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The estimated global IMR for the 1918 pandemic was about 1,500/100,000  (>25 million deaths in a population of 1.8 billion).  However, the IMR can vary by several folds within regions and within countries since such variations may occur due to: (1) differences in the spread of influenza in different populations; (2) differences in the specific population immunity to influenza viruses; (3) differences in general levels of medical care; and (4) estimation of influenza deaths is not an exact science!