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dc.contributor.authorChowell, Gerardo
dc.contributor.authorErkoreka Barrena, José Antonio
dc.contributor.authorViboud, Cécile
dc.contributor.authorEcheverri-Dávila, Beatriz
dc.date.accessioned2015-12-10T15:41:15Z
dc.date.available2015-12-10T15:41:15Z
dc.date.issued2014-07-05
dc.identifier.citationBMC Infectious Diseases 14 : (2014) // Article ID 371es
dc.identifier.issn1471-2334
dc.identifier.urihttp://hdl.handle.net/10810/16418
dc.description.abstractBackground: The impact of socio-demographic factors and baseline health on the mortality burden of seasonal and pandemic influenza remains debated. Here we analyzed the spatial-temporal mortality patterns of the 1918 influenza pandemic in Spain, one of the countries of Europe that experienced the highest mortality burden. Methods: We analyzed monthly death rates from respiratory diseases and all-causes across 49 provinces of Spain, including the Canary and Balearic Islands, during the period January-1915 to June-1919. We estimated the influenza-related excess death rates and risk of death relative to baseline mortality by pandemic wave and province. We then explored the association between pandemic excess mortality rates and health and socio-demographic factors, which included population size and age structure, population density, infant mortality rates, baseline death rates, and urbanization. Results: Our analysis revealed high geographic heterogeneity in pandemic mortality impact. We identified 3 pandemic waves of varying timing and intensity covering the period from Jan-1918 to Jun-1919, with the highest pandemic-related excess mortality rates occurring during the months of October-November 1918 across all Spanish provinces. Cumulative excess mortality rates followed a south-north gradient after controlling for demographic factors, with the North experiencing highest excess mortality rates. A model that included latitude, population density, and the proportion of children living in provinces explained about 40% of the geographic variability in cumulative excess death rates during 1918-19, but different factors explained mortality variation in each wave. Conclusions: A substantial fraction of the variability in excess mortality rates across Spanish provinces remained unexplained, which suggests that other unidentified factors such as comorbidities, climate and background immunity may have affected the 1918-19 pandemic mortality rates. Further archeo-epidemiological research should concentrate on identifying settings with combined availability of local historical mortality records and information on the prevalence of underlying risk factors, or patient-level clinical data, to further clarify the drivers of 1918 pandemic influenza mortality.es
dc.description.sponsorshipThis research was conducted in the context of the Multinational Influenza Seasonal Mortality Study (MISMS), an on-going international collaborative effort to understand influenza epidemiological and evolutionary patterns, led by the Fogarty International Center, National Institutes of Health (http://www.origem.info/misms/index.php). Funding for this project comes in part from the Office of Global Affairs' International Influenza Unit in the Office of the Secretary of the Department of Health and Human Services.es
dc.language.isoenges
dc.publisherBiomed Centrales
dc.rightsinfo:eu-repo/semantics/openAccesses
dc.subject1918-1919 influenza pandemices
dc.subjectspaines
dc.subjectspanish influenzaes
dc.subjectspring-summer wavees
dc.subjectexcess death rateses
dc.subjectrelative risk of deathes
dc.subjecttransmissibilityes
dc.subjectprovinceses
dc.subjectgeographyes
dc.subjectspatial heterogeneityes
dc.subjectepidemiologic evidencees
dc.subjectbacterial pneumoniaes
dc.subjectage distributiones
dc.subjectdeathses
dc.subjectwavees
dc.subjecttransmissiones
dc.subjectcopenhagenes
dc.subjecteuropees
dc.subjectimpactes
dc.subjectcityes
dc.titleSpatial-temporal excess mortality patterns of the 1918-1919 influenza pandemic in Spaines
dc.typeinfo:eu-repo/semantics/articlees
dc.rights.holder© 2014 Chowell et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.es
dc.relation.publisherversionhttp://www.biomedcentral.com/1471-2334/14/371/abstractes
dc.identifier.doi10.1186/1471-2334-14-371
dc.departamentoesFísica teórica e historia de la cienciaes_ES
dc.departamentoeuFisika teorikoa eta zientziaren historiaes_ES
dc.subject.categoriaINFECTIOUS DISEASES


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