Spatial-temporal excess mortality patterns of the 1918–1919 influenza pandemic in Spain

BMC Infectious Diseases

Beatriz Echeverri-Dávila³  Cécile Viboud²  Anton Erkoreka¹  Gerardo Chowell⁴ 

[1] Basque Museum of the History of Medicine and Science. University of the Basque Country, Bilbao, Spain;Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA;Grupo de Estudios de Población y Sociedad, Universidad Complutense de Madrid, Madrid, Spain;Mathematical, Computational & Modeling Sciences Center, School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA

关键词: Spatial heterogeneity;    Geography;    Provinces;    Transmissibility;    Relative risk of death;    Excess death rates;    Spring-summer wave;    Spanish influenza;    Spain;    1918–1919 influenza pandemic;   

Others  :  1127443
DOI  :  10.1186/1471-2334-14-371

 received in 2014-04-11, accepted in 2014-06-30,  发布年份 2014

【 摘 要 】

Background

The impact of socio-demographic factors and baseline health on the mortality burden of seasonal and pandemic influenza remains debated. Here we analyzed the spatial-temporal mortality patterns of the 1918 influenza pandemic in Spain, one of the countries of Europe that experienced the highest mortality burden.

Methods

We analyzed monthly death rates from respiratory diseases and all-causes across 49 provinces of Spain, including the Canary and Balearic Islands, during the period January-1915 to June-1919. We estimated the influenza-related excess death rates and risk of death relative to baseline mortality by pandemic wave and province. We then explored the association between pandemic excess mortality rates and health and socio-demographic factors, which included population size and age structure, population density, infant mortality rates, baseline death rates, and urbanization.

Results

Our analysis revealed high geographic heterogeneity in pandemic mortality impact. We identified 3 pandemic waves of varying timing and intensity covering the period from Jan-1918 to Jun-1919, with the highest pandemic-related excess mortality rates occurring during the months of October-November 1918 across all Spanish provinces. Cumulative excess mortality rates followed a south–north gradient after controlling for demographic factors, with the North experiencing highest excess mortality rates. A model that included latitude, population density, and the proportion of children living in provinces explained about 40% of the geographic variability in cumulative excess death rates during 1918–19, but different factors explained mortality variation in each wave.

Conclusions

A substantial fraction of the variability in excess mortality rates across Spanish provinces remained unexplained, which suggests that other unidentified factors such as comorbidities, climate and background immunity may have affected the 1918–19 pandemic mortality rates. Further archeo-epidemiological research should concentrate on identifying settings with combined availability of local historical mortality records and information on the prevalence of underlying risk factors, or patient-level clinical data, to further clarify the drivers of 1918 pandemic influenza mortality.

【 授权许可】

   
2014 Chowell et al.; licensee BioMed Central Ltd.

【 图 表 】

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