Background: A debate has been going on since 1918 over whether there were social differences in mortality from Spanish influenza. Mot commentators have concluded that mortality was socially neutral. In this paper it is discussed why the influenza pandemic of 1918-19 was different from recent influenza epidemics, which have displayed greater social differences in mortality than most other causes of death.
Materials and methods: Multivariate analysis and event history data are used for the first time to analyse the variation in mortality from Spanish influenza. The study is confined to a west end and an east end parish in Norway's capital city. Historical demographic data for Norway has a good reputation internationally. The data are also unique because--Norway being a neutral country--they can be used to estimate the effect of the Spanish influenza on mortality net of the effect of the First World War.
Results: Middle class and bourgeois mortality was 19-25% lower than working class mortality (not significant). Those living in apartments with four to six rooms had on average 50 % lower mortality than those living in one-room apartments (significant). Moreover, the east end parish had 50 % higher mortality than the west end parish (significant).
Interpretation: These findings challenge the myth that Spanish influenza picked its victims at random. The study may have international relevance because data difficult to obtain for other countries have been used.