Reply to Shanks and Brundage: Many plausible mechanisms of pandemic mortality disparities

In our recently published paper (1), we find evidence that several metrics of socioeconomic status were associated with influenza and pneumonia mortality during the 1918 pandemic. We agree with Shanks and Brundage (2) that there are many possible causal mechanisms behind this association and appreciate the hypotheses that they add to the several we discussed. Secondary bacterial infections, particularly those secondary bacterial infections resulting in pneumonia, have been implicated in a number of deaths during the 1918 pandemic period (3⇓–5). Our dataset includes deaths attributed both to … [↵][1]1To whom correspondence should be addressed. Email: datc{at}ufl.edu. [1]: #xref-corresp-1-1