Mamelund Svenn-Erik
Department of Economics, University of Oslo, P.O. Box 1095 Blindern, 0317 Oslo, Norway.
Soc Sci Med. 2006 Feb;62(4):923-40. doi: 10.1016/j.socscimed.2005.06.051. Epub 2005 Aug 8.
The Spanish influenza pandemic of 1918-19 was one of the most devastating diseases in history, killing perhaps as many as 50-100 million people worldwide. Much of the literature since 1918 has favored the view that mortality from Spanish influenza was class neutral. This view has prevailed, even though several contemporary surveys showed that there indeed were clear differences between the classes in disease incidence and that case fatality rates from influenza and pneumonia also varied according to socioeconomic status. Furthermore, studies of more recent influenza epidemics have also shown that there can be clear class differentials in mortality in this type of illness--is there any reason to believe that Spanish influenza was different? This paper is the first study in which individual- and household-level data which are unique for the period are utilized to test the conservative hypothesis that Spanish influenza was a socially neutral disease with respect to mortality. Through the use of Cox regressions in an analysis of two socially contrasting parishes in the Norwegian capital city of Kristiania, it is shown that apartment size as an indicator of wealth of a household, in addition to social status of place of residence, were the only socioeconomic variables that had an independent and significant effect on mortality after controlling for age, sex and marital status.
1918 - 1919年的西班牙流感大流行是历史上最具毁灭性的疾病之一,全球死亡人数可能多达5000万至1亿。自1918年以来的许多文献都倾向于认为西班牙流感造成的死亡在阶层上是无差别的。尽管当时的几项调查显示,不同阶层在疾病发病率上确实存在明显差异,而且流感和肺炎的病死率也因社会经济地位而异,但这种观点仍然盛行。此外,对近期流感疫情的研究也表明,在这类疾病的死亡率方面可能存在明显的阶层差异——有什么理由认为西班牙流感有所不同呢?本文是第一项利用该时期独特的个人和家庭层面数据来检验保守假设的研究,该假设认为西班牙流感在死亡率方面是一种社会无差别疾病。通过对挪威首都克里斯蒂安尼亚两个社会情况不同的教区进行分析,并使用考克斯回归方法,结果表明,除了居住地点的社会地位外,作为家庭财富指标的公寓面积是在控制了年龄、性别和婚姻状况后,对死亡率有独立且显著影响的唯一社会经济变量。