Birthday effect

The birthday effect (sometimes called the birthday blues, especially when referring specifically to suicide) is a statistical phenomenon where an individual's likelihood of death appears to increase on or close to their birthday. The birthday effect has been seen in studies of general populations in England and Wales,[1] Switzerland,[2][3] Ukraine,[4] and the United States,[5][6] as well as in smaller populations such as Major League Baseball players.[7] Studies do not consistently show this effect; some studies find that men's and women's mortality rates diverge in the run-up to the birthday,[5] while others find no significant gender effect.[8][9] Suggested mechanisms for the effect include alcohol consumption, psychological stress relating to the birthday, increased suicide risk, terminally ill patients attempting to hold on until their birthday, an increased mortality salience, or a physiological cycle that causes the body to weaken annually. It has also been suggested that it may be a statistical artifact, perhaps as a result of anomalies in reporting, but the birthday effect has also been seen in studies that control for known reporting anomalies.[5][7]

Studies

GabbyHartnettGoudeycard
Gabby Hartnett is one of the statistically unusual number of MLB players to have died on his birthday.[7]

With the introduction of statistical software that can process large datasets easily, a number of state- or country-wide studies have been carried out to investigate whether birthdays have any effect on mortality. The first large-scale study used the records of 2,745,149 Californians who died between 1969 and 1990. After correcting for confounding factors such as seasonality in deaths, elective surgery, and people born on February 29, there was a significant increase in deaths in the week before the individual's birthday for men, and in the week after the birthday for women – in both cases, mortality did not peak on the birthday, but close to it. This effect was consistent across age and race cohorts.[5]

A similar study among 12,275,033 Swiss found the highest mortality on the actual birthday (17% greater than the expected value), and the effect was largest for those over 80;[2] another study on Swiss data found a 13.8% excess and was able to link this to specific causes: heart attack and stroke (predominant in women) and suicides and accidents (predominant in men), as well as an increase in cancer deaths.[3] Among 25 million Americans who died between 1998 and 2011, 6.7% more people than expected die on their birthday, and the effect was most pronounced at weekends and among the young – among 20 to 29 year olds, the excess was over 25%.[6] An even greater excess was found in the population of Kiev, where between 1990 and 2000 there were 44.4% more deaths than expected among men on their birthdays and 36.2% more than expected among women.[4] Smaller biographical studies have also shown a birthday effect within subpopulations, such as among Major League Baseball (MLB) players[7] and people with entries in the Encyclopedia of American History.[5]

Focusing on suicide deaths alone, large studies have found evidence for a peak in suicides on or just after a birthday in Denmark[10] and Hungary,[11] but not in Bavaria[12] or Taiwan.[12]

However, other studies have not found such a correlation. A study using the populations of Denmark and Austria (a total of 2,052,680 deaths over the time period) found that although people's life span tended to correlate with their month of birth, there was no consistent birthday effect, and people born in autumn or winter were more likely to die in the months further from their birthday.[8] A study of all cancer deaths in Germany from 1995 to 2009 found no evidence of a birthday effect, although it did find a related Christmas effect.[9] A small study by Leonard Zusne found birthday effects among both male and female cohorts, where women were more likely to die immediately before a birthday and men more likely to die immediately after, but that when averaged together there was no birthday effect among the population as a whole.[13] The same was found for a study of mortality data in England and Wales, where there was a statistically significant birthday effect among each subgroup (men and women; never married, married, divorced and widowed) but it was not seen in the population as a whole.[1]

Possible explanations

External causes

Birthday celebrations are often associated with large increases in alcohol consumption. Binge drinking can increase an individual's risk of death through alcohol poisoning, accidents and drunk driving, as well as by exacerbating existing conditions and increasing suicide risk.[4][11] In the USA where the drinking age is 21, there is a very large mortality rate excess on the 21st birthday and the day immediately following, almost entirely attributable to an increase in accidents.[14][15]

Psychosomatic and psychological

Two mutually contradictory explanations have been put forward that rely on psychosomatic effects. On the one hand, a birthday provides a fixed date to focus on, allowing the terminally ill to hold on until the day itself. On the other hand, a birthday also reminds the individual of mortality and offers an occasion to look back on life.[5][16] According to the terror management theory, this causes stress which can accelerate death. The uneven mortality rate distribution between men and women, and between more and less successful baseball players, suggests that both may play a role in the birthday effect: people who have focused on the public sphere of life (for example, career-driven people or professional athletes) might be reminded that their glory days have passed, while those who lived more in the private sphere (such as stay-at-home parents and amateur sports players) are more aware of what they will lose in death and try to hold on.[5][7][16] Related is the "broken promise effect", whereby a person suffering suicidal ideation will wait until a birthday or other significant event to see whether their circumstances will improve.[11]

The psychosomatic/psychological model would also explain the similar increase in cancer deaths around holidays such as Christmas,[9] and is supported by the fact that these appear to be dependent on culture – there is a Passover effect among the Jewish community (which moves with the festival itself), and a Mid-Autumn Festival effect among the Chinese.[5][16]

Physiological

It has been suggested that, like the 24-hour circadian rhythm, the body also has a yearly "circannual" biological rhythm. Vaiserman et al. have suggested that the climatic conditions at birth act as a zeitgeber that triggers internal stress and increases the chance of death.[4]

Statistical

It is possible when processing death certificates to confuse the date of birth and date of death fields, which would increase the apparent number of certificates in which these coincide.[5] Additionally, where the exact date is not known, the 1st and 15th of the month are often used as placeholders.[17] These will cause an excess of births and deaths recorded on these dates. However studies also find changes in the mortality rate in the days immediately before and after (which are unlikely to be caused by data processing anomalies), which suggests that statistical artifacts alone cannot explain the birthday effect.[5]

References

  1. ^ a b Anderson, M (1975). "Relationship between month of birth and month of death in the elderly". British Journal of Preventive & Social Medicine. 29 (3): 151–156. PMC 478908. PMID 1191883.
  2. ^ a b Bovet, J; Spagnoli, J; Sudan, C (1997). "[Mortality and birthdays]". Sozial- und Präventivmedizin (in French). 42 (3): 151–161. PMID 9334087.
  3. ^ a b Ajdacic-Gross, Vladeta; et al. (2012). "Death has a preference for birthdays—an analysis of death time series". Annals of Epidemiology. 22 (8): 603–606. doi:10.1016/j.annepidem.2012.04.016. PMID 22658822.
  4. ^ a b c d Vaiserman, Alexander; Grigoryev, Pavel; Belaya, Irina; Voitenko, Vladimir (2003). "Variation of mortality rate during the individual annual cycle". Biogerontology. 4 (4): 221–225. doi:10.1023/A:1025168932058.
  5. ^ a b c d e f g h i j Phillips, David; Van Voorhees, Camilla; Ruth, Todd (1992). "The Birthday: Lifeline or Deadline?". Psychosomatic Medicine. 54 (5): 532–542. CiteSeerX 10.1.1.103.5726. doi:10.1097/00006842-199209000-00001.
  6. ^ a b Peña, Pablo (2015). "A not so happy day after all: Excess death rates on birthdays in the U.S". Social Science & Medicine. 126: 59–66. doi:10.1016/j.socscimed.2014.12.014. PMID 25528555.
  7. ^ a b c d e Abel, Ernest; Kruger, Michael (2009). "Mortality Salience of Birthdays on Day of Death in the Major Leagues". Death Studies. 33 (2): 175–184. doi:10.1080/07481180802138936. PMID 19143110.
  8. ^ a b Doblhammer, Gabrielle (1999). "Longevity and month of birth: Evidence from Austria and Denmark". Demographic Research. 1 (3). doi:10.4054/DemRes.1999.1.3.
  9. ^ a b c Medenwald, Daniel; Kuss, Oliver (2014). "Deaths and major biographical events: a study of all cancer deaths in Germany from 1995 to 2009". BMJ Open. 4 (4): e004423. doi:10.1136/bmjopen-2013-004423. PMC 3987729. PMID 24694623.
  10. ^ Jessen, Gert; Jensen, Børge (1999). "Postponed Suicide Death? Suicides around Birthdays and Major Public Holidays". Suicide and Life-Threatening Behavior. 29 (3): 272–283. doi:10.1111/j.1943-278X.1999.tb00302.x (inactive 2019-03-16).
  11. ^ a b c Zonda, Tamás; Bozsonyi, Károly; Veres, Előd; Kmetty, Zoltán (2010). "The Effect of Birthday on the Fluctuation of Suicides in Hungary (1970–2002)" (PDF). Review of Sociology. 20 (2): 96–105.
  12. ^ a b Reulbach, Udo; Biermann, Teresa; Markovic, Katrin; Kornhuber, Johannes; Bleich, Stefan (2007). "The myth of the birthday blues: a population-based study about the association between birthday and suicide". Comprehensive Psychiatry. 48 (6): 554–557. doi:10.1016/j.comppsych.2007.06.006. PMID 17954141.
  13. ^ Zusne, Leonard (1987). "Some Factors Affecting the Birthday-Deathday Phenomenon". OMEGA: Journal of Death and Dying. 17 (1): 9–26. doi:10.2190/RR4D-4W0L-5QAK-X4YX.
  14. ^ Carpenter, Christopher; Dobkin, Carlos (1 January 2009). "The Effect of Alcohol Consumption on Mortality: Regression Discontinuity Evidence from the Minimum Drinking Age". American Economic Journal: Applied Economics. 1 (1)): 164–182. doi:10.1257/app.1.1.164. PMC 2846371. PMID 20351794.
  15. ^ Carpenter, Christopher; Dobkin, Carlos (1 January 2009). "The Effect of Alcohol Consumption on Mortality: Regression Discontinuity Evidence from the Minimum Drinking Age (Web Appendix A and B)" (PDF). American Economic Journal: Applied Economics.
  16. ^ a b c Blakeslee, Sandra (22 September 1992). "Birthdays: a Matter Of Life and Death". New York Times. Retrieved 7 April 2016.
  17. ^ Abel, Ernest; Kruger, Michael (2006). "Heaping in Anniversary Reaction Studies: A Cautionary Note". OMEGA: Journal of Death and Dying. 54 (1): 59–65. doi:10.2190/V752-6773-1KMW-3334.
Algor mortis

Algor mortis (Latin: algor—coldness; mortis—of death), the second stage of death, is the change in body temperature post mortem, until the ambient temperature is matched. This is generally a steady decline, although if the ambient temperature is above the body temperature (such as in a hot desert), the change in temperature will be positive, as the (relatively) cooler body acclimates to the warmer environment. External factors can have a significant influence.

The term was first used by Dowler in 1849. The first published measurements of the intervals of temperature after death were done by Dr John Davey in 1839.

Dead on arrival

Dead on arrival (DOA), also dead in the field and brought in dead (BID), indicates that a patient was found to be already clinically dead upon the arrival of professional medical assistance, often in the form of first responders such as emergency medical technicians, paramedics, or police.

In some jurisdictions, first responders must consult verbally with a physician before officially pronouncing a patient deceased, but once cardiopulmonary resuscitation is initiated, it must be continued until a physician can pronounce the patient dead.

Death messenger

Death messengers, in former times, were those who were dispatched to spread the news that an inhabitant of their city or village had died. They were to wear unadorned black and go door to door with the message, "You are asked to attend the funeral of the departed __________ at (time, date, and place)." This was all they were allowed to say, and were to move on to the next house immediately after uttering the announcement. This tradition persisted in some areas to as late as the mid-19th century.

Death rattle

Terminal respiratory secretions (or simply terminal secretions), known colloquially as a death rattle, are sounds often produced by someone who is near death as a result of fluids such as saliva and bronchial secretions accumulating in the throat and upper chest. Those who are dying may lose their ability to swallow and may have increased production of bronchial secretions, resulting in such an accumulation. Usually, two or three days earlier, the symptoms of approaching death can be observed as saliva accumulates in the throat, making it very difficult to take even a spoonful of water. Related symptoms can include shortness of breath and rapid chest movement. While death rattle is a strong indication that someone is near death, it can also be produced by other problems that cause interference with the swallowing reflex, such as brain injuries.It is sometimes misinterpreted as the sound of the person choking to death, or alternatively, that they are gargling.

Dignified death

Dignified death is a somewhat elusive concept often related to suicide. One factor that has been cited as a core component of dignified death is maintaining a sense of control. Another view is that a truly dignified death is an extension of a dignified life. There is some concern that assisted suicide does not guarantee a dignified death, since some patients may experience complications such as nausea and vomiting. There is some concern that age discrimination denies the elderly a dignified death.

Dysthanasia

In medicine, dysthanasia means "bad death" and is considered a common fault of modern medicine.Dysthanasia occurs when a person who is dying has their biological life extended through technological means without regard to the person's quality of life. Technologies such as an implantable cardioverter defibrillator, artificial ventilation, ventricular assist devices, and extracorporeal membrane oxygenation can extend the dying process.

Dysthanasia is a term generally used when a person is seen to be kept alive artificially in a condition where, otherwise, they cannot survive; sometimes for some sort of ulterior motive. The term was used frequently in the investigation into the death of Formula One driver Ayrton Senna in 1994.

Fan death

Fan death is a well-known superstition in Korean culture, where it is thought that running an electric fan in a closed room with unopened or no windows will prove fatal. Despite no concrete evidence to support the concept, belief in fan death persists to this day in Korea, and also to a lesser extent in Japan.

Funeral director

A funeral director, also known as an undertaker (British English) or mortician (American English), is a professional involved in the business of funeral rites. These tasks often entail the embalming and burial or cremation of the dead, as well as the arrangements for the funeral ceremony (although not the directing and conducting of the funeral itself unless clergy are not present). Funeral directors may at times be asked to perform tasks such as dressing (in garments usually suitable for daily wear), casketing (placing the human body in the coffin), and cossetting (applying any sort of cosmetic or substance to the best viewable areas of the corpse for the purpose of enhancing its appearance). A funeral director may work at a funeral home or be an independent employee.

Lazarus sign

The Lazarus sign or Lazarus reflex is a reflex movement in brain-dead or brainstem failure patients, which causes them to briefly raise their arms and drop them crossed on their chests (in a position similar to some Egyptian mummies). The phenomenon is named after the Biblical figure Lazarus of Bethany, whom Jesus raised from the dead in the Gospel of John.

Megadeath

Megadeath (or megacorpse) is one million human deaths, usually caused by a nuclear explosion. The term was used by scientists and thinkers who strategized likely outcomes of all-out nuclear warfare.

Morgue

A morgue or mortuary (in a hospital or elsewhere) is used for the storage of human corpses awaiting identification or removal for autopsy or respectful burial, cremation or other method. In modern times corpses have customarily been refrigerated to delay decomposition.

Mortality salience

Mortality salience is the awareness by an individual that his or her death is inevitable.

The term derives from terror management theory, which proposes that mortality salience causes existential anxiety that may be buffered by an individual's cultural worldview and/or sense of self-esteem.

Necronym

A necronym (from the Greek words νεκρός, nekros, "dead" and ὄνομα ónoma, "name") is a reference to, or name of, a person who has died. Many cultures have taboos and traditions associated with referring to such a person. These vary from the extreme of never again speaking the person's real name, often using some circumlocution instead, to the opposite extreme of commemorating it incessantly by naming other things or people after the deceased.

For instance, in some cultures it is common for a newborn child to receive the name (a necronym) of a relative who has recently died, while in others to reuse such a name would be considered extremely inappropriate or even forbidden. While this varies from culture to culture, the use of necronyms is quite common.

Necrophobia

Necrophobia is a specific phobia which is the irrational fear of dead things (e.g., corpses) as well as things associated with death (e.g., coffins, tombstones, funerals, cemeteries). With all types of emotions, obsession with death becomes evident in both fascination and objectification. In a cultural sense, necrophobia may also be used to mean a fear of the dead by a cultural group, e.g., a belief that the spirits of the dead will return to haunt the living.Symptoms include: shortness of breath, rapid breathing, irregular heartbeat, sweating, dry mouth and shaking, feeling sick and uneasy, psychological instability, and an altogether feeling of dread and trepidation. The sufferer may feel this phobia all the time. The sufferer may also experience this sensation when something triggers the fear, like a close encounter with a dead animal or the funeral of a loved one or friend. The fear may have developed when a person witnessed a death, or was forced to attend a funeral as a child. Some people experience this after viewing frightening media.The fear can manifest itself as a serious condition. Treatment options include medication and therapy.The word necrophobia is derived from the Greek nekros (νεκρός) for "corpse" and the Greek phobos (φόβος) for "fear".

Obituary

An obituary (obit for short) is a news article that reports the recent death of a person, typically along with an account of the person's life and information about the upcoming funeral. In large cities and larger newspapers, obituaries are written only for people considered significant. In local newspapers, an obituary may be published for any local resident upon death. A necrology is a register or list of records of the deaths of people related to a particular organization, group or field, which may only contain the sparsest details, or small obituaries. Historical necrologies can be important sources of information.

Two types of paid advertisements are related to obituaries. One, known as a death notice, omits most biographical details and may be a legally required public notice under some circumstances. The other type, a paid memorial advertisement, is usually written by family members or friends, perhaps with assistance from a funeral home. Both types of paid advertisements are usually run as classified advertisements.

Pallor mortis

Pallor mortis (Latin: pallor "paleness", mortis "of death"), the first stage of death, is an after-death paleness that occurs in those with light/white skin.

Post-mortem interval

Post-mortem interval (PMI) is the time that has elapsed since a person has died. If the time in question is not known, a number of medical/scientific techniques are used to determine it. This also can refer to the stage of decomposition of the body.

Rigor mortis

Rigor mortis (Latin: rigor "stiffness", mortis "of death"), or postmortem rigidity, is the third stage of death. It is one of the recognizable signs of death, characterized by stiffening of the limbs of the corpse caused by chemical changes in the muscles postmortem. In humans, rigor mortis can occur as soon as four hours after death.

Skeletonization

Skeletonization refers to the final stage of decomposition, during which the last vestiges of the soft tissues of a corpse or carcass have decayed or dried to the point that the skeleton is exposed. By the end of the skeletonization process, all soft tissue will have been eliminated, leaving only disarticulated bones. In a temperate climate, it usually requires three weeks to several years for a body to completely decompose into a skeleton, depending on factors such as temperature, humidity, presence of insects, and submergence in a substrate such as water. In tropical climates, skeletonization can occur in weeks, while in tundra areas, skeletonization may take years or may never occur, if subzero temperatures persist. Natural embalming processes in peat bogs or salt deserts can delay the process indefinitely, sometimes resulting in natural mummification.The rate of skeletonization and the present condition of a corpse or carcass can be used to determine the time of death.After skeletonization, if scavenging animals do not destroy or remove the bones, acids in many fertile soils take about 20 years to completely dissolve the skeleton of mid- to large-size mammals, such as humans, leaving no trace of the organism. In neutral-pH soil or sand, the skeleton can persist for hundreds of years before it finally disintegrates. Alternately, especially in very fine, dry, salty, anoxic, or mildly alkaline soils, bones may undergo fossilization, converting into minerals that may persist indefinitely.

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