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(Circulation. 2004;110:3781-3788.)
© 2004 American Heart Association, Inc.

Health Services and Outcomes Research

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, PhD; Rosalie R. Phillips, MPH

From 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.

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

Received September 10, 2004; revision received October 29, 2004; accepted November 2, 2004.

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.

Key Words: epidemiology • mortality • heart diseases • patients • holidays

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