The 1918-1919 Influenza Pandemic in Portugal: A Regional Analysis of Death Impact

American Journal of Epidemiology
B NunesHelena Rebelo-de-Andrade

Abstract

Although the impact of deaths occurring during the 1918-1919 influenza pandemic has been assessed in many archeo-epidemiologic studies, detailed estimates are not available for Portugal. We applied negative binomial models to monthly data on respiratory-related and all-cause deaths at the national and district levels from Portugal for 1916-1922. Influenza-related excess mortality was computed as the difference between observed and expected deaths. Poisson regression was used to estimate the association of geographic and sociodemographic factors with excess mortality. Two waves of pandemic influenza-July 1918 to January 1919 and April to May 1919-were identified, for which the excess all-cause death rate was 195.7 per 10,000 persons. All districts of Portugal were affected. The pandemic hit earlier in southeastern districts and the main cities, but excess mortality was highest in the northeast, in line with the high death burden experienced by northern Spanish provinces. During the period of intense excess mortality (fall/winter 1918-1919), population density was negatively associated with pandemic impact. This pattern changed during the March 1919 to June 1920 wave, when excess mortality increased with population density and in...Continue Reading

References

Mar 5, 2002·Bulletin of the History of Medicine·Niall P A S Johnson, Juergen Mueller
Jul 26, 2008·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Antoni TrillaCarolyn Daer
May 21, 2009·Influenza and Other Respiratory Viruses·Séverine AnsartAlain-Jacques Valleron
Feb 20, 2010·Influenza and Other Respiratory Viruses·Anton Erkoreka
Jul 6, 2014·BMC Infectious Diseases·Gerardo ChowellBeatriz Echeverri-Dávila

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Citations

Oct 23, 2018·American Journal of Epidemiology·Cécile Viboud, Justin Lessler
Feb 11, 2021·Postgraduate Medical Journal·Shu Ting LiangJoseph M Rosen

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Software Mentioned

Digital Library of Statistics Portugal
R
R Foundation for Statistical

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