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Abstract: This paper poses three questions: (1) Does mortality from natural causes spike around Christmas and New Year? (2) If so, does this spike exist for all major disease groups or only specialized groups? (3) If twin holiday spikes exist, need this imply that Christmas and New Year are risk factors for death? To answer these questions, we used all official U.S. death certificates, 1979–2004 (n = 57,451,944) in various hospital settings to examine daily mortality levels around Christmas and New Year. We measured the Christmas increase by comparing observed deaths with expected deaths in the week starting on Christmas. The New Year increase was measured similarly. The expected number of deaths was determined by locally weighted regression, given the null hypothesis that mortality is affected by seasons and trend but not by holidays. On Christmas and New Year, mortality from natural causes spikes in dead-on-arrival (DOA) and emergency department (ED) settings. There are more DOA/ED deaths on 12/25, 12/26, and 1/1 than on any other day. In contrast, deaths in non-DOA/ED settings display no holiday spikes. For DOA/ED settings, there are holiday spikes for each of the top five disease groups (circulatory diseases; neoplasms; respiratory diseases; endocrine/nutritional/metabolic diseases; digestive diseases). For all settings combined, there are holiday spikes for most major disease groups and for all demographic groups, except children. In the two weeks starting with Christmas, there is an excess of 42,325 deaths from natural causes above and beyond the normal winter increase. Christmas and New Year appear to be risk factors for deaths from many diseases. We tested nine possible explanations for these risk factors, but further research is needed. [ABSTRACT FROM AUTHOR]

Abstract: There is renewed interest in understanding how fluctuations in mortality and in health are related to fluctuations in economic conditions. The traditional perspective that economic recessions lower health and raise mortality has been challenged by recent findings that reveal mortality is actually procyclical. The epidemiology of the phenomenon – traffic accidents, cardiovascular disease, and smoking and drinking – suggests that socioeconomically vulnerable populations might be disproportionately at risk of “working themselves to death” during periods of heightened economic activity. In this paper, I examine mortality by individual characteristic during the 1980s and 1990s using the U.S. National Longitudinal Mortality Study. I find scant evidence that disadvantaged groups are significantly more exposed to procyclical mortality. Rather, working-age men with more education appear to bear a heavier burden, while those with little education experience countercyclical mortality. [Copyright &y& Elsevier]

Public and professional discourses in American society about what constitutes a "good death" have flourished in recent decades, as illustrated by the pivotal SUPPORT study and the growing palliative care movement. This paper examines a distinctive medical discourse from high-technology academic medical centers through an analysis of how physicians who are specialists in internal medicine tell stories about the deaths of patients in their care. 163 physicians from two major academic medical centers in the United States completed both qualitative open interviews and quantitative attitudinal measures on a recent death and on the most emotionally powerful death they experienced in the course of their careers. A subsample of 75 physicians is the primary source for the qualitative analysis, utilizing Atlas-ti. "Good death" and "bad death" are common in popular discourse on death and dying. However, these terms are rarely used by physicians in this study when discussing specific patients and individual deaths. Rather, physicians' narratives are nuanced with professional judgments about what constitutes quality end-of-life care. Three major themes emerge from these narratives and frame the positive and negative characteristics of patient death. Time and Process: whether death was expected or unexpected, peaceful, chaotic or prolonged; Medical Care and Treatment Decisions: whether end-of-life care was rational and appropriate, facilitating a "peaceful" or "gentle" death, or futile and overly aggressive, fraught with irrational decisions or adverse events; Communication and Negotiation: whether communication with patients, family and medical teams was effective, leading to satisfying management of end-of-life care, or characterized by misunderstandings and conflict. [ABSTRACT FROM AUTHOR]

Japan and the United States are both post-industrial societies, characterized by distinct trajectories of dying. Both contain multiple "cultural scripts" of the good death. Seale (Constructing Death: the Sociology of Dying and Bereavement, Cambridge University Press, Cambridge, 1998) has identified at least four "cultural scripts", or ways to die well, that are found in contemporary anglophone countries: modern medicine, revivalism, an anti-revivalist script and a religious script. Although these scripts can also be found in Japan, different historical experiences and religious traditions provide a context in which their content and interpretation sometimes differ from those of the anglophone countries. To understand ordinary people's ideas about dying well and dying poorly, we must recognize not only that post-industrial society offers multiple scripts and varying interpretive frameworks, but also that people actively select from among them in making decisions and explaining their views. Moreover, ideas and metaphors may be based on multiple scripts simultaneously or may offer different interpretations for different social contexts. Based on ethnographic fieldwork in both countries, this paper explores the metaphors that ordinary patients and caregivers draw upon as they use, modify, combine or ignore these cultural scripts of dying. Ideas about choice, time, place and personhood, elements of a good death that were derived inductively from interviews, are described. These Japanese and American data suggest somewhat different concerns and assumptions about human life and the relation of the person to the wider social world, but indicate similar concerns about the process of medicalised dying and the creation of meaning for those involved. [ABSTRACT FROM AUTHOR]

Much attention on the spread and impact of the ongoing pandemic has focused on institutional factors such as government capacity along with population-level characteristics such as race, income, and age. This paper draws on a growing body of evidence that bonding, bridging, and linking social capital - the horizontal and vertical ties that bind societies together - impact public health to explain why some U.S. counties have seen higher (or lower) excess deaths during the COVID19 pandemic than others. Drawing on county-level reports from the Centers for Disease Control and Prevention (CDC) since February 2020, we calculated the number of excess deaths per county compared to 2018. Starting with a panel dataset of county observations over time, we used coarsened exact matching to create smaller but more similar sets of communities that differ primarily in social capital. Controlling for several factors, including politics and governance, health care quality, and demographic characteristics, we find that bonding and linking social capital reduce the toll of COVID-19 on communities. Public health officials and community organizations should prioritize building and maintaining strong social ties and trust in government to help combat the pandemic. • This study examines excess death rates during the COVID19 pandemic among US counties. • We use a panel dataset of counties over 6 time-steps from February to September 2020. • We identified more comparable samples using coarsened exact matching, different only by social capital. • Bonding and linking social capital were associated with fewer excess deaths in US counties. • Bonding social capital was effective in spring, and linking social capital in summer. [ABSTRACT FROM AUTHOR]

Two important changes are happening in health care in the US. As hospitals close in high numbers, the geographies of health care services are changing. Also, the ageing of the population brings about new and complex care needs. These are not discrete trends, as ageing impacts the who, what, and where of care needs, and hospital closures remakes the geographies of where people overall access care. Developed out of research on the impacts of hospital restructuring on workers, patients, and communities, this paper aims to understand how health care financing, care needs for the ageing, and new geographies of health services are intertwined. To do so, I look back to 1980s policy changes to Medicare, the federal health insurance program for the elderly and disabled. In 1982, Congress made two important changes to Medicare. The program began covering hospice services, constituting an expansion of care, and the government drastically changed the way it reimburses providers, effectively a contraction of the program. I trace the impacts of these changes over the next decades through analysis of media coverage and secondary research on hospital budgets. Drawing on the concept of palliative space-time, I identify a contradictory logic of death at the center of this expansion and contraction of the health care system. This death logic works to destabilize an already uneven geography of health service. Yet, this crisis has the potential for more just geographies of health and care. • US population ageing poses new challenges for caring for people as they age. • Hospital closures across the US alter how and where people receive care. • Palliative Space-time shows systems that struggle to exist but have radical potential. • Palliative Space-time helps analyse health systems, death, and care. [ABSTRACT FROM AUTHOR]