Can We Generalize About the Mortality Features of the 1918‐19 Influenza Pandemic? An Examination of a Small‐Scale and Isolated British Columbian Population

OBJECTIVES: In this paper we use the small-scale population of the Fort George area (located in the central interior of British Columbia, Canada) to test the applicability of the three signature mortality features of the 1918/19 influenza pandemic: mortality rates higher than those in preceding influenza epidemics except for the elderly; rapidly recurring waves; and W-shaped age mortality distribution. MATERIALS AND METHODS: Death records from the British Columbia Archives and the University of Northern British Columbia's Geoffrey R. Weller Library and Northern BC Archives Learning Resource on 1918 influenza in Prince George (which included the Corless Funeral ledger, the Prince George Citizen, and a Record of Confinements journal) were used to assess the presence of the signature features. Analyses were conducted on monthly influenza death rates for the duration of the influenza pandemic, from September 1918 until December 1920, and on age and sex-specific influenza rates. RESULTS: The Fort George area escaped a herald wave in the spring/summer of 1918, and the overall influenza death rate was 14.17 per 1000 living. The first wave, in the fall, peaked in the month of October at a rate of 5.24 per 1000 living. The male influenza death rate was 12.46 per 1000 living, and the female rate was higher, at 16.37 per 1000 living, but the rates were not significantly different (Z = -1.34; p = 0.180). The peak influenza death rate occurred in those 65 years or older. DISCUSSION: We confirmed that two of the three mortality features were observed in Fort George. We could not assess whether the 1918/19 influenza pandemic had higher mortality rates relative to previous pandemics; however, the influenza death rate in the elderly was high, which indicates that older individuals were not exposed to the earlier influenza pandemics in the 19th century. The W-shape distribution of influenza death rates, coupled with narrative accounts, provides support for evidence that both single men and young families were negatively impacted by the pandemic.