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Cardiac Mortality Is Higher Around Christmas and New Year’s Than at Any Other Time

The Holidays as a Risk Factor for Death
  • David P. Phillips
    • , PhD
  • Jason R. Jarvinen
    • , BA
  • Ian S. Abramson
    • , and PhD
  • Rosalie R. Phillips
    • MPHFrom the Departments of Sociology (D.P.P., J.R.J.) and Mathematics (I.S.A.), University of California–San Diego, La Jolla, the San Diego Center for Patient Safety (D.P.P.), and the Tufts Health Care Institute, Tufts University School of Medicine (R.R.P.), Boston, Mass.
Originally published13 Dec 2004Circulation. 2004;110:3781–3788
    Other version(s) of this article

    Abstract

    Background— Research published in Circulation has shown that cardiac mortality is highest during December and January. We investigated whether some of this spike could be ascribed to the Christmas/New Year’s holidays rather than to climatic factors.

    Methods and Results— We fitted a locally weighted polynomial regression line to daily mortality to estimate the number of deaths expected during the holiday period, using the null hypothesis that natural-cause mortality is unaffected by the Christmas/New Year’s holidays. We then compared the number of deaths expected during the holiday period, given the null hypothesis, with the number of deaths observed. For cardiac and noncardiac diseases, a spike in daily mortality occurs during the Christmas/New Year’s holiday period. This spike persists after adjusting for trends and seasons and is particularly large for individuals who are dead on arrival at a hospital, die in the emergency department, or die as outpatients. For this group during the holiday period, 4.65% (±0.30%; 95% CI, 4.06% to 5.24%) more cardiac and 4.99% (±0.42%; 95% CI, 4.17% to 5.81%) more noncardiac deaths occur than would be expected if the holidays did not affect mortality. Cardiac mortality for individuals who are dead on arrival, die in the emergency department, or die as outpatients peaks at Christmas and again at New Year’s. These twin holiday spikes also are conspicuous for noncardiac mortality. The excess in holiday mortality is growing proportionately larger over time, both for cardiac and noncardiac mortality.

    Conclusions— Our findings suggest that the Christmas/New Year’s holidays are a risk factor for cardiac and noncardiac mortality. There are multiple explanations for this association, including the possibility that holiday-induced delays in seeking treatment play a role in producing the twin holiday spikes.

    Footnotes

    Correspondence to David P. Phillips, PhD, Department of Sociology, University of California–San Diego, La Jolla, CA 92093-0533. E-mail

    References

    • 1 Linstedt S. Travelers more willing to fly this holiday. Buffalo News. December 21, 2002: B3.Google Scholar
    • 2 Richardson T. The sugar rush of the holidays. New York Times. December 23, 2002: A25.Google Scholar
    • 3 Batal H, Tench J, McMillan S, Adams J, Mehler PS. Predicting patient visits to an urgent care clinic using calendar variables. Acad Emerg Med. 2001; 8: 48–53.CrossrefMedlineGoogle Scholar
    • 4 Holleman DR Jr, Bowling RL, Gathy C. Predicting daily visits to a walk-in clinic and emergency department using calendar and weather data. J Gen Intern Med. 1996; 11: 237–239.CrossrefMedlineGoogle Scholar
    • 5 Halpern SD, Doraiswamy PM, Tupler LA, Holland JM, Ford SM, Ellinwood EH Jr. Emergency department patterns in psychiatric visits during the holiday season. Ann Emerg Med. 1994; 24: 939–943.CrossrefMedlineGoogle Scholar
    • 6 Diehl AK, Morris MD, Mannis SA. Use of calendar and weather data to predict walk-in attendance. South Med J. 1981; 74: 709–712.CrossrefMedlineGoogle Scholar
    • 7 Latham J, Fagan J. Control of Christmas holiday census and staffing. J Nurs Adm. 1979; 9: 19–23.Google Scholar
    • 8 Verma A, Dodd ME, Haworth CS, Webb AK. Holidays and cystic fibrosis. J R Soc Med. 2000; 93: 20–26.MedlineGoogle Scholar
    • 9 Lester D. Suicide and homicide rates on national holidays. Psychol Rep. 1987; 60: 414.CrossrefMedlineGoogle Scholar
    • 10 Annual and New Year’s Day alcohol-related traffic fatalities—United States, 1982–1990. MMWR Morb Mortal Wkly Rep. 1991; 40: 821–825.Google Scholar
    • 11 Arnold R, Cerrelli EC. Holiday Effect on Traffic Fatalities. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration; 1987. Publication DOT-HS-807–115.Google Scholar
    • 12 Cold exposure and winter mortality from ischaemic heart disease, cerebrovascular disease, respiratory disease, and all causes in warm and cold regions of Europe. The Eurowinter Group. Lancet. 1997; 349: 1341–1346.CrossrefMedlineGoogle Scholar
    • 13 Keatinge WR. Winter mortality and its causes. Int J Circumpolar Health. 2002; 61: 292–299.CrossrefMedlineGoogle Scholar
    • 14 Näyhä S. Cold and the risk of cardiovascular diseases: a review. Int J Circumpolar Health. 2002; 61: 373–380.CrossrefMedlineGoogle Scholar
    • 15 Mercer JB. Cold—an underrated risk factor for health. Environ Res. 2003; 92: 8–13.CrossrefMedlineGoogle Scholar
    • 16 Seretakis D, Lagiou P, Lipworth L, Signorello LB, Rothman KJ, Trichopoulos D. Changing seasonality of mortality from coronary heart disease. JAMA. 1997; 278: 1012–1014.CrossrefMedlineGoogle Scholar
    • 17 Kloner RA, Poole WK, Perritt RL. When throughout the year is coronary death most likely to occur? A 12-year population-based analysis of more than 220,000 cases. Circulation. 1999; 100: 1630–1634.CrossrefMedlineGoogle Scholar
    • 18 Anderson RN, Miniño AM, Hoyert DL, Rosenberg HM. Comparability of Cause of Death Between ICD-9 and ICD-10: Preliminary Estimates. National Vital Statistics Reports. Vol 49, no 2. Hyattsville, Md: National Center for Health Statistics; 2001. DHHS Publication (PHS) 2001–1120 1-0355.Google Scholar
    • 19 Simonoff JS. Smoothing Methods in Statistics. New York, NY: Springer-Verlag, 1996.Google Scholar
    • 20 Ruckstuhl AF, Jacobson MP, Field RW, Dodd JA. Baseline subtraction using robust local regression estimation. J Quant Spectrosc Radiat Transf. 2001; 68: 179–193.CrossrefGoogle Scholar
    • 21 Dataplot [database online]. Gaithersburg, Md: National Institutes of Standards and Technology; 2001. Updated September 10, 2002.Google Scholar
    • 22 National Center for Health Statistics. Vital Statistics of the United States 1990. Mortality Part A. Vol 2, Sect 7, Technical Appendix. Hyattsville, Md: US Department of Health and Human Services; 1994.Google Scholar
    • 23 Phillips DP, Christenfeld N, Ryan NM. An increase in the number of deaths in the United States in the first week of the month—an association with substance abuse and other causes of death. N Engl J Med. 1999; 341: 93–98.CrossrefMedlineGoogle Scholar
    • 24 Phillips DP, Paight DJ. The impact of televised movies about suicide. A replicative study. N Engl J Med. 1987; 317: 809–811.CrossrefMedlineGoogle Scholar
    • 25 Phillips DP, Carstensen LL. Clustering of teenage suicides after television news stories about suicide. N Engl J Med. 1986; 315: 685–689.CrossrefMedlineGoogle Scholar
    • 26 Phillips DP, Christenfeld N, Glynn LM. Increase in U.S. medication-error deaths between 1983 and 1993. Lancet. 1998; 351: 643–644.CrossrefMedlineGoogle Scholar
    • 27 Phillips DP, Ruth TE, Wagner LM. Psychology and survival. Lancet. 1993; 342: 1142–1145.CrossrefMedlineGoogle Scholar
    • 28 Phillips DP, King EW. Death takes a holiday: mortality surrounding major social occasions. Lancet. 1988; 2: 728–732.CrossrefMedlineGoogle Scholar
    • 29 Phillips DP, Smith DG. Postponement of death until symbolically meaningful occasions. JAMA. 1990; 263: 1947–1951.CrossrefMedlineGoogle Scholar
    • 30 Phillips DP, Bredder CC. Morbidity and mortality from medical errors: an increasingly serious public health problem. Annu Rev Public Health. 2002; 23: 135–150.CrossrefMedlineGoogle Scholar
    • 31 Gardner MJ, Altman DG, eds. Statistics with Confidence: Confidence Intervals and Statistical Guidelines. 2nd ed. London, England: BMJ Books; 2000.Google Scholar
    • 32 Sachs L. Firm but fair policies for staff vacations and holidays. J Med Pract Manage. 2002; 18: 42–44.MedlineGoogle Scholar
    • 33 Roe CT. Leadership at work. How to call a truce in the holiday scheduling wars. RN. 1979; 42: 83–88.Google Scholar
    • 34 Outlook ’75: enough gasoline for all? US News and World Report. January 6, 1975: 19.Google Scholar
    • 35 A glut of hotel rooms just as business dips. Business Week. March 30, 1981: 52.Google Scholar
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