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Abstract BackgroundResearch on the 1918 influenza pandemic often focuses exclusively on pandemic years, reducing the potential long‐term insights about the pandemic. It is critical to frame the 1918 pandemic within the underlying population dynamics, health, and sociocultural context to understand what factors contributed to pandemic mortality and survivorship, with respect to observed inequality, and consequences of the pandemic. Materials & MethodsIndividual death records and censuses from The Rooms Provincial Archives and Memorial University of Newfoundland Digital Archives for three major causes of death—influenza and pneumonia; tuberculosis; and pooled bronchitis, measles, and whooping cough—were collected for three periods in the early 20th century: pre‐pandemic (1909–11), pandemic (March 1918–Janaury 1919), and post‐pandemic (1933–1935). We calculated pooled age‐standardized mortality rates and changes in pre‐ to post‐pandemic mortality rates by region. We fit Kaplan–Meier and Cox proportional hazards models to each period, controlling for age, cause of death, and region. ResultsPandemic mortality was higher than that of pre‐ and post‐pandemic periods. Post‐pandemic mortality was significantly lower than pre‐pandemic mortality in all regions, except Western Newfoundland. Survival was lowest during the pandemic and increased significantly post‐pandemic (p < 0.0001), with no significant differences among regions during the pandemic (p = 0.32). Significant differences in survivorship in 1933–1935 were driven by increasing differences in survivorship for P&I among the regions more than other causes of death. DiscussionMyopic perspectives of pandemics can obscure our understanding of observed outcomes. Inequalities in respiratory disease mortality are evident in pre‐ and post‐pandemic periods, but these would have been missed in investigations of the pandemic period alone.
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Biocultural perspectives on bioarchaeological and paleopathological evidence of past pandemics
Objectives: Pandemics have profoundly impacted human societies, but until rela- tively recently were a minor research focus within biological anthropology, especially within biocultural analyses. Here, we explore research in these fields, including molecular anthropology, that employs biocultural approaches, sometimes integrated with intersectionality and ecosocial and syndemic theory, to unpack relationships between social inequality and pandemics. A case study assesses the 1918 influenza pandemic's impacts on the patient population of the Mississippi State Asylum (MSA). Materials and Methods: We survey bioarchaeological and paleopathological litera- ture on pandemics and analyze respiratory disease mortality relative to sex, age, and social race amongst patient deaths (N = 2258) between 1912 and 1925. Logistic regression models were used to assess relationships between cause of death and odds of death during the pandemic (1918–1919). Results: Findings include substantial respiratory mortality during the pandemic, including from influenza and influenza syndemic with pneumonia. Older patients (40–59 years, 60+ years) had lower odds (p < 0.01) of dying from respiratory disease than younger patients, as did female patients compared to males (p < 0.05). Age pat- terns are broadly consistent with national and state trends, while elevated mortality amongst Black and/or African American patients may reflect intersections between gender roles and race-based structural violence in the Jim Crow South. Discussion: Future work in biological anthropology on past pandemics may benefit from explicit incorporation of biocultural frameworks, intersectionality, and ecosocial and syndemic theory. Doing so enables holistic analyses of interactions between social context, social inequality and pandemic outcomes, generating data informative for public health responses and pandemic preparedness.
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- Award ID(s):
- 1946203
- PAR ID:
- 10418772
- Editor(s):
- Kim, Andrew; Agarwal, Sabrina
- Date Published:
- Journal Name:
- American Journal of Biological Anthropology
- ISSN:
- 2692-7691
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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Abstract ObjectivesThe selective mortality hypothesis of tuberculosis after the 1918 influenza pandemic, laid out by Noymer and colleagues, suggests that acute exposure or pre‐existing infection with tuberculosis (TB) increased the probability of pneumonia and influenza (P&I) mortality during the 1918 influenza pandemic, leading to a hastened decline of TB mortality in post‐pandemic years. This study describes cultural determinants of the post‐pandemic TB mortality patterns in Newfoundland and evaluates whether there is support for this observation. Materials and methodsDeath records and historical documents from the Provincial Archives of Newfoundland and Labrador were used to calculate age‐standardized island‐wide and sex‐based TB mortality, as well as region‐level TB mortality, for 1900–1939. The Joinpoint Regression Program (version 4.8.0.1) was used to estimate statistically significant changes in mortality rates. ResultsIsland‐wide, females had consistently higher TB mortality for the duration of the study period and a significant shift to lower TB mortality beginning in 1928. There was no similar predicted significant decline for males. On the regional level, no models predicted a significant decline after the 1918 influenza pandemic, except for the West, where significant decline was predicted in the late‐1930s. DiscussionAlthough there was no significant decline in TB mortality observed immediately post‐pandemic, as has been shown for other Western nations, the female post‐pandemic pattern suggests a decline much later. The general lack of significant decrease in TB mortality rate is likely due to Newfoundland's poor nutrition and lack of centralized healthcare rather than a biological interaction between P&I and TB.more » « less
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.1002/ajpa.24647
