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Walking with Feet Tied to the Past: Childhood Exposure to the 1918 Influenza Pandemic and Later-Life Male Mortality

Author

Listed:
  • Hamid Noghanibehambari
  • Jason Fletcher

Abstract

Many previous studies have used cross-cohort comparisons and a focus on in utero exposure to document the lingering effects of the 1918 influenza pandemic on survivors’ outcomes later in life. A subset has examined impacts on old-age health and mortality, finding mixed results. This paper contributes to the literature by extending the analysis to evaluate early-life and childhood exposure to the pandemic on old-age longevity along with a set of candidate mechanisms. We employ Social Security Administration death records linked to the full-count 1940 census and employ event-study and difference-in-difference regressions to compare longevity of cohorts with different age-at-exposure who were born in cities with high versus low exposure based on 1918 influenza-related mortality. Our treatment-on-treated calculations suggest that cohorts with age-at-exposure of 3-8 and 9-11 experience 6.4 and 11.2 months reductions in old age longevity; importantly, we note that these cohorts are often used as “controls” in the broader literature. While our main analysis focuses on males due to data constraints, supplementary results suggest smaller and less precise effects for females. An analysis of census data suggests reductions in health, education and socioeconomic scores as potential mechanisms.

Suggested Citation

  • Hamid Noghanibehambari & Jason Fletcher, 2026. "Walking with Feet Tied to the Past: Childhood Exposure to the 1918 Influenza Pandemic and Later-Life Male Mortality," NBER Working Papers 35471, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:35471
    Note: AG CH DAE EH
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    1. Kim, Jinho & Fletcher, Jason M., 2021. "The effects of relative body weight on socioemotional and schooling outcomes among female adolescents in the United States," Social Science & Medicine, Elsevier, vol. 289(C).
    2. Clay, Karen & Lewis, Joshua & Severnini, Edson, 2019. "What explains cross-city variation in mortality during the 1918 influenza pandemic? Evidence from 438 U.S. cities," Economics & Human Biology, Elsevier, vol. 35(C), pages 42-50.
    3. Fletcher, Jason M., 2018. "New Evidence on the Impacts of Early Exposure to the 1918 Influenza Pandemic on Old-Age Mortality: A Research Note," IZA Discussion Papers 11715, IZA Network @ LISER.
    4. Thomas A. Garrett, 2007. "Economic Effects of the 1918 Influenza Pandemic: Implications for a Modern-day Pandemic," Community Development Publications and Reports, Federal Reserve Bank of St. Louis, pages 1-25, November.
    5. Fletcher, Jason M., 2015. "New evidence of the effects of education on health in the US: Compulsory schooling laws revisited," Social Science & Medicine, Elsevier, vol. 127(C), pages 101-107.
    6. Robert J. Barro & José F. Ursúa & Joanna Weng, 2020. "The Coronavirus and the Great Influenza Pandemic: Lessons from the “Spanish Flu” for the Coronavirus’s Potential Effects on Mortality and Economic Activity," NBER Working Papers 26866, National Bureau of Economic Research, Inc.
    7. Shengjie Lai & Nick W. Ruktanonchai & Liangcai Zhou & Olivia Prosper & Wei Luo & Jessica R. Floyd & Amy Wesolowski & Mauricio Santillana & Chi Zhang & Xiangjun Du & Hongjie Yu & Andrew J. Tatem, 2020. "Effect of non-pharmaceutical interventions to contain COVID-19 in China," Nature, Nature, vol. 585(7825), pages 410-413, September.
    8. Jonas Helgertz & Tommy Bengtsson, 2019. "The Long-Lasting Influenza: The Impact of Fetal Stress During the 1918 Influenza Pandemic on Socioeconomic Attainment and Health in Sweden, 1968–2012," Demography, Springer;Population Association of America (PAA), vol. 56(4), pages 1389-1425, August.
    9. C. Justin Cook & Jason M. Fletcher & Angela Forgues, 2019. "Multigenerational Effects of Early-Life Health Shocks," Demography, Springer;Population Association of America (PAA), vol. 56(5), pages 1855-1874, October.
    10. Lauren Hoehn-Velasco, 2021. "The Long-term Impact of Preventative Public Health Programs," The Economic Journal, Royal Economic Society, vol. 131(634), pages 797-826.
    11. Smith, Ken R. & Mineau, Geraldine P. & Garibotti, Gilda & Kerber, Richard, 2009. "Effects of childhood and middle-adulthood family conditions on later-life mortality: Evidence from the Utah Population Database, 1850-2002," Social Science & Medicine, Elsevier, vol. 68(9), pages 1649-1658, May.
    12. Jonathan Colmer, 2020. "What is the meaning of (statistical) life? Benefit–cost analysis in the time of COVID-19," Oxford Review of Economic Policy, Oxford University Press and Oxford Review of Economic Policy Limited, vol. 36(Supplemen), pages 56-63.
    13. Beach, Brian & Ferrie, Joseph & Saavedra, Martin & Troesken, Werner, 2016. "Typhoid Fever, Water Quality, and Human Capital Formation," The Journal of Economic History, Cambridge University Press, vol. 76(1), pages 41-75, March.
    14. Jason M. Fletcher, 2018. "New Evidence on the Impacts of Early Exposure to the 1918 Influenza Pandemic on Old-Age Mortality," Working Papers 18-06, Center for Economic Studies, U.S. Census Bureau.
    15. Myrskylä, M. & Mehta, N.K. & Chang, V.W., 2013. "Early life exposure to the 1918 influenza pandemic and old-age mortality by cause of death," American Journal of Public Health, American Public Health Association, vol. 103(7), pages 83-90.
    16. Carlos Bozzoli & Angus Deaton & Climent Quintana-Domeque, 2009. "Adult height and childhood disease," Demography, Springer;Population Association of America (PAA), vol. 46(4), pages 647-669, November.
    17. repec:plo:pone00:0069586 is not listed on IDEAS
    18. Smith, Ken R. & Hanson, Heidi A. & Norton, Maria C. & Hollingshaus, Michael S. & Mineau, Geraldine P., 2014. "Survival of offspring who experience early parental death: Early life conditions and later-life mortality," Social Science & Medicine, Elsevier, vol. 119(C), pages 180-190.
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    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • J10 - Labor and Demographic Economics - - Demographic Economics - - - General

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