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

42 Pages Posted: 7 Mar 2019

See all articles by Karen Clay

Karen Clay

Carnegie Mellon University - H. John Heinz III School of Public Policy and Management; National Bureau of Economic Research (NBER)

Joshua Lewis

University of Montreal

Edson Severnini

Carnegie Mellon University

Date Written: February 16, 2019

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 the 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.

Keywords: influenza, air pollution, mortality

JEL Classification: I18, N32, Q53

Suggested Citation

Clay, Karen B. and Lewis, Joshua and Severnini, Edson, What Explains Cross-City Variation in Mortality During the 1918 Influenza Pandemic? Evidence from 438 U.S. Cities (February 16, 2019). Available at SSRN: https://ssrn.com/abstract=3335921 or http://dx.doi.org/10.2139/ssrn.3335921

Karen B. Clay (Contact Author)

Carnegie Mellon University - H. John Heinz III School of Public Policy and Management ( email )

Pittsburgh, PA 15213-3890
United States

National Bureau of Economic Research (NBER) ( email )

1050 Massachusetts Avenue
Cambridge, MA 02138
United States

Joshua Lewis

University of Montreal ( email )

C.P. 6128 succursale Centre-ville
Montreal, Quebec H3C 3J7
Canada

Edson Severnini

Carnegie Mellon University

Pittsburgh, PA 15213-3890
United States

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