December 13, 2004

UCSD Researcher Finds Death Toll Climbs At Winter Holidays

By Inga Kiderra

More Americans 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 winter.

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 said.

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 be compromised.”

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 Phillips.

The researchers’ 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.”

Interestingly, and 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.

Phillips’ coauthors 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.

Media Contacts:
Inga Kiderra (858) 822-0661 or Barry Jagoda (858) 534-8567