Brief communication: Rethinking the impact of the 1918 influenza pandemic on sex differentials in mortality

Abstract

This study will assess the general impact of the 1918 influenza on overall mortality and its impact on mortality attributable to pulmonary tuberculosis in a small-scale population. Using life table and decomposition methodologies, changes in mortality in Gibraltar used a scheme that identified a pre-epidemic period (1904-1917), the epidemic year (1918), and the post-epidemic period (1919-1927). Overall health in both sexes fell significantly in 1918 with a drop in life expectancy at birth, however, health quickly rebounded in the post-epidemic period. In the case of women, there was a significant increase in life expectancy at birth after the epidemic. The impact of influenza on the magnitude of sex differentials in the life expectancy at birth fell during epidemic year but returned to a level comparable to that of the pre-epidemic period. With respect to respiratory tuberculosis deaths, the immediate impact of influenza was restricted to only a significant increase in the rate among women (aged 15-54). In the post-epidemic period, tuberculosis mortality rates returned to the pre-epidemic state in both sexes. The findings from Gibraltar stand in contrast opposition to results reported for experience in the United States during the 1918 flu.

Age-Specific Mortality During the 1918 Influenza Pandemic: Unravelling the Mystery of High Young Adult Mortality

“…This hypothesis rests on a higher male mortality during the 1918 influenza pandemic and therefore cannot be extended to other parts of the world where females died in greater proportion than males [23].…”

Situating mortality: Quantifying crisis points and periods of stability

“…5a and Table 1). For more information on sex difference in influenza deaths during this epidemic, see Sawchuk (2009). Interestingly, while the flu made numerous visitations to the Maltese Islands, including the pandemic of 1918 (second wave H 5 6.47, third wave H 5 1.05), influenza never appeared to play a significant role in the pattern of mortality as indicated by low Z values throughout the study period (see Fig.…”

“…Here we see a divergence in the pattern in the post-34 age bracket as shown in Figure 7. For more information on sex difference in influenza deaths during this epidemic, see Sawchuk (2009). Further evidence of a marked difference in mortality between the sexes can be seen from the examination of the Colonial Hospital returns taken from mid-June to August 9 (see Table 2).…”

The 1918 influenza pandemic affected sex differentials in mortality: Comment on Sawchuk

“…Sawchuk (2009) presents data from Gibraltar from the early 20th century. He finds no evidence in the British colony of selective mortality in the 1918 influenza pandemic, as seen by Noymer and Garenne (2000) in American data.…”

“…As Sawchuk notes (p 589), this only goes to show that Gibraltar is not the United States. The historical‐demographic data presented by Sawchuk (2009) are interesting, and nobody has more expertise on the historical demography of Gibraltar than Sawchuk (confer his literature cited). Nonetheless, the present note explains why Sawchuk's title, rethinking the impact of the 1918 influenza pandemic on sex differentials in mortality, seems inappropriate.…”