The Spanish flu and the health system: Considerations from the city of Parma, 1918

BACKGROUND The gravity of the Spanish flu has been often associated with inadequate health systems. However, few studies have used health data effectively in their analysis of epidemics. OBJECTIVE To analyze the role of hospitals in an Italian town during the Spanish flu and its effect on the risk of dying at home. METHODS Individual-level information from the Permission of Burials was used to evaluate the impact of the epidemic on city hospitals. A logistic model was used to estimate the odds of a home death in order to elucidate possible sociodemographic mechanisms linked to hospital saturation issues.