Early life exposure to the 1918 influenza pandemic and old-age mortality by cause of death

M. Myrskylä, N.K. Mehta and V.W. Chang

American Journal of Public Health, 2013, vol. 103, issue 7, e83-e90

Abstract: Objectives. We sought to analyze how early exposure to the 1918 influenza pandemic is associated with old-age mortality by cause of death. Methods. We analyzed the National Health Interview Survey (n = 81 571; follow-up 1989-2006; 43 808 deaths) and used year and quarter of birth to assess timing of pandemic exposure. We used Cox proportional and Fine-Gray competing hazard models for all-cause and cause-specific mortality, respectively. Results. Cohorts born during pandemic peaks had excess all-cause mortality attributed to increased noncancer mortality. We found evidence for a trade-off between noncancer and cancer causes: cohorts with high noncancer mortality had low cancer mortality, and vice versa. Conclusions. Early disease exposure increases old-age mortality through noncancer causes, which include respiratory and cardiovascular diseases, and may trigger a trade-off in the risk of cancer and noncancer causes. Potential mechanisms include inflammation or apoptosis. The findings contribute to our understanding of the causes of death behind the early disease exposure-latermortality association. The cancer-noncancer trade-off is potentially important for understanding the mechanisms behind these associations. Copyright © 2012 by the American Public Health Association®.

Keywords: aged; article; cardiovascular disease; cause of death; cohort analysis; communicable disease; cross-sectional study; environmental exposure; female; follow up; health survey; human; influenza; male; middle aged; mortality; neoplasm; pandemic; perinatal period; proportional hazards model; respiratory tract disease; United States; very elderly, Aged; Aged, 80 and over; Cardiovascular Diseases; Cause of Death; Cohort Studies; Communicable Diseases; Cross-Sectional Studies; Environmental Exposure; Female; Follow-Up Studies; Health Surveys; Humans; Influenza, Human; Male; Middle Aged; Mortality; Neoplasms; Pandemics; Peripartum Period; Proportional Hazards Models; Respiratory Tract Diseases; United States (search for similar items in EconPapers)
Date: 2013
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Citations: View citations in EconPapers (25)

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Persistent link: https://EconPapers.repec.org/RePEc:aph:ajpbhl:10.2105/ajph.2012.301060_2

DOI: 10.2105/AJPH.2012.301060

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