Inequalities in Excess Mortality during the 1918-9 Influenza Pandemic in the Netherlands

Rick J. Mourits, International Institute of Social History
Auke Rijpma, Utrecht University
Schalk Ruben, Utrecht University
Ingrid K van Dijk, Lund University
Richard L. Zijdeman, International Institute of Social History

A century after the Spanish Flu the COVID-19 pandemic has re-ignited scholarly interest in the earlier pandemic. Socioeconomic and occupational differences in the pandemic flu mortality are still poorly understood, and although it has become clear that non-linear socioeconomic differences in Spanish flu mortality existed, it remains unclear through which pathways. In this paper, we explore the relation between occupational characteristics and excess mortality during the pandemic. Our aim is to disentangle social standing and conditions for viral transmission. Therefore, we calculated the excess mortality rate by age group, sex, and occupational cluster within 6,028 municipalities. Using OLS regression models, we estimate whether social position, regular interaction with strangers in the workplace, and working with others in an enclosed space affected excess mortality during the autumn wave of 1918 in the Netherlands. Findings suggest that part of the non-linear socioeconomic differences in pandemic flu mortality are driven by occupational characteristics, as individuals who worked indoors and met few strangers were less likely to experience excess mortality, both in less-hit and more strongly affected regions.

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 Presented in Session 59. The Consequences of Epidemics