US Death Rate Rises Sharply
At Beginning Of The Month
By Gene Emery

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 the trend.
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 said.
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 disability payments.
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 calendar.
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.