The 1918 influenza pandemic did not accelerate tuberculosis mortality decline in early‐20th century Newfoundland: Investigating historical and social explanations
The 1918 influenza pandemic did not accelerate tuberculosis mortality decline in early‐20th century Newfoundland: Investigating historical and social explanations
复制标题
1918 年流感大流行并没有加速 20 世纪初纽芬兰的结核病死亡率下降：调查历史和社会解释
DOI：
10.1002/ajpa.24332
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发表时间：
2021
影响因子：
2.8
通讯作者：
Sattenspiel, Lisa
中科院分区：
文献类型：
--
作者：
van Doren, Taylor P.;Sattenspiel, Lisa
Nomer和他的同事提出的1918年流感大流行后结核病的选择性死亡假说表明，1918年流感大流行期间，急性暴露或先前存在的结核病感染增加了肺炎和流感(P&I)死亡的可能性，导致大流行后几年结核病死亡率加速下降。这项研究描述了纽芬兰大流行后结核病死亡模式的文化决定因素，并评估是否支持这一观察结果。材料和方法纽芬兰和拉布拉多省档案馆的死亡记录和历史文件被用来计算1900-1939年全岛和基于性别的年龄标准化结核病死亡率，以及区域一级的结核病死亡率。使用Joinpoint回归程序(版本4.8.0.1)估计死亡率的显著变化。结果在整个岛屿范围内，在研究期间，女性的结核病死亡率一直较高，并从1928年开始显著转向较低的结核病死亡率。对于男性，没有类似的预测显着下降。在地区层面上，没有任何模型预测1918年流感大流行后出现显著下降，除了西方，那里在20世纪30年代末预测了显著下降。讨论尽管没有像其他西方国家那样，在大流行后立即观察到结核病死亡率显著下降，但女性大流行后的模式表明，大流行后很长时间才出现下降。结核病死亡率总体上没有明显下降，可能是由于纽芬兰营养不良和缺乏集中保健，而不是由于P&I和结核病之间的生物相互作用。
ObjectivesThe selective mortality hypothesis of tuberculosis after the 1918 influenza pandemic, laid out by Noymer and colleagues, suggests that acute exposure or pre‐existing infection with tuberculosis (TB) increased the probability of pneumonia and influenza (P&I) mortality during the 1918 influenza pandemic, leading to a hastened decline of TB mortality in post‐pandemic years. This study describes cultural determinants of the post‐pandemic TB mortality patterns in Newfoundland and evaluates whether there is support for this observation.Materials and methodsDeath records and historical documents from the Provincial Archives of Newfoundland and Labrador were used to calculate age‐standardized island‐wide and sex‐based TB mortality, as well as region‐level TB mortality, for 1900–1939. The Joinpoint Regression Program (version 4.8.0.1) was used to estimate statistically significant changes in mortality rates.ResultsIsland‐wide, females had consistently higher TB mortality for the duration of the study period and a significant shift to lower TB mortality beginning in 1928. There was no similar predicted significant decline for males. On the regional level, no models predicted a significant decline after the 1918 influenza pandemic, except for the West, where significant decline was predicted in the late‐1930s.DiscussionAlthough there was no significant decline in TB mortality observed immediately post‐pandemic, as has been shown for other Western nations, the female post‐pandemic pattern suggests a decline much later. The general lack of significant decrease in TB mortality rate is likely due to Newfoundland's poor nutrition and lack of centralized healthcare rather than a biological interaction between P&I and TB.