the ‘white death’. We show that elite women benefited from lower mortality due to tuberculosis but also, more unexpectedly, the maids. Higher mortality affected white-collar workers and the many day laborers. Overcrowding throughout the city worsened these contrasts. We highlight the importance of considering mortality inequalities from the perspective of the accumulation of (dis)advantages. We also show how the theory of fundamental causes, which explains mortality disparities based on socio-economic status, should take into account health-related migrant selection.