UCSD Researcher Finds Death Toll Climbs At Winter
By Inga Kiderra
die from natural causes on Christmas, the day after and New
Year’s than on any other days of the year.
According to new research
published in the American Heart Association journal Circulation,
the 14-day holiday period between Dec. 25 and Jan. 7 shows a
spike in death rates significantly above what would be expected
for the winter season. The likely culprit: Delays in seeking
necessary medical treatment.
Led by University
of California, San Diego sociologist David Phillips, the study
finds that this “holiday effect” on mortality is
particularly large for individuals who are dead on arrival at
a hospital, die in the emergency department or die as outpatients.
In this category, there are 4.65 percent more cardiac fatalities
and 4.99 percent more non-cardiac fatalities than would be expected
For cardiac patients
in this category, Christmas was the most perilous day, with
12.4 percent more deaths than expected.
Phillips and colleagues
analyzed 53 million deaths between 1973 and 2001 as recorded
by the National Center for Health Statistics, which maintains
a database of all U.S. death certificates. They excluded deaths
from suicide, homicide and accidents. They also controlled for
the effects of winter, a season well-documented for higher mortality.
“We found that
there is a general tendency for cardiac and noncardiac deaths
to peak during the winter, but above and beyond this seasonal
increase, there are additional increases in heart attack and
other deaths around Christmas and New Year’s,” Phillips
In all, the researchers
observed that there were more than 42,000 “extra”
deaths during the holidays over the 26-year period of the study.
After examining 10
potential causes for the spike, including changes in diet, alcohol
consumption and levels of stress, the study concluded that putting
off treatment, either due to travel or a reluctance to spoil
the spirit of the season, is one of the most plausible explanations.
“Of all the things we considered that might impact the
increase in holiday deaths from natural causes, only two were
consistent with our data,” Phillips said. “One possibility
is that people tend to delay seeking care for symptoms. Another
is that there are often changes in medical staff during the
holidays and, consequently, the quality of medical care might
One possible solution:
“Our study suggests that people should not postpone getting
medical care even during the holidays and should know how to
find the best care if they happen to be traveling,” said
hypothesis is supported by the two years that did not show increased
holiday mortality. The figures show that peaks in cardiac deaths
occurred in 24 of 26 study years but not in 1973 or 1981. The
authors write, “Was this a fluke or are these years unusual
in some way? The Organization of Petroleum-Exporting Countries’
embargo on exporting petroleum products to the United States
and other countries included the holiday period, December 25,
1973 through January 7, 1974. Travel during the embargo was
markedly reduced, and it was also reduced during the recession
of 1981. If the holiday effect occurs in part because of delays
in seeking medical treatment by travelers, then a reduction
in travel may produce a reduction in the holiday effect.”
in line with the hypothesis, inpatient cardiac deaths during
the holidays showed a rise but only a modest one: 1.6 percent.
The study also notes
that the size of the holiday mortality spike has been increasing
in recent years. This suggests, Phillips said, that it is particularly
important to identify and control the factors leading to increased
natural-cause deaths on and around the holidays.
are Jason R. Jarvinen, sociology student, UCSD; Ian S. Abramson,
professor of mathematics, UCSD; and Rosalie Phillips, executive
director of the Tufts Health Care Center, Tufts University.
Inga Kiderra (858) 822-0661
or Barry Jagoda (858)