Death on the permafrost: revisiting the 1918-1920 influenza pandemic in Alaska using death certificates.

This article quantitatively analyzes mortality during the 1918-1920 influenza pandemic in Alaska, focusing on differences between Alaska Native (AN) and non-Alaska Native (non-AN) populations using individual death certificates (n=7,147) from 1915 to 1921. Findings reveal that ANs accounted for 83% of pneumonia and influenza (P&I) deaths and experienced an 8.1-fold higher excess mortality rate than non-ANs, with 1,048 excess deaths among ANs versus 163 among non-ANs. The study identifies four distinct mortality outbreaks, including previously unrecognized peaks in 1920, and shows differing age-specific mortality patterns: non-AN mortality peaked in young adults and declined after age 30, while AN mortality remained high through middle age, suggesting limited prior exposure to H1-type influenza viruses among ANs. The research underscores the severe impact of the pandemic on Alaska's Indigenous populations and highlights the importance of disaggregating data by ethnic group to accurately assess pandemic effects.