Same place, different stories: The mortality burden of the 1918-1920 influenza pandemic in Denmark

The 1918-1920 Spanish influenza pandemic is iconic, leading in multiple waves to millions of deaths of mostly otherwise healthy young adults. In this paper, we study the pandemic’s regional mortality burden in rural and urban Denmark. We find that 0,3% of Denmark’s population died during the four waves that constituted the pandemic. There were substantial regional differences with eastern Zealand being hit much harder than northern Jutland. Urbanization appears to have been an important discriminating factor behind influenza
mortality, and the Spanish flu can be seen as an urban disease. On a regional scale, factors such as population density and access to medical care were not associated with increased influenza mortality while socioeconomic conditions were. We note that our study has limitations, and that other more local factors such as mitigation strategies, differing age-patterns and nutritional status may also explain the variances.