Is the 1918 Influenza Pandemic Over? Long-term Effects of In Utero Influenza Exposure in the Post-1940 U.S. Population

This paper studies the long-term impact of the fall 1918 Influenza Pandemic. In the 1960-1980 Decennial U.S. Census data, cohorts in utero during the height of the Pandemic typically display reduced educational attainment, increased rates of physical disability, lower income, lower socioeconomic status, as well as accelerated adult mortality compared with other birth cohorts. In addition, persons born in states with more severe exposure to the Pandemic experienced worse outcomes than those born in states with less severe Pandemic exposures. These results demonstrate that investments aimed at improving fetal health can have substantial long-term effects on subsequent health and economic outcomes. Financial Support by the National Institute of Aging through Grant Number T32-AG00186 to the National Bureau of Economic Research and NIH/National Institute of Aging Grant: R03AG023939-01 is gratefully acknowledged. Comments and suggestions from Hoyt Bleakley, David Card, Ken Chay, Dora Costa, Lena Edlund, Amy Finkelstein, Michael Greenstone, Bhash Mazumder, Marie McCormick, Ellen Meara, Kevin Milligan, Tara Watson, and seminar participants at several universities are gratefully acknowledged. Timely and extensive information on current pandemic influenza risks, provided by Daniel Sharp and his associates at the Royal Institution World Science Assembly, is gratefully acknowledged. Sharon Schaff provided excellent research assistance. Data used include those provided by the National heart, Lung and Blood Institute, NIH, and DHHS from the National Longitudinal Mortality Study and do not necessarily reflect the views of the National Heart, Lung, and Blood Institute, the Bureau of the Census, or the National Center for Health Statistics. I am responsible for all errors.