almond_1918 - Is the 1918 Inuenza Pandemic Over LongTerm...

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672 [ Journal of Political Economy, 2006, vol. 114, no. 4] 2006 by The University of Chicago. All rights reserved. 0022-3808/2006/11404-0003$10.00 Is the 1918 Influenza Pandemic Over? Long- Term Effects of In Utero Influenza Exposure in the Post-1940 U.S. Population Douglas Almond Columbia University and National Bureau of Economic Research This paper uses the 1918 influenza pandemic as a natural experiment for testing the fetal origins hypothesis. The pandemic arrived unex- pectedly in the fall of 1918 and had largely subsided by January 1919, generating sharp predictions for long-term effects. Data from the 1960–80 decennial U.S. Census indicate that cohorts in utero during the pandemic displayed reduced educational attainment, increased rates of physical disability, lower income, lower socioeconomic status, and higher transfer payments compared with other birth cohorts. These results indicate that investments in fetal health can increase human capital. I. Introduction According to the fetal origins hypothesis (Barker 1992), certain chronic health conditions can be traced to the course of fetal development. Randomized experiments with animals have supported the hypothesis, but its relevance for humans remains controversial because of obstacles to evaluation. Chief among these are (i) omitted factors, such as genetic I am indebted to Kenneth Chay, my dissertation advisor. I also wish to thank Alan Auerbach, David Card, Dexter Chu, Dora Costa, Lena Edlund, Michael Greenstone, George Lamson, Ronald Lee, Bhashkar Mazumder, Cristian Pop-Eleches, and Steven Levitt. Financial support from the National Institutes of Health (NIA grant 5R03AG23939-2), suggestions from seminar participants, particularly those at the Center for Health and Wellbeing, Princeton University, and anonymous referee comments are gratefully ac- knowledged. The Journal of the American Medical Association ’s blithe 1918 editorial was discovered courtesy of Alfred Crosby. Stein et al.’s (1975) study of the Dutch famine has been an inspiring example. All errors are my own.
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1918 influenza pandemic 673 endowments, that may “stack” nonexperimental studies toward positive findings and (ii) the inherent difficulty of detecting delayed effects, particularly when the period of latency is long. The 1918 influenza pandemic presents an exceptional opportunity to evaluate effects of the prenatal environment using U.S. Census data. Twenty-five million persons in the United States contracted the debili- tating influenza strain and survived. Some of the highest infection rates were observed among women of childbearing age, one-third of whom contracted influenza. As census micro data identify both the place and quarter of birth of respondents, these can be linked to the timing and geographic variation in influenza infection. Two distinct features of the 1918 pandemic severely limit the scope for omitted variables bias. First, the pandemic struck without warning 1 in October 1918 and had largely dissipated by the beginning of 1919 (figs. 1 a and 1 b ), implying that cohorts born just months apart expe- rienced markedly different in utero conditions. This presents a severe
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