Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918–20 pandemic: a quantitative analysis
Source: The Lancet

Were a strain of influenza much the same as that which caused the 1918–20 pandemic to emerge in 2004, we estimate that it could kill 51–81 million individuals. This estimate is based strictly on recorded patterns of mortality in countries with nearly complete vital registration systems, rather than on theoretical models or assumptions about attack rates and case-fatality rates.

Our results indicate that deaths would be concentrated in the 0–14, 15–19, and 30–44 years age-groups. Various theories have been proposed for the unique pattern of mortality by age exhibited by the 1918–20 pandemic strain. Our results suggest that deaths in the 15–19 and 30–40 years age-groups would probably be a result of high age-specific death rates, whereas those in individuals aged 0–14 years would most likely be due to the large population size and moderate mortality in this age-group.

Most of the strong relation that we observed between per-head income and pandemic mortality must be mediated through factors such as nutritional status, co-morbidity, community characteristics associated with poverty, and the effect of supportive care, since therapeutic interventions had little or no effect on mortality in 1918–20. This income effect is consistent with a contemporary observation of a relation in 1918–20 between household income and mortality.

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