Sex‐ and age‐based differences in mortality during the 1918 influenza pandemic on the island of Newfoundland

Abstract

Objectives Our aim was to understand sex‐ and age‐based differences in mortality during the 1918 influenza pandemic on the island of Newfoundland. The pandemic's impact on different age groups has been the focus of other research, but sex‐based differences in mortality are rarely considered. Aspects of social organization, labor patterns, and social behaviors that contribute to mortality between males and females at all ages are used to explain observed mortality patterns. Methods Recorded pneumonia and influenza deaths on the island (n = 1871) were used to calculate cause‐specific death rates and to evaluate differences in sex‐based mortality. Mortality levels in 17 districts and four regions (Avalon, North, South, and West) were compared using standardized mortality ratios (SMRs). A logistic regression model was fit to determine in which regions sex‐based mortality could be predicted using age and region as interactive predictors. Results Differences in sex‐based mortality varied across regions; they were not significant for the aggregate population. SMRs were also variable, with no significant sex‐based differences. Sex‐based differences were highly variable within regions. Results from a logistic regression analysis suggest that females in the South region may have experienced a higher probability of death than other island residents. Conclusions Mortality analysis for aggregate populations homogenizes important epidemiologic patterns. Men and women did not experience the 1918 influenza pandemic in the same way, and by analyzing data at the regional and district geographic levels, patterns emerge that can be explained by the economies and social organization of the people who lived there.

The 1918 influenza pandemic did not accelerate tuberculosis mortality decline in early‐20th century Newfoundland: Investigating historical and social explanations

“…At the very least, in these regions, higher female TB mortality during the pandemic may have been driven by the corresponding higher female P&I mortality. It is likely that, as was observed by Paskoff and Sattenspiel (2019) for influenza, differing levels of socioeconomic status, geographic isolation, and lack of medical resources, especially in the rural South, contributed to the observed pattern of TB mortality in the current study.…”

“…In addition to the prolific burden of TB, Newfoundland's burden of influenza during the 1918 pandemic makes it an ideal population to study post-pandemic TB mortality. The pandemic hit Newfoundland hard between fall 1918 and spring 1920 with a total mortality rate of 74.5 deaths per 10,000 (Sattenspiel, 2011), and sex-specific mortality rates of 71.1 and 77.1 deaths per 10,000 for males and females, respectively (Paskoff & Sattenspiel, 2019), all figures calculated as the total number of deaths for pandemic years (1918)(1919)(1920) per 1918 population estimate. Figure 1 shows the difference in sex-based mortality between pre-pandemic year 1917 and 1918, the deadliest pandemic year.…”

“…In Newfoundland, agestandardized mortality rates from the beginning of the twentieth century through 1939 clearly indicate higher female TB mortality rates (Figure 2). Paskoff and Sattenspiel (2019) showed that rates of P&I mortality by sex during the 1918 pandemic could be used to predict mortality among the four different regions, especially for the South, in which females were more likely to die than males. Results of this study also showed that substantial differences in P&I mortality between males and females occurred only in the South and West (Paskoff & Sattenspiel, 2019).…”

“…Paskoff and Sattenspiel (2019) showed that rates of P&I mortality by sex during the 1918 pandemic could be used to predict mortality among the four different regions, especially for the South, in which females were more likely to die than males. Results of this study also showed that substantial differences in P&I mortality between males and females occurred only in the South and West (Paskoff & Sattenspiel, 2019). At the very least, in these regions, higher female TB mortality during the pandemic may have been driven by the corresponding higher female P&I mortality.…”

Covid-19 in Historical Context: Creating a Practical Past

“…Serving as a kind of stress test, COVID-19 is highlighting the nation’s long history of health disparities based on race, sex and gender. In 1918, "differences in sex‐based mortality varied across regions; they were not significant for the aggregate population" (Paskoff and Sattenspiel 2018 , p. 1; Viboud et al 2013 ). Today, early sex-disaggregated data suggest that fewer women are dying from COVID 19 than men (Gausman and Langer 2020 ) though Gausman and Langer of Harvard’s T.H.…”