I ♥ the Holidays

Why Christmas Is So Deadly

It’s the year’s most lethal day, but don’t blame stress or gluttony. Kent Sepkowitz on the real culprit.


In addition to being the time of lovely weather for a sleigh ride together with you, Christmas turns out to be the most lethal day of the year. By a long shot. Followed by New Year’s Day. Followed by the other 363 days of the year, more or less in a heap, though the rate slopes up for a few weeks pre-Xmas, then sinks after the big day.

The observation was made several times in the last decade or so, first with cardiac disease—the so-called Merry Christmas Coronary (here and here)—and then with other diseases, with increasingly incontrovertible data. Scrooge rules. The one that clinched it was carried out by a team of sociologists in balmy, non-Christmas-y La Jolla, Calif.: “Christmas and New Year as Risk Factors for Death.” They took 25 years of death certificates (about 57 million deaths) and plotted out each dead-on-arrival or died-in the-emergency-room death, according to the Julian day-at-a-time calendar. According to their way of slicing up the bad news, thousands more people over the years have died on these two holidays than on any other day. (The graphs tell the story quickly.) That’s a lot of bereft holiday families.

Data-based observations of this sort invariably bring out the theorists, each with his own axe to grind or idea to sell, or to confidently proclaim that this is yet another example of [hare-brained theory here] in action.

The initial explanation from many, and one favored by the you-are-what-you-eat-people, is this: citizens stuff their yuletide faces on Christmas and somehow this hardens the arteries in short order, not unlike the ice-nine of Vonnegut’s Cat’s Cradle. This surely makes sense to all of us who have feasted to within an inch of our life, but then again maybe not—what about the other Great American Days of Gluttony: Thanksgiving? Super Bowl Sunday? Perhaps Mother’s Day? (OK, maybe appetites are lost there.) What about Fourth of July, that hot-dog-consumption apogee? Though tempting at first glance, this one sinks pretty easily on the simple logic that the Christmas feast is not unique enough to drive such a one-day death spike.

And while we’re at it, let’s agree to dismiss cold weather and shoveling snow on the same grounds—not unique to Christmas.

So what about blaming family? You know—stress, that explanation so beloved by shrinks and shrink-ish people. Seeing the family surely feels lethal some years. Plus cousins’ cousins who married more distant cousins and moved to New Jersey because of the real-estate taxes that they want to review with you. In detail. And the cost of converting their garage to a den. Including the effect on the property value when last assessed by the county guy whom they know from their kid’s school.

Admittedly, this is about enough to kill a guy, but how different really is the onslaught compared to other family-enriched holidays? And can stress—this sort of stress—really kill? I mean, this is not stress really but annoyance, boredom, and need for oxygen—but not drop-dead heart attack territory just because your wife’s nephew won a MacArthur Genius award and you have to hear about how surprised they all were! We never knew what he was doing! And now they call him a genius! Oh my! Close yes—but not fatal. Once again, the burden of Christmas is simply not unique.

Which leaves this: what about the possibility that American health care doesn’t suck? And that people on Christmas are sick, but opt to not call their doctor or visit the ER because it’s Christmas and they don’t want to bother anyone? (Or the doc is covered by someone who, in turn, is covered by someone else, who is maybe the same cousin with the MacArthur grant?) Anyone who has been in emergency rooms knows Christmas is just about always the quietest day of the year. And anyone caring for someone with chest pain knows the critical nature of “door-to-balloon time.” This refers to the interval when a person with a possible heart attack first arrives in the emergency room until he is in the cardiac catheterization laboratory to have the salutary balloon inserted to pop open the affected artery.

According to experts, the door-to-balloon time should be 90 minutes or less because a longer delay can result in permanent damage to the heart. It is likely that a similar phenomenon of expedience translating into better health governs other diseases as well. To translate this to Christmas-ese, shrugging off that chest pain for an hour or two or three just to maintain family serenity moves someone well outside the optimal door-to-balloon time. And the longer the time from symptoms to treatment, the higher the death rate.

In other words, all this extra death over the holidays is likely not due to too much ice cream or cold weather or irksome relatives, but rather because people are not seeing a doctor in a timely fashion. Which is worth considering as we talk about the effect of expanding health care and health-care access in the years ahead. Timeliness saves lives. Overcrowded ERs that can’t move patients through may result in lost lives. People who have a doctor to call when they feel ill do better than those with no one to call and nowhere to go. With all the fake debate about whether Obamacare will improve people’s health (it obviously will) and the parallel view that American health care is a murderous mess not unlike Big Government, this elemental truth is worth holding in mind: health care improves health. A Christmas gift of a functioning doctor and a functioning health-care system will go a long way to fix the heartbreaking problem of the Christmas patient who waited a little too long.