bloodrayne
12-16-2004, 10:07 AM
Natural-Causes Deaths Jump Over The Holidays
Delayed care may be to blame, says UCSD researcher
Death from natural causes doesn't take a holiday on Christmas or New Year's. It works extra hard, perhaps because its victims delay medical care until it's too late.
That's the finding from a paper published today in Circulation, the journal of the American Heart Association, by noted death researcher David Phillips of UC San Diego.
Phillips found that no two-week stretch has as many deaths as the one from Dec. 25 to Jan. 7.
Specifically, more people die of heart attacks Christmas Day than on any other day of the year. Dec. 26 has the most deaths from natural causes other than heart attacks. New Year's Day has the third highest daily death count for both categories.
The difference between the number of deaths on these three dates and a normal winter day has grown gradually during the 26 years of the study. Phillips doesn't know why, but he believes more analysis will explain the phenomenon.
"You're having pain in your chest or a headache or difficulty breathing – symptoms you should be paying attention to. But you don't because you're on your way to your relatives and don't want to spoil the holidays," said Phillips, a sociologist.
He urged people to always get care as soon as they experience symptoms. He also advised out-of-town travelers to determine beforehand what hospitals and clinics will be available to them during their journey.
Researchers long have known that the daily death toll goes up during the winter and that homicides, suicides and injuries from vehicle collisions escalate on Christmas and New Year's Day. Phillips' study is the first to determine that death from natural causes increases so greatly Dec. 25, Dec. 26 and Jan. 1.
Christmas Day is especially high for fatal heart attacks, with 12.4 percent more deaths than would be expected for a winter day, the report showed.
"This is a very robust finding," Phillips said. "It just hits you in the eye."
For the study, he looked at 53 million U.S. death certificates filed during a 26-year period. The National Center for Health Statistics had compiled these documents.
Phillips discovered that the death spikes did not occur in 1973 and 1981, maybe because the oil embargo in 1973 and the 1981 recession dramatically reduced holiday travel. That pattern further bolstered his hypothesis.
The spikes were highest for deaths that occurred on the way to a hospital, in an emergency room or in an urgent-care setting, Phillips concluded.
Phillips suggested the additional deaths could occur if people go to an inappropriate hospital or if medical facilities are understaffed or lack well-trained emergency personnel on Christmas and New Year's Day, he said.
"We're not saying our data prove the staff isn't as qualified, but the question is raised," Phillips said. "The data are consistent with the idea that a change in medical staff is playing a potential role."
If the report is correct, it is "an opportunity for us to remind everyone that protracted chest pressure or heartburn – especially if associated with shortness of breath – warrants an evaluation no matter what day of the year it is," said Dr. Paul Phillips, director of interventional cardiology at Scripps Mercy Hospital in Hillcrest.
He described the study as flawed because it relies on death certificates that might be wrong.
When the doctor doesn't know the patient, "he usually guesses cardiac arrest or cardiovascular death since it is the most likely cause in any event," Paul Phillips said. "And the days of the year when the patient's primary doctor is least likely to be around to sign the certificate are, you guessed it, Christmas and New Year's."
Dr. John LeMoines, a critical-care director at Sharp Memorial Hospital in Kearny Mesa, said "there's no question that around Christmas and the holidays, people may get misdirected to a hospital, and that might incur a delay and contribute to a bad result."
But larger hospitals dealing with higher volumes of patients would have the same level of experienced staffers year-round, LeMoines said. He also pointed out that asthma, known to be worse at year's end, can exacerbate lots of other conditions, such as respiratory and heart diseases.
Still, these factors wouldn't explain why the death spikes occur on three specific dates, David Phillips said.
In his analysis, Phillips discounted other lifestyle changes likely to occur during the holidays that could affect general death rates during winter.
Modifications in diet, exercise level and alcohol consumption were ruled out. That is because overall wintertime deaths also increased among people already hospitalized or living in nursing homes – patients who wouldn't be using alcohol or eating large amounts of unhealthy food.
Phillips also considered the possibility that stress, perhaps ignited by family tension, could lead to higher mortality. He discounted that factor, too, because the death spikes also occurred among people with Alzheimer's disease, who presumably would be less aware of such pressure.
He weighed the effect of lower temperatures, but found that southern areas of the country had death peaks slightly higher than northern areas.
Besides, he said, "the fact that it gets colder in the winter cannot explain why there are these peaks on Christmas and New Year's."
Phillips' report was co-authored by sociology student Jason Jarvinen and math professor Ian Abramson, both from UCSD, and Tufts Health Care Center director Rosalie Phillips, the author's sister.
In an accompanying editorial titled "Merry Christmas Coronary and Happy New Year Heart Attack Phenomenon," Los Angeles cardiologist Robert Kloner called Phillips' report "an important contribution" but said more research is needed to nail down definite reasons for the holiday death phenomenon.
Kloner suggested other causes such as the burning of fireplace wood, which leads to airborne pollutants that can aggravate heart disease or respiratory problems.
He advised hospital administrators to staff emergency rooms with people aware of the holiday effect, to remind patients about taking medications such as aspirin or beta blockers, and to warn people about heavy-duty physical activities such as shoveling snow.
Delayed care may be to blame, says UCSD researcher
Death from natural causes doesn't take a holiday on Christmas or New Year's. It works extra hard, perhaps because its victims delay medical care until it's too late.
That's the finding from a paper published today in Circulation, the journal of the American Heart Association, by noted death researcher David Phillips of UC San Diego.
Phillips found that no two-week stretch has as many deaths as the one from Dec. 25 to Jan. 7.
Specifically, more people die of heart attacks Christmas Day than on any other day of the year. Dec. 26 has the most deaths from natural causes other than heart attacks. New Year's Day has the third highest daily death count for both categories.
The difference between the number of deaths on these three dates and a normal winter day has grown gradually during the 26 years of the study. Phillips doesn't know why, but he believes more analysis will explain the phenomenon.
"You're having pain in your chest or a headache or difficulty breathing – symptoms you should be paying attention to. But you don't because you're on your way to your relatives and don't want to spoil the holidays," said Phillips, a sociologist.
He urged people to always get care as soon as they experience symptoms. He also advised out-of-town travelers to determine beforehand what hospitals and clinics will be available to them during their journey.
Researchers long have known that the daily death toll goes up during the winter and that homicides, suicides and injuries from vehicle collisions escalate on Christmas and New Year's Day. Phillips' study is the first to determine that death from natural causes increases so greatly Dec. 25, Dec. 26 and Jan. 1.
Christmas Day is especially high for fatal heart attacks, with 12.4 percent more deaths than would be expected for a winter day, the report showed.
"This is a very robust finding," Phillips said. "It just hits you in the eye."
For the study, he looked at 53 million U.S. death certificates filed during a 26-year period. The National Center for Health Statistics had compiled these documents.
Phillips discovered that the death spikes did not occur in 1973 and 1981, maybe because the oil embargo in 1973 and the 1981 recession dramatically reduced holiday travel. That pattern further bolstered his hypothesis.
The spikes were highest for deaths that occurred on the way to a hospital, in an emergency room or in an urgent-care setting, Phillips concluded.
Phillips suggested the additional deaths could occur if people go to an inappropriate hospital or if medical facilities are understaffed or lack well-trained emergency personnel on Christmas and New Year's Day, he said.
"We're not saying our data prove the staff isn't as qualified, but the question is raised," Phillips said. "The data are consistent with the idea that a change in medical staff is playing a potential role."
If the report is correct, it is "an opportunity for us to remind everyone that protracted chest pressure or heartburn – especially if associated with shortness of breath – warrants an evaluation no matter what day of the year it is," said Dr. Paul Phillips, director of interventional cardiology at Scripps Mercy Hospital in Hillcrest.
He described the study as flawed because it relies on death certificates that might be wrong.
When the doctor doesn't know the patient, "he usually guesses cardiac arrest or cardiovascular death since it is the most likely cause in any event," Paul Phillips said. "And the days of the year when the patient's primary doctor is least likely to be around to sign the certificate are, you guessed it, Christmas and New Year's."
Dr. John LeMoines, a critical-care director at Sharp Memorial Hospital in Kearny Mesa, said "there's no question that around Christmas and the holidays, people may get misdirected to a hospital, and that might incur a delay and contribute to a bad result."
But larger hospitals dealing with higher volumes of patients would have the same level of experienced staffers year-round, LeMoines said. He also pointed out that asthma, known to be worse at year's end, can exacerbate lots of other conditions, such as respiratory and heart diseases.
Still, these factors wouldn't explain why the death spikes occur on three specific dates, David Phillips said.
In his analysis, Phillips discounted other lifestyle changes likely to occur during the holidays that could affect general death rates during winter.
Modifications in diet, exercise level and alcohol consumption were ruled out. That is because overall wintertime deaths also increased among people already hospitalized or living in nursing homes – patients who wouldn't be using alcohol or eating large amounts of unhealthy food.
Phillips also considered the possibility that stress, perhaps ignited by family tension, could lead to higher mortality. He discounted that factor, too, because the death spikes also occurred among people with Alzheimer's disease, who presumably would be less aware of such pressure.
He weighed the effect of lower temperatures, but found that southern areas of the country had death peaks slightly higher than northern areas.
Besides, he said, "the fact that it gets colder in the winter cannot explain why there are these peaks on Christmas and New Year's."
Phillips' report was co-authored by sociology student Jason Jarvinen and math professor Ian Abramson, both from UCSD, and Tufts Health Care Center director Rosalie Phillips, the author's sister.
In an accompanying editorial titled "Merry Christmas Coronary and Happy New Year Heart Attack Phenomenon," Los Angeles cardiologist Robert Kloner called Phillips' report "an important contribution" but said more research is needed to nail down definite reasons for the holiday death phenomenon.
Kloner suggested other causes such as the burning of fireplace wood, which leads to airborne pollutants that can aggravate heart disease or respiratory problems.
He advised hospital administrators to staff emergency rooms with people aware of the holiday effect, to remind patients about taking medications such as aspirin or beta blockers, and to warn people about heavy-duty physical activities such as shoveling snow.