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

Christopher JL Murray, Alan D. Lopez, Brian Chin, Dennis Feehan, Kenneth H. Hill

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The threat of an avian influenza pandemic is causing widespread public concern and health policy response, especially in high-income countries. Our aim was to use high-quality vital registration data gathered during the 1918-20 pandemic to estimate global mortality should such a pandemic occur today. Methods: We identified all countries with high-quality vital registration data for the 1918-20 pandemic and used these data to calculate excess mortality. We developed ordinary least squares regression models that related excess mortality to per-head income and absolute latitude and used these models to estimate mortality had there been an influenza pandemic in 2004. Findings: Excess mortality data show that, even in 1918-20, population mortality varied over 30-fold across countries. Per-head income explained a large fraction of this variation in mortality. Extrapolation of 1918-20 mortality rates to the worldwide population of 2004 indicates that an estimated 62 million people (10th-90th percentile range 51 million-81 million) would be killed by a similar influenza pandemic; 96% (95% CI 95-98) of these deaths would occur in the developing world. If this mortality were concentrated in a single year, it would increase global mortality by 114%. Interpretation: This analysis of the empirical record of the 1918-20 pandemic provides a plausible upper bound on pandemic mortality. Most deaths will occur in poor countries-ie, in societies whose scarce health resources are already stretched by existing health priorities.

Original languageEnglish (US)
Pages (from-to)2211-2218
Number of pages8
JournalLancet
Volume368
Issue number9554
DOIs
StatePublished - Dec 23 2006

ASJC Scopus subject areas

  • Medicine(all)

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