Volume 47 - Article 32 | Pages 1009–1018  

The Spanish flu and the health system: Considerations from the city of Parma, 1918

By Matteo Manfredini

Abstract

Background: The gravity of the Spanish flu has been often associated with inadequate health systems. However, few studies have used health data effectively in their analysis of epidemics.

Objective: To analyze the role of hospitals in an Italian town during the Spanish flu and its effect on the risk of dying at home.

Methods: Individual-level information from the Permission of Burials was used to evaluate the impact of the epidemic on city hospitals. A logistic model was used to estimate the odds of a home death in order to elucidate possible sociodemographic mechanisms linked to hospital saturation issues.

Results: During the epidemic the odds of dying at home increased by 29% overall, driven especially by an increase in home deaths among the poorest social groups. However, the well-off maintained the highest odds of dying at home throughout 1918.

Conclusions: Hospitals facilitated the spread of the epidemic in the city and contributed to its high mortality level. The increase in the odds of dying at home for the poorest was likely associated with hospital saturation, which conversely does not appear to have affected the well-off. In fact, this social group already had very high levels of home deaths in the pre-epidemic period.

Contribution: Evaluating the role of hospitals during the Spanish flu allows better comprehension of the spread and evolution of the epidemic, especially regarding possible saturation issues and differential access to health resources.

Author's Affiliation

Other articles by the same author/authors in Demographic Research

Deaths and survivors in war: The Italian soldiers in WWI
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Patterns of reproductive behavior in transitional Italy: The rediscovery of the Italian fertility survey of 1961
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Demographic responses to short-term stress in a 19th century Tuscan population: The case of household out-migration
Volume 25 - Article 15

Health and socio-demographic conditions as determinants of marriage and social mobility: Male partner choice in Sardinia, late 19th-early 20th century
Volume 22 - Article 33

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