Age-specific mortality and the role of living remotely: The 1918-20 influenza pandemic in Kautokeino and Karasjok, Norway

ABSTRACT

The 1918–20 pandemic influenza killed 50–100 million people worldwide, but mortality varied by ethnicity and geography. In Norway, areas dominated by Sámi experienced 3–5 times higher mortality than the country’s average. We here use data from burial registers and censuses to calculate all-cause excess mortality by age and wave in two remote Sámi areas of Norway 1918–20. We hypothesise that geographic isolation, less prior exposure to seasonal influenza, and thus less immunity led to higher Indigenous mortality and a different age distribution of mortality (higher mortality for all) than was typical for this pandemic in non-isolated majority populations (higher young adult mortality & sparing of the elderly). Our results show that in the fall of 1918 (Karasjok), winter of 1919 (Kautokeino), and winter of 1920 (Karasjok), young adults had the highest excess mortality, followed by also high excess mortality among the elderly and children. Children did not exhibit excess mortality in the second wave in Karasjok in 1920. It was not the young adults alone who produced the excess mortality in Kautokeino and Karasjok. We conclude that geographic isolation caused higher mortality among the elderly in the first and second waves, and among children in the first wave.

KEYWORDS:

• 1918-20 influenza
• Spanish flu
• pandemic influenza
• sámi
• sápmi
• indigenous people
• Norway

Acknowledgments

This article is an edited version of a master thesis in Norwegian written by the first author Ingrid H. Nygaard [31]. The work on the current article is written as part of the project “Social Science Meets Biology: Indigenous People and Severe Influenza Outcomes”, funded by the Centre for Advanced Study at the Norwegian Academy of Science and Letters in Oslo. The research in is this article has been approved by the Norwegian Expert Ethics Committee for Sámi Health Research (SEK 006/22, approval number SMT166-1088316) and by the Norwegian Regional Committees for Medical and Health Research Ethics (REK, approval number 375156).

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No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

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Funding

This work was supported by the Centre for Advanced Study at the Academy of Science and Letters in Oslo, Norway;