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What Explains Cross-City Variation in Mortality During the 1918 Influenza Pandemic? Evidence from 438 U.S. Cities

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  • Clay, Karen

    () (Carnegie Mellon University)

  • Lewis, Joshua

    () (University of Montreal)

  • Severnini, Edson R.

    () (Carnegie Mellon University)

Abstract

Disparities in cross-city pandemic severity during the 1918 Influenza Pandemic remain poorly understood. This paper uses newly assembled historical data on annual mortality across 438 U.S. cities to explore the determinants of pandemic mortality. We assess the role of three broad factors: i) pre-pandemic population health and poverty, ii) air pollution, and iii) the timing of onset and proximity to military bases. Using regression analysis, we find that cities in the top tercile of the distribution of pre-pandemic infant mortality had 21 excess deaths per 10,000 residents in 1918 relative to cities in the bottom tercile. Similarly, cities in the top tercile of the distribution of proportion of illiterate residents had 21.3 excess deaths per 10,000 residents during the pandemic relative to cities in the bottom tercile. Cities in the top tercile of the distribution of coal-fired electricity generating capacity, an important source of urban air pollution, had 9.1 excess deaths per 10,000 residents in 1918 relative to cities in the bottom tercile. There was no statistically significant relationship between excess mortality and city proximity to World War I bases or the timing of onset. Together the three statistically significant factors accounted for 50 percent of cross-city variation in excess mortality in 1918.

Suggested Citation

  • Clay, Karen & Lewis, Joshua & Severnini, Edson R., 2019. "What Explains Cross-City Variation in Mortality During the 1918 Influenza Pandemic? Evidence from 438 U.S. Cities," IZA Discussion Papers 12177, Institute of Labor Economics (IZA).
  • Handle: RePEc:iza:izadps:dp12177
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    References listed on IDEAS

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    3. Vellore Arthi & John Parman, 2020. "Disease, Downturns, and Wellbeing: Economic History and the Long-Run Impacts of COVID-19," NBER Working Papers 27805, National Bureau of Economic Research, Inc.
    4. Karen Clay & Joshua A. Lewis & Edson R. Severnini & Xiao Wang, 2020. "The Value of Health Insurance during a Crisis: Effects of Medicaid Implementation on Pandemic Influenza Mortality," NBER Working Papers 27120, National Bureau of Economic Research, Inc.
    5. Tamara Power & Denise Wilson & Odette Best & Teresa Brockie & Lisa Bourque Bearskin & Eugenia Millender & John Lowe, 2020. "COVID‐19 and Indigenous Peoples: An imperative for action," Journal of Clinical Nursing, John Wiley & Sons, vol. 29(15-16), pages 2737-2741, August.
    6. Brian Beach & Karen Clay & Martin Saavedra, 2020. "The 1918 Influenza Pandemic and its Lessons for COVID-19," Working Papers 2020-15, The George Washington University, Institute for International Economic Policy.
    7. Scott A. Carson, 2020. "Female and Male Body Mass, Height, and Weight during US Economic Development: 1860s-1930s," CESifo Working Paper Series 8447, CESifo.
    8. Daniel L. Mendoza & Tabitha M. Benney & Rajive Ganguli & Rambabu Pothina & Benjamin Krick & Cheryl S. Pirozzi & Erik T. Crosman & Yue Zhang, 2020. "Understanding the Relationship between Social Distancing Policies, Traffic Volume, Air Quality, and the Prevalence of COVID-19 Outcomes in Urban Neighborhoods," Papers 2008.01828, arXiv.org.
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    More about this item

    Keywords

    influenza; pandemic; mortality; air pollution;

    JEL classification:

    • N32 - Economic History - - Labor and Consumers, Demography, Education, Health, Welfare, Income, Wealth, Religion, and Philanthropy - - - U.S.; Canada: 1913-
    • N52 - Economic History - - Agriculture, Natural Resources, Environment and Extractive Industries - - - U.S.; Canada: 1913-
    • N72 - Economic History - - Economic History: Transport, International and Domestic Trade, Energy, and Other Services - - - U.S.; Canada: 1913-
    • Q40 - Agricultural and Natural Resource Economics; Environmental and Ecological Economics - - Energy - - - General
    • Q53 - Agricultural and Natural Resource Economics; Environmental and Ecological Economics - - Environmental Economics - - - Air Pollution; Water Pollution; Noise; Hazardous Waste; Solid Waste; Recycling
    • O13 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Agriculture; Natural Resources; Environment; Other Primary Products

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