title: Cardiac mortality is higher around Christmas and New Year's than at any other time: the holidays as a risk factor for death.
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.
  
  
  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.
authors.affiliation: Department of Sociology, University of California-San Diego, La Jolla, CA 92093-0533, USA. dphillips@ucsd.edu
authors.forename: David P
authors.initials: DP
authors.lastname: Phillips
authors.forename: Jason R
authors.initials: JR
authors.lastname: Jarvinen
authors.forename: Ian S
authors.initials: IS
authors.lastname: Abramson
authors.forename: Rosalie R
authors.initials: RR
authors.lastname: Phillips
mesh_terms: D000397:Air Pollution; D000428:Alcohol Drinking / Q000009:adverse effects; D002423:Cause of Death; D003080:Cold Temperature / Q000009:adverse effects; D015897:Comorbidity; D003644:Death Certificates; D004032:Diet / Q000009:adverse effects; D042241:Early Diagnosis; D006331:Heart Diseases / Q000401:mortality*; D006693:Holidays; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D009026:Mortality / Q000639:trends; D010342:Patient Acceptance of Health Care / Q000523:psychology; D012044:Regression Analysis; D012120:Respiration Disorders / Q000453:epidemiology; D012189:Retrospective Studies; D012621:Seasons; D013315:Stress, Psychological / Q000150:complications; D014481:United States / Q000453:epidemiology; D016526:Workload