1. Simple Short Reports #5 Hospital admissions and the World Cup 1998 Dr. Craig Jackson Senior Lecturer in Health Psychology School of Health and Policy Studies Faculty of Health & Community Care University of Central England craig.jackson@uce.ac.uk

2. Admissions and World Cup 1998 To examine hospital admissions for a range of diagnoses on days surrounding England's 1998 World Cup football matches. Analysis of hospital admissions obtained from English hospital episode statistics. Pop. Aged 15 – 64 years Ratio of number of admissions for Acute MI Acute MI Stroke Stroke Deliberate self harm Deliberate self harm Road traffic injuries Road traffic injuries on the day of and five days after England's World Cup matches. Compared with admissions at the same time in previous and following years and in the month preceding the tournament. Carroll, D et al. 2002

3. Admissions and World Cup 1998 England's matches in the 1998 World Cup 15 June (England 2, Tunisia 0) 22 June (Romania 2, England 1) 26 June (Colombia 0, England 2) 30 June (Argentina 2, England 2) Argentina won penalties 4-2 Extracted hospital admissions data for acute myocardial infarction, stroke, deliberate self harm, and road traffic injuries among men and women aged 15 to 64. Extracted hospital admissions data for acute myocardial infarction, stroke, deliberate self harm, and road traffic injuries among men and women aged 15 to 64. Also extracted data for the month before the World Cup and for the same periods in 1997 and 1999 for comparison. Games all took place in late evening. Examined the same associations using only the two days after the match that is, omitting the day of the match as the exposed condition.

4. Admissions and World Cup 1998 Results: During the period of England's World Cup matches (15 June to 1 July) 81 433 emergency admissions occurred: 1348 (2%) for myocardial infarction 662 (1%) for stroke 662 (1%) for stroke 856 (1%) for road traffic injury 856 (1%) for road traffic injury 3308 (4%) for deliberate self harm observed / expectedactual – expectedARR admissionsadmissions Day of match91 / 7219.21.25 (0.99 to 1.57) 1 day after88 / 7216.01.21 (0.96 to 1.57) 2 days after91 / 7120.01.27 (1.01 to 1.61) 3 days after76 / 74 1.70.99 (0.77 to 1.27) 4 days after71 / 74 3.40.92 (0.71 to 1.19) 5 days after83 / 7210.91.13 (0.89 to 1.43)

5. Admissions and World Cup 1998 Results: Admission Within 2 days Within 2 days Within 2 days of P value diagnosisof winof 1-2 loss loss on penalty M.I0.990.911.250.007 0.89 - 1.110.78 - 1.071.08 - 1.44 Stroke0.870.971.000.42 0.74 - 1.030.79 - 1.190.82 - 1.23 RTA0.990.960.850.51 0.85 - 1.140.79 - 1.170.69 - 1.05 DSH1.081.011.050.26 1.00 - 1.160.91 - 1.120.95 - 1.16 Periods after a win and 1st first loss were not associated with increased admissions On the day of and the two days after the match against Argentina with a penalty shoot-out, admissions for acute MI increased by 25%. No increases in admission were seen for any of the other diagnoses.

6. Admissions and World Cup 1998 Conclusions: Findings support hypothesis that major environmental events, whether physical catastrophes or cultural disappointments, are capable of triggering myocardial infarction. If the triggering hypothesis is true, preventive efforts should consider strategies for dealing with the effects of acute physical and psychosocial upheavals. Perhaps the lottery of the penalty shoot-out should be abandoned on public health grounds. Limitations: Harvesting effect?Reporting tendency?Sudden deaths?