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美国城市 1918 年流感大流行期间的死亡率存在种族差异。

Racial Disparities in Mortality During the 1918 Influenza Pandemic in United States Cities.

机构信息

Department of Sociology, Duke University, Durham, NC, USA.

Department of Sociology and Minnesota Population Center, University of Minnesota, Twin Cities, Minneapolis, MN, USA.

出版信息

Demography. 2022 Oct 1;59(5):1953-1979. doi: 10.1215/00703370-10235825.

Abstract

Against a backdrop of extreme racial health inequality, the 1918 influenza pandemic resulted in a striking reduction of non-White to White influenza and pneumonia mortality disparities in United States cities. We provide the most complete account to date of these reduced racial disparities, showing that they were unexpectedly uniform across cities. Linking data from multiple sources, we then examine potential explanations for this finding, including city-level sociodemographic factors such as segregation, implementation of nonpharmaceutical interventions, racial differences in exposure to the milder spring 1918 "herald wave," and racial differences in early-life influenza exposures, resulting in differential immunological vulnerability to the 1918 flu. While we find little evidence for the first three explanations, we offer suggestive evidence that racial variation in childhood exposure to the 1889-1892 influenza pandemic may have shrunk racial disparities in 1918. We also highlight the possibility that differential behavioral responses to the herald wave may have protected non-White urban populations. By providing a comprehensive description and examination of racial inequality in mortality during the 1918 pandemic, we offer a framework for understanding disparities in infectious disease mortality that considers interactions between the natural histories of particular microbial agents and the social histories of those they infect.

摘要

在极端的种族健康不平等背景下,1918 年流感大流行导致美国城市中非白人到白人的流感和肺炎死亡率差距显著缩小。我们提供了迄今为止关于这些种族差异缩小的最完整的描述,表明它们在各个城市中出人意料地一致。我们通过链接多个来源的数据,然后检查了这一发现的潜在解释,包括城市层面的社会人口因素,如隔离、非药物干预措施的实施、种族间对温和的 1918 年春季“先兆波”的暴露差异,以及种族间在幼儿时期接触流感的差异,导致对 1918 年流感的免疫脆弱性不同。虽然我们几乎没有证据支持前三个解释,但我们提供了有说服力的证据表明,儿童时期接触 1889-1892 年流感大流行的种族差异可能缩小了 1918 年的种族差异。我们还强调了对先兆波的不同行为反应可能保护了非白人城市人口的可能性。通过全面描述和检查 1918 年大流行期间的死亡率不平等,我们提供了一个理解传染病死亡率差异的框架,该框架考虑了特定微生物剂的自然史与受感染者的社会史之间的相互作用。

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