Abstract
Against a backdrop of extreme racial health inequality, the 1918 influenza pandemic resulted in a striking reduction of non-White to White influenza and pneumonia mortality disparities in United States cities. We provide the most complete account to date of these reduced racial disparities, showing that they were unexpect-edly uniform across cities. Linking data from multiple sources, we then examine potential explanations for this finding, including city-level sociodemographic factors such as segregation, implementation of nonpharmaceutical interventions, racial dif-fer ences in exposure to the milder spring 1918 “herald wave,” and racial differences in early-life influenza exposures, resulting in differential immunological vulnerability to the 1918 flu. While we find little evidence for the first three explanations, we offer suggestive evidence that racial variation in childhood exposure to the 1889–1892 influenza pandemic may have shrunk racial disparities in 1918. We also highlight the possibility that differential behavioral responses to the herald wave may have protected non-White urban populations. By providing a comprehensive description and examination of racial inequality in mortality during the 1918 pandemic, we offer a framework for understanding disparities in infectious disease mortality that consid-ers interactions between the natural histories of particular microbial agents and the social histories of those they infect.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1953-1979 |
| Number of pages | 27 |
| Journal | Demography |
| Volume | 59 |
| Issue number | 5 |
| DOIs | |
| State | Published - Oct 1 2022 |
Bibliographical note
Funding Information:Acknowledgments The authors thank Chris Muller for formative collaboration at an early stage of the project. We thank Alain Gagnon, Andrew Halpern-Manners, Herb Smith, Dylan Connor, Hampton Gaddy, Michelle Niemann, and the audience at the PANSOC seminar at the Oslo Metropolitan University for their helpful comments on drafts. We also thank John Hobbs, Evan Ferstl, Kelly Cain Jackson, Kenzie Maybrun, Thomas Patrick Pearson, Danial Shariat, Katarina Tolic, and Simeng Wang for invaluable research assistance. This work was supported by the Eunice Kennedy Shriver Institute for Child Health and Human Development via the Minnesota Population Center (P2CHD041023), the Berkeley Population Center (P2CHD073964), the Population Studies Center at the University of Pennsylvania (R24HD044964), and the Center for Demography and Ecology at the University of Wisconsin (P2CHD047873); the National Institute on Aging via the Life Course Center at the University of Minnesota (P30AG066613); and the Fesler-Lampert Chair in Aging Studies at the University of Minnesota.
Publisher Copyright:
© 2022 The Authors.
Keywords
- 1918 influenza pandemic
- Immunological imprinting
- Nonpharmaceutical interventions
- Racial disparities
- Residential segregation
