Walking With Feet Tied to the Past: Childhood Exposure to the 1918 Influenza Pandemic and Later‐Life Male Mortality

Many previous studies have used cross-cohort comparisons and a focus on in utero exposure to document the lingering effects of the 1918 influenza pandemic on survivors' outcomes later in life. A subset has examined impacts on old-age health and mortality, finding mixed results. This paper contributes to the literature by extending the analysis to evaluate early-life and childhood exposure to the pandemic on old-age longevity along with a set of candidate mechanisms. We employ Social Security Administration death records linked to the full-count 1940 census and employ event-study and difference-in-difference regressions to compare longevity of cohorts with different age-at-exposure who were born in cities with high versus low exposure based on 1918 influenza-related mortality. Our treatment-on-treated calculations suggest that cohorts with age-at-exposure of 0-5 and 6-11 experience 7.2 and 10.9 months reductions in old age longevity; importantly, we note that these cohorts are often used as "controls" in the broader literature. While our main analysis focuses on males due to data constraints, supplementary results suggest similar effects for females. An analysis of census data suggests reductions in health, education and socioeconomic scores as potential mechanisms. The findings of this paper have important policy implications for interventions and identifying the populations at higher risks of adverse long-term outcomes during major pandemics.