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Pollution, Infectious Disease, and Mortality: Evidence from the 1918 Spanish Influenza Pandemic

  • Karen Clay (a1), Joshua Lewis (a2) and Edson Severnini (a3)


The 1918 Influenza Pandemic killed millions worldwide and hundreds of thousands in the United States. This article studies the impact of air pollution on pandemic mortality. The analysis combines a panel dataset on infant and all-age mortality with a novel measure of air pollution based on the burning of coal in a large sample of U.S. cities. We estimate that air pollution contributed significantly to pandemic mortality. Cities that used more coal experienced tens of thousands of excess deaths in 1918 relative to cities that used less coal with similar pre-pandemic socioeconomic conditions and baseline health. Factors related to poverty, public health, and the timing of onset also affected pandemic mortality. The findings support recent medical evidence on the link between air pollution and influenza infection, and suggest that poor air quality was an important cause of mortality during the pandemic.

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We thank Martha Bailey, Antonio Bento, Christian Dippel, Walker Hanlon, Frank Lewis, and seminar participants at the 2015 NBER DAE Summer Meetings, the 2015 CNEH Meetings, the 2015 AERE Summer Conference, the 2015 Annual Meeting of the Population Association of America, McGill University, Carnegie Mellon University, and University of Southern California for valuable comments and suggestions. Edson Severnini thanks the Energy Policy Institute at the University of Chicago for research support and its generous hospitality during his semester-long visit, when part of this project was executed. Clay and Severnini acknowledge financial support from Heinz College and the Berkman Fund at Carnegie Mellon University. Lewis acknowledges financial support from Université de Montréal.



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Pollution, Infectious Disease, and Mortality: Evidence from the 1918 Spanish Influenza Pandemic

  • Karen Clay (a1), Joshua Lewis (a2) and Edson Severnini (a3)


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