Social Inequalities, Urban Living Conditions, and Tuberculosis Mortality in Madrid, 1905–1927: Individual Risks and Spatial Hotspots

Pulmonary tuberculosis was an emblematic disease of the industrialisation and urbanisation. While some contemporaries emphasised the socioeconomic determinants of tuberculosis, others identified overcrowded and unsanitary buildings as major centres of infection threatening the wider urban population. These perceived tuberculosis hotspots became central to arguments in favour of urban renewal and public health interventions. This study revisits these debates by examining the individual and spatial determinants of tuberculosis mortality in Madrid, a large southern European capital city. We explore how socioeconomic status, sex, age, migration, and living conditions shaped mortality risks and assess whether tuberculosis deaths were concentrated in particular urban locations.  Our findings suggest that tuberculosis mortality in early twentieth-century Madrid cannot be explained exclusively by either socioeconomic deprivation or the existence of particularly unhealthy places. Although tuberculosis hotspots were a measurable reality, their demographic significance was considerably smaller than contemporary physicians, hygienists, and urban reformers assumed. Rather than being confined to a small number of buildings, tuberculosis mortality reflected broader social and environmental inequalities operating across the city. 

Dr. Diego Ramiro-Fariñas is Professor of Demography and Director of the Institute of Economics, Geography and Demography at the Spanish National Research Council. His research and publications focus on mortality, demographic analysis, and spatial demography.  He is also active in the development of longitudinal studies and the use of BigData.  Dr. Ramiro has served on editorial boards for Demography and Spatial Demography, and on the Historical Demography and Digital Demography panels of the International Union for the Scientific Study of Population.  He was the founding Secretary General and President of the European Society of Historical Demography. He is also the director of the graduate course and lecture series Demography Today of the Fundación Banco Bilbao Vizcaya Argentaria (FBBVA). 

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