Spatial-temporal excess mortality patterns of the 1918-1919 influenza pandemic in Spain.
Identifieur interne : 000206 ( Main/Exploration ); précédent : 000205; suivant : 000207Spatial-temporal excess mortality patterns of the 1918-1919 influenza pandemic in Spain.
Auteurs : Gerardo Chowell [États-Unis] ; Anton Erkoreka ; Cécile Viboud ; Beatriz Echeverri-DávilaSource :
- BMC infectious diseases [ 1471-2334 ] ; 2014.
Descripteurs français
- KwdFr :
- MESH :
- mortalité : Pandémie de grippe de 1918-1919.
- épidémiologie : Espagne.
- Adolescent, Adulte, Analyse spatio-temporelle, Enfant, Facteurs de risque, Femelle, Humains, Modèles théoriques, Mâle, Nourrisson, Pandémies.
English descriptors
- KwdEn :
- MESH :
- epidemiology : Spain.
- mortality : Influenza Pandemic, 1918-1919.
- Adolescent, Adult, Child, Female, Humans, Infant, Male, Models, Theoretical, Pandemics, Risk Factors, Spatio-Temporal Analysis.
Abstract
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.
DOI: 10.1186/1471-2334-14-371
PubMed: 24996457
PubMed Central: PMC4094406
Affiliations:
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Cecile" sort="Viboud, Cecile" uniqKey="Viboud C" first="Cécile" last="Viboud">Cécile Viboud</name></author><author><name sortKey="Echeverri Davila, Beatriz" sort="Echeverri Davila, Beatriz" uniqKey="Echeverri Davila B" first="Beatriz" last="Echeverri-Dávila">Beatriz Echeverri-Dávila</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2014">2014</date><idno type="RBID">pubmed:24996457</idno><idno type="pmid">24996457</idno><idno type="doi">10.1186/1471-2334-14-371</idno><idno type="pmc">PMC4094406</idno><idno type="wicri:Area/Main/Corpus">00203</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">00203</idno><idno type="wicri:Area/Main/Curation">000203</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">000203</idno><idno type="wicri:Area/Main/Exploration">000203</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Spatial-temporal excess mortality patterns of the 1918-1919 influenza pandemic in Spain.</title><author><name sortKey="Chowell, Gerardo" sort="Chowell, Gerardo" uniqKey="Chowell G" first="Gerardo" last="Chowell">Gerardo Chowell</name><affiliation wicri:level="2"><nlm:affiliation>Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA. gchowell@asu.edu.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD</wicri:regionArea><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Erkoreka, Anton" sort="Erkoreka, Anton" uniqKey="Erkoreka A" first="Anton" last="Erkoreka">Anton Erkoreka</name></author><author><name sortKey="Viboud, Cecile" sort="Viboud, Cecile" uniqKey="Viboud C" first="Cécile" last="Viboud">Cécile Viboud</name></author><author><name sortKey="Echeverri Davila, Beatriz" sort="Echeverri Davila, Beatriz" uniqKey="Echeverri Davila B" first="Beatriz" last="Echeverri-Dávila">Beatriz Echeverri-Dávila</name></author></analytic><series><title level="j">BMC infectious diseases</title><idno type="eISSN">1471-2334</idno><imprint><date when="2014" type="published">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent (MeSH)</term><term>Adult (MeSH)</term><term>Child (MeSH)</term><term>Female (MeSH)</term><term>Humans (MeSH)</term><term>Infant (MeSH)</term><term>Influenza Pandemic, 1918-1919 (mortality)</term><term>Male (MeSH)</term><term>Models, Theoretical (MeSH)</term><term>Pandemics (MeSH)</term><term>Risk Factors (MeSH)</term><term>Spain (epidemiology)</term><term>Spatio-Temporal Analysis (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adolescent (MeSH)</term><term>Adulte (MeSH)</term><term>Analyse spatio-temporelle (MeSH)</term><term>Enfant (MeSH)</term><term>Espagne (épidémiologie)</term><term>Facteurs de risque (MeSH)</term><term>Femelle (MeSH)</term><term>Humains (MeSH)</term><term>Modèles théoriques (MeSH)</term><term>Mâle (MeSH)</term><term>Nourrisson (MeSH)</term><term>Pandémie de grippe de 1918-1919 (mortalité)</term><term>Pandémies (MeSH)</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Spain</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Influenza Pandemic, 1918-1919</term></keywords><keywords scheme="MESH" qualifier="mortalité" xml:lang="fr"><term>Pandémie de grippe de 1918-1919</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Espagne</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Child</term><term>Female</term><term>Humans</term><term>Infant</term><term>Male</term><term>Models, Theoretical</term><term>Pandemics</term><term>Risk Factors</term><term>Spatio-Temporal Analysis</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adolescent</term><term>Adulte</term><term>Analyse spatio-temporelle</term><term>Enfant</term><term>Facteurs de risque</term><term>Femelle</term><term>Humains</term><term>Modèles théoriques</term><term>Mâle</term><term>Nourrisson</term><term>Pandémies</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>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.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>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.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>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.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>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.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" IndexingMethod="Curated" Owner="NLM"><PMID Version="1">24996457</PMID><DateCompleted><Year>2015</Year><Month>06</Month><Day>17</Day></DateCompleted><DateRevised><Year>2018</Year><Month>12</Month><Day>02</Day></DateRevised><Article PubModel="Electronic"><Journal><ISSN IssnType="Electronic">1471-2334</ISSN><JournalIssue CitedMedium="Internet"><Volume>14</Volume><PubDate><Year>2014</Year><Month>Jul</Month><Day>05</Day></PubDate></JournalIssue><Title>BMC infectious diseases</Title><ISOAbbreviation>BMC Infect. Dis.</ISOAbbreviation></Journal><ArticleTitle>Spatial-temporal excess mortality patterns of the 1918-1919 influenza pandemic in Spain.</ArticleTitle><Pagination><MedlinePgn>371</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1186/1471-2334-14-371</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="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.</AbstractText><AbstractText Label="METHODS" NlmCategory="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.</AbstractText><AbstractText Label="RESULTS" NlmCategory="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.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="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. 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