Holiday and weekend effects on mortality for acute myocardial infarction in Shanxi, China: a cross-sectional study
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ORIGINAL ARTICLE
Holiday and weekend effects on mortality for acute myocardial infarction in Shanxi, China: a cross-sectional study Xiaojun Lin1 • Jeremy C. Green2 • Hong Xian3 • Miao Cai3 • Julia Skrzypek4 • Hongbing Tao5 Received: 8 August 2019 / Revised: 13 July 2020 / Accepted: 16 July 2020 Swiss School of Public Health (SSPH+) 2020
Abstract Objectives To examine the effects of holiday and weekend admission on in-hospital mortality for patients with acute myocardial infarction (AMI) in China. Methods Patients with AMI in 31 tertiary hospitals in Shanxi, China from 2014 to 2017 were included (N = 54,968). Multivariable logistic regression models were used to examine the effects of holiday and weekend admission on in-hospital mortality. Results Compared to non-holiday and weekday admissions, holiday and weekend admissions, respectively, were associated with increases in risk-adjusted mortality rates. Chinese National Day was associated with an additional 10 deaths per 1000 admissions (95% confidence interval (CI): (0, 20))—a relative increase from baseline mortality of 64% (95% CI: (1%, 128%)). Sunday was associated with an additional 4 deaths per 1000 admissions (95% CI: (0, 7))—a relative increase from baseline mortality of 23% (95% CI: (3%, 45%)). We found no evidence of gender differences in holiday or weekend effects on mortality. Conclusions Holiday and weekend admissions were associated with in-hospital AMI mortality. The admissions on Chinese National Day and Sunday contributed to the observed ‘‘holiday effect’’ and ‘‘weekend effect,’’ respectively. Keywords Holiday effect Weekend effect Mortality Acute myocardial infarction China
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00038-020-01443-x) contains supplementary material, which is available to authorized users. & Hongbing Tao [email protected] 1
West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
2
The Mamdouha S. Bobst Center for Peace and Justice, Princeton University, Princeton, NJ, USA
3
Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
4
Department of Health Management and Policy, College for Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
5
Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
Since the study of Bell and Redelmeier (2001), the relationship between weekend admission and patient outcome has been debated widely in scientific literature. The evidence of observed increases in mortality during holidays and weekends—so-called the ‘‘weekend effect’’—has been provided in diverse clinical settings, especially the cardiology (Kostis et al. 2007; Isogai et al. 2015) and emergency medicine (Walker et al. 2017; Sun et al. 2019). Al
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