Pandemic Patterns: The Long-Term Health Outcomes of 1918 Influenza Survivors in the St. John's General Hospital of Newfoundland and Labrador.

objectivesResearch surrounding the 1918 influenza pandemic has primarily been a story of mortality despite theoretical and practical reasons to focus on the pandemic's long-term impacts. We investigate survivorship among individuals who were hospitalized with influenza and pneumonia (P&I) before and during the 1918 flu to explore morbidity and understand the effects of viral pandemic illness on long-term individual health. MATERIALS AND

methodsWe synthesize a novel dataset of hospitalization records from St. John's General Hospital in Newfoundland & Labrador with vital records to calculate survivorship beyond hospitalization with P&I from a non-pandemic period (1914-1917) and the 1918 flu period (1918-1920) (total n = 127). We use a Kaplan-Meier log-rank test to identify differences in cumulative survivorship and a Cox proportional hazards model to predict survivorship controlling for period, length of hospitalization, and age at hospitalization (ɑ = 0.10).

resultsKaplan-Meier results indicate no significant differences in survival probability between the two time periods (non-pandemic vs. pandemic P&I, p = 0.12). Cox proportional hazards results support this observation (HR for pandemic hospitalizations = 0.8, p = 0.32). The number of days spent hospitalized (HR = 1.01, p = 0.096) and age at hospitalization (HR = 1.05, p < 0.001) were significant predictors of survival probability.

conclusionThis innovative research investigating morbidity as well as mortality during pandemic events links individual pandemic survivors with their long-term mortality data. The results speak to the complex nature of tracing individual and population health outcomes over time.