- BOSTON - Mondays may be tough,
but the first week of a month can be a killer, a study of U.S. death rates
appearing in Thursday's New England Journal of Medicine found.
- The study, which examined records from 1983 to 1988,
found the combined death rate from substance abuse, suicide, accidents
and homicide typically jumped 14 percent during the first week of each
month compared with the last seven days of the previous month.
- And because the rates are even higher among the poor,
the research team from the University of California at San Diego suggested
monthly benefit checks that arrive at the beginning of the month may explain
- Although several diseases also peaked at the start of
the month, the trend "was particularly strong for homicides, suicides,
and accidents, and for deaths involving substance abuse," the researchers
- They said "money for purchasing drugs or alcohol
tends to be available at the beginning of the month and is relatively less
available (for people with low incomes) at the end of the month, when discretionary
funds may be exhausted."
- Led by sociologist David P. Phillips, the team said the
findings suggested "that limiting the amount of discretionary income
available for drugs and alcohol might help reduce the number of deaths
that occur at the beginning of the month."
- This was not the first study to link health problems
to government payments.
- Four years ago the New England Journal of Medicine published
research showing cocaine use and psychiatric symptoms increased at the
beginning of each month when 105 veterans with schizophrenia received their
- That study sparked suggestions for changes in the way
payments are distributed, so more money could be used for food and shelter
and less was available for drugs and alcohol.
- Phillips' study surveyed more than 31 million computerized
death certificates to conclude, "The number of deaths was unusually
low in the week preceding the first of the month and abruptly increased
on the first of the month."
- Specifically, during the first week of the month, the
substance-abuse death rate was 14 percent higher than at the end of the
month, the homicide rate rose 6.2 percent, suicide rates were up 5.3 percent
and motor vehicle accident rates were 2.8 percent higher, the study found.
- For unknown reasons deaths caused by cancer, heart, liver
and respiratory problems were also higher " about 1 percent "
at the beginning of the month. Deaths from infections, pregnancy complications
and mental disorders unrelated to drug abuse showed no relationship to
- The researchers used race as an indirect marker to assess
whether federal benefits might be linked to higher death rates because
death certificates do not indicate income.
- Their rationale: "Nonwhites are considerably more
likely to be poor than whites." When researchers looked at death rates
for nonwhites, the trends were even more dramatic.