Why More People Die at Christmas: The Holiday Death Spike Explained

Picture Christmas afternoon in a house full of family. The table is cleared, the plates are stacked, and an older relative is sitting quietly in the armchair, rubbing their arm and saying it is just indigestion from the turkey. Nobody wants to spoil the day. Nobody wants to spend Christmas in A&E. So everyone agrees to see how it feels in the morning.

That scene, repeated in millions of homes, is part of the reason researchers have found that more people die of heart disease on Christmas Day, Boxing Day and New Year's Day than on any other days of the year. Around 170,000 people die on an ordinary day worldwide, a total you can watch climb on our live death counter. At Christmas, in the countries where it is celebrated, that number bends upwards.

This article looks at what the research actually shows, what causes the holiday spike, and what it means for you and your family.

The headline finding

The best-known study comes from the sociologist David Phillips and colleagues at the University of California, San Diego. They analysed 53 million US death certificates from 1973 to 2001 and published the results in the journal Circulation in 2004, under a title that says it all: "Cardiac mortality is higher around Christmas and New Year's than at any other time".

Study	Country	What it found
Phillips et al., Circulation 2004	United States	Cardiac deaths peak on 25 December, 26 December and 1 January; natural deaths over the two-week holiday period about 5% above expected
Kloner et al., Circulation 1999	United States (Los Angeles County)	Coronary deaths in December and January about a third higher than in summer, with a peak around the holidays
Mohammad et al., BMJ 2018	Sweden	Heart attack risk about 15% higher over Christmas and New Year; about 37% higher on Christmas Eve, peaking around 10pm
Knight et al., Journal of the American Heart Association 2016	New Zealand	About 4% more cardiac deaths outside hospital over Christmas, even though it falls in summer there

The details differ, but the direction is the same in every country studied. The days around Christmas and New Year are dangerous for the heart.

How big is the effect?

It is worth being precise, because headlines often make it sound larger than it is. A 5% rise in deaths over the holiday period means that for every 100 deaths you would normally expect in those two weeks, there are about 105. Across a country the size of the US, that adds up to thousands of extra deaths every year. For any one person, it is a small nudge to an already small daily risk.

Scale	What a 5% holiday rise looks like (rough illustration)
United States (about 3.1 million deaths a year)	about 6,000 extra deaths over the two-week holiday period
UK (about 660,000 deaths a year)	about 1,300 extra deaths over the same period
One healthy 40-year-old	a barely measurable change in risk
One 80-year-old with heart disease	a real increase, worth taking seriously

These are illustrations based on national totals, not measured counts for any year. The effect is concentrated in people who already have heart disease, and above all in those who delay getting help.

Reason 1: people wait to get help

The single most striking detail in the Phillips study was where the extra deaths happened. The rise was largest among people who died at home, in emergency departments, or who were dead on arrival at hospital. In other words, people who had not been admitted in time.

That fits the scene at the start of this article. Over Christmas people are reluctant to "make a fuss", travel to a family home far from their own doctor, or wait for the holiday to end before seeking care. Some clinics are closed. Some people simply do not want to ruin the day for everyone else.

Every minute matters in a heart attack. The muscle starts dying within minutes of the blood supply being cut off, and treatment within the first hour or two saves far more of it. The warning signs often start long before the attack itself, as we explain in heart attack warning signs your body shows a month before.

Reason 2: the cold

Christmas falls in the middle of the northern winter, and winter is hard on the heart. Cold weather narrows blood vessels and raises blood pressure. Blood becomes slightly thicker and more prone to clotting. Respiratory infections, which peak in winter, add extra strain.

Month (England and Wales, typical recent year)	Approximate deaths registered
January	55,000 to 65,000
April	45,000 to 50,000
August	40,000 to 43,000
December	48,000 to 55,000

December looks lower than January partly because register offices close over Christmas, so deaths that happen at the end of December are often registered in early January. Counting by date of death, the peak sits squarely across the holidays. We cover the wider winter pattern in why winter kills more people than summer.

Cold cannot be the whole story, though. The New Zealand study is important precisely because Christmas there falls in midsummer, and cardiac deaths still rose.

Reason 3: food, drink and salt

Christmas is the most indulgent time of the year in many countries. A large meal diverts blood to the gut and can trigger heart rhythm problems in vulnerable people. Salty food raises blood pressure. Heavy drinking can cause an irregular heartbeat, sometimes called "holiday heart syndrome", a term coined by doctors in the 1970s after they noticed a pattern of patients arriving with atrial fibrillation after weekends and holidays.

Holiday factor	Effect on the body
Very large meals	Raised heart rate, blood diverted to digestion
Salt-heavy food	Higher blood pressure for hours to days
Binge drinking	Irregular heartbeat (holiday heart syndrome), raised blood pressure
Missed medication	Blood pressure and heart rate drift out of control
Less sleep	Raised stress hormones and blood pressure

We look at the long-term effect of salt on the heart in how many people die from eating too much salt, and at alcohol more broadly in how many people die from alcohol every day.

Reason 4: emotional strain

The Swedish study offers a clue here. The biggest single peak was not Christmas Day but Christmas Eve, the main day of celebration in Sweden, with risk highest around 10pm. The authors pointed to emotional stress, anger, anxiety and sadness, all known triggers for heart attacks.

Holidays can be joyful, but they can also be exhausting. There is family conflict, money worry, travel, hosting, and for many people grief, as they spend Christmas without someone they love. Loneliness at this time of year is a real risk factor too. We cover its long-term effects in the link between loneliness and early death, and the specific danger of bereavement in can you die of a broken heart?

Reason 5: flu season

Christmas usually lands just as the flu season gets going in the northern hemisphere. Families travel, crowd into warm homes and mix generations, which is exactly how respiratory viruses spread from children to grandparents. Flu does not only cause pneumonia; a 2018 study in the New England Journal of Medicine found that the risk of a heart attack was about six times higher in the week after a confirmed flu infection.

You can see how many people die from flu each year on our seasonal flu page, and the full picture in how many people die from flu every year.

Other holiday hazards

Heart disease drives most of the excess, but it is not the only risk at this time of year.

Hazard	Why it rises at Christmas
House fires	Candles, fairy lights, overloaded sockets, cooking and drinking
Drink-driving	Parties and New Year's Eve
Falls	Ice outside, ladders and decorations inside
Food poisoning	Undercooked or reheated poultry
Carbon monoxide	Heating systems working hardest, poorly ventilated homes

We cover fire deaths in detail in how many people die in fires every day.

The myth: suicides do not peak at Christmas

One belief deserves to be put to rest. It is widely assumed that suicides spike over Christmas. In most countries where this has been studied, they do not. December usually has some of the lowest suicide rates of the year, and rates tend to peak in spring and early summer.

That does not mean the season is easy for everyone. Many people find it painful, and the days around New Year can be harder than Christmas itself. If you are struggling, you do not have to wait for the holidays to end to talk to someone. In the UK and Ireland, Samaritans answer 24 hours a day on 116 123. Our suicide statistics page lists support services in other countries.

Do people "hold on" until Christmas?

A related idea is that dying people sometimes hold on until a meaningful date, such as Christmas, a birthday or a family visit, and then die shortly after. It is a moving thought and families often describe it. The evidence is weak. A study of over 300,000 cancer deaths in Ohio, published in JAMA in 2004 by Young and Hade, found no sign that deaths dipped before Christmas, Thanksgiving or birthdays and rose afterwards. We look at the birthday version of this question in are you more likely to die on your birthday?

How to stay safe this Christmas

None of this is a reason to fear the holidays. It is a reason to take a few simple steps.

• Do not wait. Chest pain, pain spreading to the arm, jaw or back, breathlessness, sweating or sudden weakness all mean calling emergency services immediately. In the UK that is 999. Christmas is not a reason to delay.
• Pack your medicines. If you are travelling, take enough of every regular medication, and keep taking it.
• Go easy on salt and alcohol, especially if you have high blood pressure or heart disease.
• Get the flu jab if you are eligible, ideally weeks before Christmas.
• Check smoke and carbon monoxide alarms, and never leave candles burning unattended.
• Look in on people who are alone. A phone call matters more than most people realise.

If you want to understand your own longer-term heart risk, our risk calculator and cardiovascular disease page are good places to start, alongside our article on how many people die of heart attacks per day.

While you were reading this

You have spent about 12 minutes with this article. In that time, roughly 1,400 people have died around the world, and around 420 of them died from heart disease or stroke. On Christmas Day in much of the world, that share will be a little higher.

You can follow today's running total on our deaths today page, or watch every death on earth as it happens on the live death counter.

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Data sources: Phillips DP, Jarvinen JR, Abramson IS, Phillips RR, "Cardiac mortality is higher around Christmas and New Year's than at any other time" (Circulation, 2004); Kloner RA et al. (Circulation, 1999); Mohammad MA et al. (BMJ, 2018); Knight J et al. (Journal of the American Heart Association, 2016); Kwong JC et al. (New England Journal of Medicine, 2018); Young DC and Hade EM (JAMA, 2004); Office for National Statistics; World Health Organization. Study results are summarised and rounded; figures for extra deaths are illustrations based on national totals, not measured counts. This article is for informational purposes only and does not constitute medical advice. If you have symptoms of a heart attack or stroke, call emergency services immediately.