Does in utero exposure to Illness matter? The 1918 influenza epidemic in Taiwan as a natural experiment

J Health Econ. 2014 Sep:37:152-63. doi: 10.1016/j.jhealeco.2014.05.004. Epub 2014 Jun 4.


This paper tests whether in utero conditions affect long-run developmental outcomes using the 1918 influenza pandemic in Taiwan as a natural experiment. Combining several historical and current datasets, we find that cohorts in utero during the pandemic are shorter as children/adolescents and less educated compared to other birth cohorts. We also find that they are more likely to have serious health problems including kidney disease, circulatory and respiratory problems, and diabetes in old age. Despite possible positive selection on health outcomes due to high infant mortality rates during this period (18%), our paper finds a strong negative impact of in utero exposure to influenza.

Keywords: 1918 influenza; Disease and mortality; Education; Fetal origins hypothesis; Height.

Publication types

  • Historical Article
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged, 80 and over
  • Anthropometry
  • Cohort Studies
  • Educational Status*
  • Female
  • Fetal Development
  • Health Status*
  • History, 20th Century
  • Humans
  • Influenza, Human / complications*
  • Influenza, Human / epidemiology*
  • Influenza, Human / history
  • Male
  • Maternal Exposure*
  • Pandemics / history
  • Pregnancy
  • Prenatal Exposure Delayed Effects / epidemiology*
  • Prenatal Exposure Delayed Effects / history
  • Risk
  • Socioeconomic Factors
  • Taiwan / epidemiology