NATIONAL BUREAU OF ECONOMIC RESEARCH
NATIONAL BUREAU OF ECONOMIC RESEARCH

Pollution, Infectious Disease, and Mortality: Evidence from the 1918 Spanish Influenza Pandemic

Karen Clay, Joshua Lewis, Edson Severnini

NBER Working Paper No. 21635
Issued in October 2015, Revised in September 2017
NBER Program(s):Development of the American Economy, Environment and Energy Economics

The 1918 Influenza Pandemic killed millions worldwide and hundreds of thousands in the United States. This paper studies the impact of air pollution on pandemic mortality. The analysis combines a panel dataset on infant and all-age mortality with a novel measure of air pollution based on the burning of coal in a large sample of U.S. cities. We estimate that air pollution contributed significantly to pandemic mortality. Cities that used more coal experienced tens of thousands of excess deaths in 1918 relative to cities that used less coal with similar pre-pandemic socioeconomic conditions and baseline health. Factors related to poverty, public health, and the timing of onset also affected pandemic mortality. The findings support recent experimental evidence on the link between air pollution and influenza infection, and suggest that poor air quality was an important cause of mortality during the pandemic.

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Document Object Identifier (DOI): 10.3386/w21635

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