Short‐ and medium‐run health and literacy impacts of the 1918 Spanish Flu pandemic in Brazil
研究1918年西班牙流感对巴西圣保罗地区婴儿死亡率、性别比及男性识字率的影响，发现疫情导致婴儿死亡率和死产上升、出生性别比下降，但男性识字率在1920年和1940年均有显著提升，尤其在老年人口多、识字率低和医生资源少的地区影响更大。
Abstract We study the lasting repercussions of the 1918 influenza (‘Spanish Flu’) pandemic on health measures and literacy rates in São Paulo, Brazil, the most populous city in South America today, but significantly poorer a century ago. Leveraging temporal and spatial variation in district‐level estimates of influenza‐related deaths for the 1917–20 time period, combined with a unique database on demographic and literacy outcomes as well as a detailed set of socio‐economic, infrastructure, and regional determinants newly constructed from historical data, we find that the pandemic had significant impacts. In particular, infant mortality and stillbirths rose, sex ratios at birth fell, and there was a marked improvement in male literacy rates for those 15 years and above in 1920. Further analyses reveal that these impacts are most pronounced in districts with older populations, less literate districts, and districts where access to doctors was relatively limited. We find evidence that the male literacy effects persist in 1940. These results highlight that ramifications of the 1918 Spanish Flu pandemic were experienced for at least two decades after the event in a context where institutions were relatively weak and resources for mitigation were limited.