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Is Four a Deadly Number for the Chinese?

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Is Four a Deadly Number for the Chinese? CHRISTMAS OFFERINGS OFFERINGS Is four a deadly number for the Chinese? Nirmal S Panesar, Noel C Y Chan, Shi N Li, Joyce K Y Lo, Vivien W Y Wong, Isaac B Yang and Emily K Y Yip PSYCHOLOGICAL STRESS, perhaps involving endocrinological mechanisms, ABSTRACT can lead to heart disease.1 Patients with Background: The numbers 4, 14 and 24 are associated with death for Cantonese- coronary artery disease have been speaking Chinese people, as the words for these numbers sound like the words for described as exhibiting an exaggerated “death”, “must die” and “easy to die”, respectively. A previous study in the United The Medical Journal of Australia ISSN: cerebral cortical response to mental States investigating psychological stress engendered by fear of the number 4 found 0025-729X2 1/15 December 2003 179 11/ stress, and another study has found more cardiac deaths in Chinese and Japanese people, compared with white that, 12in 656-658such patients, the presence of Americans, on the 4th day of the month. ©The Medical Journal of Australia 2003 mental stress-induced ischaemia pre- www.mja.com.au 3 Objective: To determine whether more cardiac deaths occur in Hong Kong Chinese dicts Christmassubsequent Offerings death. people on the days of the month with “deathly connotations” (4, 14 and 24). Recently, Phillips et al investigated the effect of the psychological stress Design: Analysis of mortality data (1995–2000) of the Chinese population of Hong associated with fear of the number 4. Kong from the Census and Statistics Department of the Hong Kong Government for According to these authors, the word these three days of the month, compared with the remaining days, according to both for “four” in Mandarin, Cantonese and the Gregorian and Lunar calendars. Japanese sounds very like the word for Results: There were 17 346 cardiac deaths registered under ICD-9 codes 410–414 “death”.4 They reported that in Amer- in 1995–2000. The mean (+ 1 SD) of the cumulative number of cardiac deaths on each ica there are more cardiac deaths in day of the month was 587 (+ 30) for the Gregorian calendar or 573 (+ 24) for the Lunar Chinese and Japanese people compared calendar. The mean number of deaths on the 4th, 14th and 24th day of the month was with whites on the 4th day of the not significantly different from the mean number of deaths on the remaining days of the month. This phenomenon was termed month. “the Baskervilles effect”, based on the Conclusion: Our study of Hong Kong Chinese people does not support the concept fictional story by Sir Arthur Conan that more cardiac deaths occur in Cantonese people on the 4th, 14th and 24th day of Doyle, “The hound of the Baskervilles” in the month. which Sir Charles Baskerville has a fatal heart attack induced by extreme psy- MJA 2003; 179: 656–658 chological stress. We contend that the word for “four” sounds like the word for “death” only in quite apparent, for example, when visit- We used the same codes as Phillips et Cantonese, and for Cantonese people ing some high-rise buildings in Hong al4 (ie, codes 410–414 of the Interna- four is regarded as a bearer of bad luck. Kong, where Floors 4, 14 and 24 are tional statistical classification of diseases, However, to a Mandarin-speaking Chi- often “missing” (Box 1). injuries and causes of death, 9th edition nese, there may not be an aversion to As the study by Phillips et al4 was [ICD-9]) for the years 1995–2000 to the word “four”. To the Japanese, four conducted in the United States, it could test “the Baskervilles effect” in Hong has both lucky and unlucky connota- be argued that the practice and beliefs Kong, where over 95% of the popula- tions. In Cantonese, 14 and 24 have of traditional Cantonese culture may even more “deathly” connotations, as not be as strong there as in Hong Kong, 1: List of the floors in a high-rise these words sound like “must die” and for example. Furthermore, a second building in Hong Kong “easy to die”, respectively. study based on the same data was not These three numbers evoke discom- able to demonstrate an increased mor- fort in Cantonese people, especially tality rate on the 4th day of the month.5 concerning events related to death. Among the points of contention raised They avoid saying the word “four” at were the heart disease classification the Lunar New Year, and the aversion codes chosen by Phillips et al for their to the use of these three numbers is various studies.4,6,7 Department of Chemical Pathology, Faculty of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, NT, Hong Kong, SAR, China. Nirmal S Panesar, BSc PhD, Associate Professor; Noel C Y Chan, Medical Student; Shi N Li, Medical Student; Joyce K Y Lo, Medical Student; Vivien W Y Wong, Medical Student; Isaac B Yang, Medical “Four” represents bad Feng-shui, but if you Student; Emily K Y Yip, Medical Student. live on floor 5, 16, 27 or 38, then you cannot Reprints: Dr Nirmal S Panesar, Department of Chemical Pathology, Faculty of Medicine, Prince of Wales possibly be living on floor 4, 14, 24 or 34 — Hospital, Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China. or are you? A question of out of sight, out of [email protected] mind! 656 MJA Vol 179 1/15 December 2003 CHRISTMAS OFFERINGS tion is Cantonese speaking, and where METHODS dar in 1995. We converted these dates to cultural beliefs, including numeral Lunar dates using the Western–Chinese Mortality data superstitions, have a strong influence. Calendar Converter.8 We excluded days Phillips et al only studied the incidence Mortality data for 1995–2000 for the (and deaths on those days) not common of death associated with the 4th day of Chinese population only (persons cate- to all months in each calendar (29th, the month in the Gregorian calendar. gorised as having resided in Hong 30th and 31st for the Gregorian calendar However, if this day, or the other Kong, China, Taiwan and Macau) were and 30th for the Lunar calendar). “deathly” days, are bearers of misfor- obtained from the Census and Statistics tune, they are more likely to be associ- Department of the Hong Kong Govern- Statistical analysis ated with the Chinese Lunar calendar, ment. Daily death rates were recorded which determines all Chinese cultural for all causes, and for cardiac mortality After eliminating incomplete records, events (eg, the Lunar New Year). encompassing ICD-9 codes 410–414 statistical analysis was performed using the Poisson regression model using Sta- Thus, we studied cardiac mortality (acute myocardial infarction; other 9 rates on the 4th, 14th and 24th days of acute and subacute forms of ischaemic tistica software. The number of cardiac the month in both the Gregorian and heart disease; old myocardial infarction; deaths (encompassing ICD-9 codes Lunar calendars. We also looked at the angina pectoris; and other forms of 410–414) on each day of the month were considered as the dependent varia- influence of the 3rd and 8th day of the chronic ischaemic heart disease, respec- ble, and the unlucky days (4th, 14th month on cardiac mortality, as the tively). numbers 3 and 8 are perceived as lucky and 24th combined), or the lucky days by the Cantonese. In Cantonese, the (3rd and 8th combined), versus the word for “three” sounds like “life” or Calendars remaining days were treated as the inde- “longevity”, and number 8 is associated The Hong Kong Census and Statistics pendent variable. The statistical signifi- with prosperity and is a highly desired Department started recording dates of cance of the difference in mean cardiac number (eg, for car licence plates). death according to the Gregorian calen- mortality for the two comparison groups was tested by the deviance dif- ference test statistic (which follows a ␹2 2: Deaths from heart disease on the different days of the month distribution) before and after adding in (1995–2000) the group effect.10 A 800 700 RESULTS 600 There were 188 487 deaths from all 500 causes over the 6-year period, of which 178 447 (94.7%) were in Chinese peo- 400 ple. The means (+ 1 SD) of the cumula- 300 tive number of deaths from all-causes Number of deaths on each day of the month in Chinese 200 people were 6040 (+ 75) and 5876 100 (+ 83), according to the Lunar and the Gregorian calendars, respectively. Over 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 the 6-year period, there were 17 346 Day of the month (Lunar calendar) cardiac deaths (9.7% of the total) classi- B 800 fied under codes 410–414 in Chinese 700 people, and the means (+ 1 SD) of the 600 cumulative number of deaths for each day of the month were 587 (+ 30) and 500 573 (+ 24), for the Gregorian and 400 Lunar calendars, respectively (Box 2). There was no significant difference in 300 the mean of the cumulative deaths on Number of deaths 200 the 4th, 14th and 24th day of the month and the mean of the cumulative deaths 100 on the remaining days (577 [95% CI, 0 551–605] v 588 [95% CI, 579–597; 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Day of the month (Gregorian calendar) P = 0.46] for the Lunar calendar; and 575 [95% CI, 548–602] v 572 [95% CI, Number of deaths (95% CI) from heart disease by day of the month according to the Lunar (A) 563–582; P = 0.88] for the Gregorian and Gregorian (B) calendars among Hong Kong Chinese people, for the period 1995–2000.
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