Background The threat of an avian influenza pandemic is causing widespread public concern and health policy response, especially in high-income countries. Our aim was to use high-quality vital registration data gathered during the 1918-20 pandemic to estimate global mortality should such a pandemic occur today. Methods We identified all countries with high-quality vital registration data for the 1918-20 pandemic and used these data to calculate excess mortality. We developed ordinary least squares regression models that related excess mortality to per-head income and absolute latitude and used these models to estimate mortality had there been an influenza pandemic in 2004. Findings Excess mortality data show that, even in 1918-20, population mortality varied over 30-fold across countries. Per-head income explained a large fraction of this variation in mortality. Extrapolation of 1918-20 mortality rates to the worldwide population of 2004 indicates that an estimated 62 million people (10th-90th percentile range 51 million-81 million) would be killed by a similar influenza pandemic; 96% (95% CI 95-98) of these deaths would occur in the developing world. If this mortality were concentrated in a single year, it would increase global mortality by 114%. Interpretation This analysis of the empirical record of the 1918-20 pandemic provides a plausible upper bound on pandemic mortality. Most deaths will occur in poor countries-ie, in societies whose scarce health resources are already stretched by existing health priorities.

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   |wiki=    Sante
   |area=    PandemieGrippaleV1
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   |étape=   Exploration
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   |clé=     Pascal:07-0045566
   |texte=   Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918-20 pandemic : a quantitative analysis. Commentary
}}