Abstract
During epidemics, the poorest part of the population usually suffers the most. Alfred Crosby noted that the norm changed during the 1918 influenza pandemic in the US: The black population (which were expected to have higher influenza morbidity and mortality) had lower morbidity and mortality than the white population during the autumn of 1918. Crosby’s explanation for this was that black people were more exposed to a mild spring/summer wave of influenza earlier that same year. In this paper, we review the literature from the pandemic of 1918 to better understand the crossover in the role of race on mortality. The literature has used insurance, military, survey, and routine notification data. Results show that the black population had lower morbidity, and during September, October, and November, lower mortality but higher case fatality than the white population. The results also show that the black population had lower influenza morbidity prior to 1918. The reasons for lower morbidity among the black population both at baseline and during the herald and later waves in 1918 remain unclear. Results may imply that black people had a lower risk of developing the disease given exposure, but when they did get sick, they had a higher risk of dying.
Highlights
The 1918–1919 “Spanish Flu” Pandemic infected a third of the global population, killing an estimated 50–100 million globally (2.5%–5.0%) and 675,000 in the United States (0.7%) [1,2,3]
We identified a total of 13 quantitative studies researching the association between race and 1918 influenza morbidity and mortality in the United States
One key contribution of our paper is that we review studies that use different sources of data rather than only reviewing studies that rely on one specific source of data to cast light on race as proxy for socioeconomic status leading to disparities in exposure, susceptibility, access to care, and eventually disparities in 1918 influenza pandemic outcomes
Summary
The 1918–1919 “Spanish Flu” Pandemic infected a third of the global population, killing an estimated 50–100 million globally (2.5%–5.0%) and 675,000 in the United States (0.7%) [1,2,3]. One hypothesis is that black people, who mainly lived in the South and under miserable living- and working conditions, cramped conditions, white racism and violence, and poor medical care, were less susceptible to the 1918 influenza pandemic autumn wave due to higher exposure to the less virulent spring and summer waves [2,3] This hypothesis, the mechanisms for the crossover in the role of race in 1918 pandemic mortality, and the subsequent return to the “normal” pattern of higher black than white mortality in 1919 have received little attention in the literature, nor has this (or other) hypothesis been theoretically or empirically substantiated. In this paper, we do the first review of the published data, contextual literature, and the suggested hypotheses
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