A unique set of events that took place in Puerto Rico during 1918-1919 generated conditions of a “double “quasi-natural experiment. We exploit these conditions to empirically identify effects of exposure to the 1918 flu pandemic, those of the devastation left by an earthquake-tsunami that struck the island in 1918, and those associated with the joint occurrence of these events. We use geographic variation to identify the effects of the quake and timing of birth variation to identify those of the flu. In addition, we use markers of nutritional status gathered in a nationally representative sample of individuals aged 75 and older in 2002. This unique data set enables to make two distinct contributions. First, unlike most fetal-origins research that singles out early nutritional status as a determinant of adult health, we test the hypothesis that the 1918 flu had deleterious effects on the nutritional status on adult survivors who at the time of the flu were in utero or infants. Second, and unlike most research on the effects of the flu, we focus on markers of nutritional status set when the adult survivors were children or adolescents. We find that estimates of effects of the pandemic are sizeable primarily among females and among those who, in addition to the flu, were exposed to the earthquake-tsunami. We argue that these findings constitute empirical evidence supporting the conjecture that effects of the 1918 flu alone and the combined effects of the flu and the earthquake are associated not just with damage experienced during the fetal period but also postnatally.

中文翻译：

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1918年流感对幸存者营养状况的影响：双重自然实验

1918-1919年在波多黎各发生的一系列独特事件产生了“双重”准自然实验的条件。我们利用这些条件从经验上确定暴露于1918年流感大流行的影响，1918年袭击该岛的地震海啸所造成的破坏性影响以及与这些事件共同发生有关的影响。我们使用地理变化来确定地震的影响，并使用出生变化的时机来确定流感的影响。此外，我们使用2002年全国有代表性的75岁以上老年人的样本中收集的营养状况标记。这一独特的数据集可以做出两个不同的贡献。首先，与大多数胎儿起源研究不同，该研究指出早期营养状况是决定成人健康的因素，我们检验了1918年流感对成年幸存者的营养状况具有有害影响的假说，这些成年幸存者是在子宫内或婴儿中。其次，与大多数有关流感影响的研究不同，我们关注的是成年幸存者是儿童或青少年时所设定的营养状况标记。我们发现，对大流行的影响的估计主要是在女性中以及除流感外还遭受地震海啸影响的女性中。我们认为，这些发现构成了支持这一推测的经验证据，即仅1918年流感的影响以及流感和地震的综合影响不仅与胎儿期遭受的损害有关，而且与出生后有关。