Lessons (Not) Learned: Chicago Death Inequities during the 1918 Influenza and COVID-19 Pandemics

Abstract

During historical and contemporary crises in the U.S., Blacks and other marginalized groups experience an increased risk for adverse health, social, and economic outcomes. These outcomes are driven by structural factors, such as poverty, racial residential segregation, and racial discrimination. These factors affect communities' exposure to risk and ability to recover from disasters, such as pandemics. This study examines whether areas where descendants of enslaved Africans and other Blacks lived in Chicago were vulnerable to excess death during the 1918 influenza pandemic and whether these disparities persisted in the same areas during the COVID-19 pandemic. To examine disparities, demographic data and influenza and pneumonia deaths were digitized from historic weekly paper maps from the week ending on 5 October 1918 to the week ending on 16 November 1918. Census tracts were labeled predominantly Black or white if the population threshold for the group in a census tract was 40% or higher for only one group. Historic neighborhood boundaries were used to aggregate census tract data. The 1918 spatial distribution of influenza and pneumonia mortality rates and cases in Chicago was then compared to the spatial distribution of COVID-19 mortality rates and cases using publicly available datasets. The results show that during the 1918 pandemic, mortality rates in white, immigrant and Black neighborhoods near industrial areas were highest. Pneumonia mortality rates in both Black and immigrant white neighborhoods near industrial areas were approximately double the rates of neighborhoods with predominantly US-born whites. Pneumonia mortality in Black and immigrant white neighborhoods, far away from industrial areas, was also higher (40% more) than in US-born white neighborhoods. Around 100 years later, COVID-19 mortality was high in areas with high concentrations of Blacks based on zip code analysis, even though the proportion of the Black population with COVID was similar or lower than other racial and immigrant groups. These findings highlight the continued cost of racial disparities in American society in the form of avoidable high rates of Black death during pandemics.

Keywords: 1918 influenza; COVID-19; black; pandemic; racial disparity; social death; social determinants of health; vulnerability.

Figure 1

Majority race and identified industrial areas by community settlement in Chicago at the time of the 1918 influenza pandemic.

Figure 2

Map of the 1918 influenza and pneumonia mortality rates and census tract characteristics.

Figure 3

COVID-19 mortality and neighborhood characteristics by census tracts.

Figure 4

The mortality rate of the historic 1918 pandemic in Chicago. (a) Influenza mortality rate by race and industry area proximity, (b) Pneumonia mortality rate by race and industry area proximity, (c) COVID-19 cumulative incidence rate by race: comparison between the majority race neighbor-based estimation and true rate, and (d) COVID-19 mortality rate by race: comparison between the majority race neighbor-based estimation and true rate. (*** p < 0.001).