The Spanish flu and the health system: Considerations from the city of Parma, 1918 (original) (raw)
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Spatial-temporal excess mortality patterns of the 1918–1919 influenza pandemic in Spain
BMC Infectious Diseases, 2014
Background: The impact of socio-demographic factors and baseline health on the mortality burden of seasonal and pandemic influenza remains debated. Here we analyzed the spatial-temporal mortality patterns of the 1918 influenza pandemic in Spain, one of the countries of Europe that experienced the highest mortality burden. Methods: We analyzed monthly death rates from respiratory diseases and all-causes across 49 provinces of Spain, including the Canary and Balearic Islands, during the period January-1915 to June-1919. We estimated the influenza-related excess death rates and risk of death relative to baseline mortality by pandemic wave and province. We then explored the association between pandemic excess mortality rates and health and socio-demographic factors, which included population size and age structure, population density, infant mortality rates, baseline death rates, and urbanization. Results: Our analysis revealed high geographic heterogeneity in pandemic mortality impact. We identified 3 pandemic waves of varying timing and intensity covering the period from Jan-1918 to Jun-1919, with the highest pandemic-related excess mortality rates occurring during the months of October-November 1918 across all Spanish provinces. Cumulative excess mortality rates followed a south-north gradient after controlling for demographic factors, with the North experiencing highest excess mortality rates. A model that included latitude, population density, and the proportion of children living in provinces explained about 40% of the geographic variability in cumulative excess death rates during 1918-19, but different factors explained mortality variation in each wave. Conclusions: A substantial fraction of the variability in excess mortality rates across Spanish provinces remained unexplained, which suggests that other unidentified factors such as comorbidities, climate and background immunity may have affected the 1918-19 pandemic mortality rates. Further archeo-epidemiological research should concentrate on identifying settings with combined availability of local historical mortality records and information on the prevalence of underlying risk factors, or patient-level clinical data, to further clarify the drivers of 1918 pandemic influenza mortality.
1918 pandemic morbidity: the first wave hits the poor, the second wave hits the rich
Influenza and other Respiratory Viruses, 2018
Background: Whether morbidity from the 1918-19 influenza pandemic discriminated by socioeconomic status has remained a subject of debate for 100 years. In lack of data to study this issue recent literature have hypothesized that morbidity was “socially neutral”. Objectives: To study the associations between Influenza like illness (ILI) and socioeconomic status (SES), gender and wave during the 1918-19 influenza pandemic. Methods: Availability of incidence data on the 1918-19 pandemic is scarce, in particular for waves other than the “fall wave” October-December 1918. Here, an overlooked survey from Bergen, Norway (n=10,633), is used to study differences in probabilities of ILI and ILI probability ratios by apartment size as a measure of SES and gender for three waves including the waves prior to and after the “fall wave”. Results: SES was negatively associated with ILI in the first wave, but positively associated in the second wave. At all SES levels, men had the highest ILI in the summer, while women had the highest ILI in the fall. There were no SES or gender differences in ILI in the winter of 1919. Conclusions: For the first time it is documented a crossover in the role of socioeconomic status in 1918 pandemic morbidity. The poor came down with influenza first, while the rich with less exposure in the first wave had the highest morbidity in the second wave. The study suggest that socioeconomically disadvantaged should be prioritized if vaccines are of limited availability in a future pandemic.
Social factors, mortality and the Spanish Influenza in Kristiania 1918-19
Complexity. Interdisciplinary Communications 2006/2007, 2008
Studies of historical epidemiology have shown that poor populations suffer more from the burden of disease and death from epidemics, with cholera and tuberculosis being two good examples. However, much of the literature since 1918 has favored the view that the Spanish influenza pandemic of 1918–19 struck victims independent of class or other social indices. This view has prevailed although contemporary household surveys after the 1918 pandemic showed that there were indeed clear differences between the classes in disease incidence and that case fatality rates from influenza and pneumonia also varied according to socioeconomic status (Hanssen 1923, Sydenstricker 1931). This paper is the first to combine multivariate event history analysis with unique individual and household-level data to test the conservative hypothesis that Spanish influenza was a socially neutral disease with respect to mortality.
Social Science & Medicine , 2006
The Spanish influenza pandemic of 1918–19 was one of the most devastating diseases in history, killing perhaps as many as 50–100 million people worldwide. Much of the literature since 1918 has favored the view that mortality from Spanish influenza was class neutral. This view has prevailed, even though several contemporary surveys showed that there indeed were clear differences between the classes in disease incidence and that case fatality rates from influenza and pneumonia also varied according to socioeconomic status. Furthermore, studies of more recent influenza epidemics have also shown that there can be clear class differentials in mortality in this type of illness—is there any reason to believe that Spanish influenza was different? This paper is the first study in which individual- and household-level data which are unique for the period are utilized to test the conservative hypothesis that Spanish influenza was a socially neutral disease with respect to mortality. Through the use of Cox regressions in an analysis of two socially contrasting parishes in the Norwegian capital city of Kristiania, it is shown that apartment size as an indicator of wealth of a household, in addition to social status of place of residence, were the only socioeconomic variables that had an independent and significant effect on mortality after controlling for age, sex and marital status.
Annals of epidemiology, 2017
Although the 1889-1890 influenza pandemic was one of the most important epidemic events of the 19th century, little is known about the mortality impact of this pandemic based on detailed respiratory mortality data sets. We estimated excess mortality rates for the 1889-1890 pandemic in Madrid from high-resolution respiratory and all-cause individual-level mortality data retrieved from the Gazeta de Madrid, the Official Bulletin of the Spanish government. We also generated estimates of the reproduction number from the early growth phase of the pandemic. The main pandemic wave in Madrid was evident from respiratory and all-cause mortality rates during the winter of 1889-1890. Our estimates of excess mortality for this pandemic were 58.3 per 10,000 for all-cause mortality and 44.5 per 10,000 for respiratory mortality. Age-specific excess mortality rates displayed a J-shape pattern, with school children aged 5-14 years experiencing the lowest respiratory excess death rates (8.8 excess re...
Pandemics and socio-economic status. Evidence from the plague of 1630 in northern Italy
This paper investigates the biological, socioeconomic , and institutional factors shaping the individual risk of death during a major pre-industrial epidemic. We use a micro-demographic database for an Italian city (Carmagnola) during the 1630 plague to explore in detail the survival dynamics of the population admitted to the isolation hospital (lazzaretto). We develop a theoretical model of admissions to the lazzaretto, for better interpretation of the observational data. We explore how age and sex shaped the individual risk of death, and we provide a one-of-a-kind study of the impact of socioeconomic status. We report an inversion of the normal mortality gradient by status for those interned at the lazzaretto. The rich enjoyed a greater ability to make decisions about their hospitalization, but this backfired. Instead, the poor sent to the lazzaretto faced a relatively low risk of death because they enjoyed better conditions than they would have experienced outside the hospital.
Spanish Flu 1918-1919 – Aspects of Demographic Implications
Scripta Medica, 2020
The usual perception of the influenza pandemic that ravaged the world throughout 1918-19 (and in a much less manner in 1920) is structured into analyzing three different waves that touched almost the whole of humanity in quick succession from the spring of 1918 onwards. Results from pandemics regarding the statistical records of influenza morbidity and mortality are the focus of medical science for a long time. Although the evolution of estimations across recent decades almost always tended towards higher and higher estimates, has led to visions of over 100 million deaths throughout definitely the most deadly influenza epidemic, it is clear that such numbers should be taken with a huge dose of skepticism. The approach of this paper is centred on the methods used in determining demographic estimations, and especially evaluations, of historical developments in the situation where the influenza pandemic overlapped with World War I.
2004
The Spanish Influenza pandemic of 1918-19 was one of the most devastating diseases in history, killing perhaps as many as 50-100 million people worldwide. In addition to the high death toll and the high general lethality, the disease had a peculiar feature: the largest increase in death rates occurred among those between the age of 20 and 40 as opposed to the very young and the elderly, which is the more typical pattern of influenza epidemics. Furthermore, it appeared that it was the most robust population groups and the previously healthy that had highest mortality rates. Much of the literature favors the view that Spanish Influenza was class neutral with respect to mortality. This paper uses individual level data and applies Cox regressions to test the hypothesis that the blue-collar working class in 1918 suffered higher death rates from Spanish Influenza than the bourgeois and white-collar middle class in two parishes of the Norwegian capital of Kristiania (renamed Oslo in 1924).