Content area
Abstract
ABSTRACT
Background
The impact of a “weekend effect” on US acute coronary syndrome (ACS) mortality remains uncertain. We compared weekend and weekday age‐adjusted mortality rates (AAMRs) and analyzed demographic, geographic, and temporal trends from 1999 to 2020.
Methods
We conducted a national analysis of ACS deaths (age ≥ 25 years) using CDC WONDER (ICD‐10: I20.0; I21.0–I21.4; I21.9; I22.0–I22.9; I24.8; I24.9). Crude and AAMRs (per 100 000; 2000 U.S. standard) were calculated, and trends were assessed by joinpoint regression to estimate annual percent changes (APCs) and average APCs (AAPCs).
Results
From 1999 to 2020, there were 3, 101, 451 ACS deaths: 2, 222, 468 on weekdays (AAMR 46.4; 95% CI 46.39–46.51) and 878, 983 on weekends (AAMR 18.4), a 2.5:1 ratio. Both periods saw two‐phase declines—APCs of ≈ –6.4%/year before 2009–2010 and –3.3 to –3.7%/year thereafter (all p < 0.001). Disparities persisted: Black adults had the highest AAMRs (20.9 weekend; 53.2 weekday), rural rates exceeded urban (28.7 vs. 15.8; 72.0 vs. 40.2), men exceeded women (23.8 vs. 14.0; 60.2 vs. 35.4), and rates rose steeply with age (weekend 0.3–223.0; weekday 0.7–561.0). After 2009, declines slowed, and weekday deaths in Black adults rose after 2018.
Conclusions
The weekend effect on ACS mortality is minimal, with weekday deaths far outnumbering weekend deaths. Persistent—and sometimes widening—disparities by race, rurality, sex, and age highlight the need for equity‐focused interventions, strengthened rural cardiac care, and targeted prevention.
Details
; Nazir, Abubakar 2
; Elgendy, Mohamed S. 3
; Awashra, Ameer 4
; Zeidalkilani, Jehad 5 ; Alqadi, Mohammad 6 ; Khreshi, Suleiman 7
1 Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
2 Oli Health Magazine Organization, Kigali, Rwanda, Faculty of Medicine, King Edward Medical University, Lahore, Pakistan
3 Faculty of Medicine, Tanta University, Tanta, Egypt
4 Department of Medicine, An‐Najah National University, Nablus, West Bank, Palestine
5 Department of Internal Medicine, MercyOne Siouxland Medical Center, Sioux City, Iowa, USA
6 Department of Internal Medicine, University of Toledo, Toledo, Ohio, USA
7 Department of Internal Medicine, St. Mary Medical Center, Trinity Health Mid‐Atlantic, Langhorne, Pennsylvania, USA