Brief communication: Rethinking the impact of the 1918 influenza pandemic on sex differentials in mortality.

This study will assess the general impact of the 1918 influenza on overall mortality and its impact on mortality attributable to pulmonary tuberculosis in a small-scale population. Using life table and decomposition methodologies, changes in mortality in Gibraltar used a scheme that identified a pre-epidemic period (1904-1917), the epidemic year (1918), and the post-epidemic period (1919-1927). Overall health in both sexes fell significantly in 1918 with a drop in life expectancy at birth, however, health quickly rebounded in the post-epidemic period. In the case of women, there was a significant increase in life expectancy at birth after the epidemic. The impact of influenza on the magnitude of sex differentials in the life expectancy at birth fell during epidemic year but returned to a level comparable to that of the pre-epidemic period. With respect to respiratory tuberculosis deaths, the immediate impact of influenza was restricted to only a significant increase in the rate among women (aged 15-54). In the post-epidemic period, tuberculosis mortality rates returned to the pre-epidemic state in both sexes. The findings from Gibraltar stand in contrast opposition to results reported for experience in the United States during the 1918 flu.