Determinants of Influenza Mortality Trends: Age-Period-Cohort Analysis of Influenza Mortality in the United States, 1959–2016

Enrique Acosta, Stacey A. Hallman, Lisa Y. Dillon, Nadine Ouellette, Robert Bourbeau, D. Ann Herring, Kris Inwood, David J. D. Earn, Joaquin Madrenas, Matthew S. Miller and Alain Gagnon ()
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Enrique Acosta: Université de Montréal
Stacey A. Hallman: Statistics Canada
Lisa Y. Dillon: Université de Montréal
Nadine Ouellette: Université de Montréal
Robert Bourbeau: Université de Montréal
D. Ann Herring: McMaster University
David J. D. Earn: McMaster University
Joaquin Madrenas: Harbor-UCLA Medical Center
Matthew S. Miller: McMaster University
Alain Gagnon: Université de Montréal

Demography, 2019, vol. 56, issue 5, No 6, 1723-1746

Abstract: Abstract This study examines the roles of age, period, and cohort in influenza mortality trends over the years 1959–2016 in the United States. First, we use Lexis surfaces based on Serfling models to highlight influenza mortality patterns as well as to identify lingering effects of early-life exposure to specific influenza virus subtypes (e.g., H1N1, H3N2). Second, we use age-period-cohort (APC) methods to explore APC linear trends and identify changes in the slope of these trends (contrasts). Our analyses reveal a series of breakpoints where the magnitude and direction of birth cohort trends significantly change, mostly corresponding to years in which important antigenic drifts or shifts took place (i.e., 1947, 1957, 1968, and 1978). Whereas child, youth, and adult influenza mortality appear to be influenced by a combination of cohort- and period-specific factors, reflecting the interaction between the antigenic experience of the population and the evolution of the influenza virus itself, mortality patterns of the elderly appear to be molded by broader cohort factors. The latter would reflect the processes of physiological capital improvement in successive birth cohorts through secular changes in early-life conditions. Antigenic imprinting, cohort morbidity phenotype, and other mechanisms that can generate the observed cohort effects, including the baby boom, are discussed.

Keywords: Influenza mortality; Antigenic imprinting; Cohort morbidity phenotype; Lexis surfaces; Age-period-cohort analysis (search for similar items in EconPapers)
Date: 2019
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Citations: View citations in EconPapers (5)

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DOI: 10.1007/s13524-019-00809-y

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