A cohort study of tuberculosis and influenza mortality in the twentieth century

We reviewed period and cohort mortality for tuberculosis and influenza and pneumonia over the twentieth century and data on the roles of influenza and tuberculosis as underlying and contributory causes of death. As would be consistent with long-term trends, each cohort had lower tuberculosis mortality but there was no decisive downturn in age specific tuberculosis mortality for any male cohort until after 1945. Tuberculosis mortality among females fell steadily from cohort to cohort as well as within each cohort. In every cohort born from around 1890 to around 1930, tuberculosis mortality was higher among women than among men at ages under 30, suggesting that prevalence in women was also higher, but death rates of females crossed under those of males at about age 30. Tuberculosis death rates rose more for males than females around 1918; however, any unusual increase that could be attributable to the 1918 influenza pandemic must have been brief. Contrary to expectations in the medical community, tuberculosis mortality did not rise following the 1918 influenza pandemic. Some portion of the rise in death rates around 1918 may have been associated with the influenza, but a comparison of the increase in male tuberculosis mortality during and after World War II, when there was no influenza pandemic, with male mortality in a similar period during and after World War I suggests that any excess in tuberculosis mortality among males in both periods may have been due to wartime mobilization rather than influenza.