Death, demography and the denominator: Age-adjusted Influenza-18 mortality in Ireland.

Using the Irish experience of the 1918-1919 Spanish flu pandemic ("Influenza-18"), we demonstrate how pandemic mortality statistics can be sensitive to the demographic composition of a country. We build a new spatially disaggregated population database for Ireland's 32 counties for 1911-1920 with vital statistics on births, ageing, migration and deaths. Our principal contribution is to show why, and how, age-at-death data should be used to construct the age-standardised statistics necessary to make meaningful comparisons of mortality rates across time and space. We conclude that studies of the economic consequences of pandemics must better control for demographic factors if they are to yield useful policy-relevant insights. For example, while Northern Ireland had a higher crude death rate during the first wave of the Covid-19 pandemic, it also has an older population; age-adjusted mortality paints a very different picture.