Elsevier

Social Science & Medicine

Volume 71, Issue 8, October 2010, Pages 1463-1471
Social Science & Medicine

Christmas and New Year as risk factors for death

https://doi.org/10.1016/j.socscimed.2010.07.024Get rights and content

Abstract

This paper poses three questions: (1) Does mortality from natural causes spike around Christmas and New Year? (2) If so, does this spike exist for all major disease groups or only specialized groups? (3) If twin holiday spikes exist, need this imply that Christmas and New Year are risk factors for death? To answer these questions, we used all official U.S. death certificates, 1979–2004 (n = 57,451,944) in various hospital settings to examine daily mortality levels around Christmas and New Year. We measured the Christmas increase by comparing observed deaths with expected deaths in the week starting on Christmas. The New Year increase was measured similarly. The expected number of deaths was determined by locally weighted regression, given the null hypothesis that mortality is affected by seasons and trend but not by holidays. On Christmas and New Year, mortality from natural causes spikes in dead-on-arrival (DOA) and emergency department (ED) settings. There are more DOA/ED deaths on 12/25, 12/26, and 1/1 than on any other day. In contrast, deaths in non-DOA/ED settings display no holiday spikes. For DOA/ED settings, there are holiday spikes for each of the top five disease groups (circulatory diseases; neoplasms; respiratory diseases; endocrine/nutritional/metabolic diseases; digestive diseases). For all settings combined, there are holiday spikes for most major disease groups and for all demographic groups, except children. In the two weeks starting with Christmas, there is an excess of 42,325 deaths from natural causes above and beyond the normal winter increase. Christmas and New Year appear to be risk factors for deaths from many diseases. We tested nine possible explanations for these risk factors, but further research is needed.

Introduction

A recent study in this journal found that the level of deliberate self harm fluctuated significantly around Christmas and New Year (Bergen & Hawton, 2007). Similarly, other studies have found significant fluctuations in the number of homicides (Bridges, 2004) and motor vehicle accidents (National Highway Traffic Safety Administration, 2009) around these holidays. However, although many studies have examined the effect of Christmas and New Year on external causes of death (like suicide, homicide, and accidents), few have examined the effect of these holidays on natural causes of death (Phillips, Jarvinen, Abramson, & Phillips, 2004). This omission seems significant because natural causes account for 93% of all mortality, while external causes account for only 7% (National Center for Health Statistics, 1994).

These considerations raise several important questions: (1) Is there a spike in deaths from natural causes around Christmas and New Year? (2) If so, does this spike exist for all major disease groups, or just for some specialized groups? (3) If there are twin holiday spikes, does this imply that Christmas and New Year are risk factors for death?

There are reasons to suspect the existence of these holiday spikes in deaths from natural causes because medical care may worsen around the holidays. First, the number of physicians (as well as nurses and other health care professionals) may decrease at this time because many want to suspend work during the holidays (Keatinge and Donaldson, 2005, Sachs, 2002). Second, the number of patients may increase at this time, especially in the Emergency Department (ED) (Salazar et al., 2002, Zheng et al., 2007).

These medical concerns have been assessed with non-comprehensive studies that focused on cardiac diseases and/or small, geographically non-representative samples (Keatinge and Donaldson, 2005, Kloner et al., 1999, Milne, 2005, Rouse, 1999, Zheng et al., 2007). An earlier study of cardiac diseases (Phillips et al., 2004) found a double spike in deaths at Christmas and at New Year. As Phillips et al. were the first to note, there are more cardiac deaths on and around these two holidays than at any other time of the year. The cause of these cardiac holiday spikes is under debate and is sometimes ascribed to psychological stress, patients’ delay in seeking treatment, and/or reduced quality of medical care (Kloner, 2004, Kloner et al., 1999, Milne, 2005, Phillips et al., 2004).

In this paper, we sought to determine whether there are holiday mortality spikes for (1) every major disease group and/or (2) every demographic group. Following earlier research, we focused initially on ED deaths but also examined deaths in other settings.

Section snippets

Methods

We examined all official computerized death certificates for the United States (n = 57,451,944) (Mortality detail file, 1979–2004). Our dataset starts on 1/1/1979 (when the 9th Revision of the International Classification of Diseases (ICD) began) and ends on 12/31/2004 (the latest date for which exact date of death is available).

We initially examined deaths from all natural causes combined, and then examined separately the five most common disease groups, i.e., diseases of the circulatory

Results

Fig. 1A displays daily observed and expected ED mortality levels from all natural causes combined. ED mortality displays distinct spikes around Christmas and New Year: there are more ED deaths on Christmas, the day after Christmas, and New Year’s Day than on any other day of the year. In the week starting with Christmas (henceforth “Christmas week”), 78,441 deaths are observed versus 73,550.9 expected [C = 78,441/73,550.9 = 1.066 (1.059–1.074)]. Similarly, in the week starting with New Year

Discussion

DOA and ED mortality from natural causes display distinct spikes around Christmas and New Year. There are more DOA and ED deaths on Christmas, the day after Christmas, and New Year than on any other day of the year. In contrast, deaths in non-DOA/ED settings do not display two, distinct holiday spikes. Instead, these deaths display a small, diffused spike that starts just after Christmas and extends for more than a week past New Year. For each of the top five disease groups, there are excess

Conclusion

The two weeks starting with Christmas are associated with an excess of 42,325 natural deaths over a 25 year period. This nontrivial loss of life is an important public health concern and warrants further research.

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