Regional and Racial Inequality in Infectious Disease Mortality in US Cities, 1900-1948

Working Paper: NBER ID: w25345

Authors: James J. Feigenbaum; Christopher Muller; Elizabeth Wrigley-Field

Abstract: In the first half of the twentieth century, the rate of death from infectious disease in the United States fell precipitously. Although this decline is well-known and well-documented, there is surprisingly little evidence about whether it took place uniformly across the regions of the U.S. We use data on infectious disease deaths from all reporting U.S. cities to describe regional patterns in the decline of urban infectious mortality from 1900 to 1948. We report three main results: First, urban infectious mortality was higher in the South in every year from 1900 to 1948. Second, infectious mortality declined later in southern cities than in cities in the other regions. Third, comparatively high infectious mortality in southern cities was driven primarily by extremely high infectious mortality among African Americans. From 1906 to 1920, African Americans in cities experienced a rate of death from infectious disease greater than what urban whites experienced during the 1918 flu pandemic.

Keywords: Infectious Disease Mortality; Regional Inequality; Racial Disparities

JEL Codes: I14; J1; N3

Causal Claims

Cause	Effect
high rates of infectious mortality in southern cities (I14)	disproportionately high mortality rates among African Americans (I14)
African Americans' high mortality risk from infectious diseases (I12)	high rates of infectious mortality in southern cities (I14)
urban infectious mortality in southern cities (R23)	higher urban infectious mortality compared to other regions (R11)
timing of decline in infectious mortality rates (C41)	lag in southern cities compared to northeast, midwest, and west (R11)
regional disparities in infectious disease mortality (I14)	racial composition (J15)
age distribution control (J11)	isolation of effects attributable to regional and racial characteristics (R23)