Shubietah Abdalhakim, Nazir Abubakar, Elgendy Mohamed S, Awashra Ameer, Zeidalkilani Jehad, Alqadi Mohammad, Khreshi Suleiman
Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA.
Oli Health Magazine Organization, Kigali, Rwanda.
Clin Cardiol. 2025 Jul;48(7):e70175. doi: 10.1002/clc.70175.
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.
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).
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.
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.
“周末效应”对美国急性冠脉综合征（ACS）死亡率的影响仍不确定。我们比较了周末和工作日的年龄调整死亡率（AAMR），并分析了1999年至2020年的人口统计学、地理和时间趋势。
我们使用疾病控制与预防中心的WONDER（国际疾病分类第十版：I20.0；I21.0-I21.4；I21.9；I22.0-I22.9；I24.8；I24.9）对ACS死亡（年龄≥25岁）进行了全国性分析。计算了粗死亡率和年龄调整死亡率（每10万人；2000年美国标准），并通过连接点回归评估趋势，以估计年度百分比变化（APC）和平均APC（AAPC）。
1999年至2020年，共有3101451例ACS死亡：工作日为2222468例（AAMR为46.4；95%CI为46.39-46.51），周末为878983例（AAMR为18.4），比例为2.5:1。两个时期均呈现两阶段下降——2009-2010年前APC约为-6.4%/年，此后为-3.3%至-3.7%/年（所有p<0.001）。差异持续存在：黑人成年人的AAMR最高（周末为20.9；工作日为53.2），农村地区的死亡率超过城市地区（分别为28.7对15.8；72.0对40.2），男性超过女性（分别为23.8对14.0；60.2对35.4），且死亡率随年龄急剧上升（周末为0.3-223.0；工作日为0.7-561.0）。2009年后，下降速度放缓，2018年后黑人成年人的工作日死亡人数上升。
周末对ACS死亡率的影响微乎其微，工作日死亡人数远多于周末死亡人数。种族、农村地区、性别和年龄方面持续存在且有时扩大的差异凸显了以公平为重点的干预措施、加强农村心脏护理和针对性预防的必要性。
