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BACKGROUND: There are concerns that quality of medical care may be poorer on weekends than weekdays. Invasive meningococcal disease, comprising septicaemia and meningitis, is often life threatening unless it is immediately and effectively treated regardless of day of the week. We test the hypothesis that numbers of deaths from meningococcal disease outside hospital without admission, and case fatality rates (CFRs) following admission, did not differ between weekends and weekdays. METHODS: Analysis of linked hospital and mortality data, England, 1999-2010. RESULTS: The study comprised 19 729 people. There was no significant difference between days of the week in the number of deaths outside hospital in people who never reached hospital care. Of people who were admitted, CFRs for weekend and weekday admissions were the same: 4.9% (262/5315) on weekends and 4.9% (678/13 798) on weekdays. We undertook sensitivity analyses and analysed multivariate models but, however the data were analysed, the result of no 'weekend effect' remained. CONCLUSIONS: There are few, if any, other acute diseases in which the difference in mortality outcome between no treatment and effective treatment is so great and unequivocally related to care itself. There was no evidence of excess deaths from meningococcal disease associated with weekend care.

Original publication




Journal article


J Public Health (Oxf)

Publication Date





413 - 421


communicable diseases, emergency care, health services, Adolescent, Adult, Age Factors, Aged, Child, Child, Preschool, Databases, Factual, Female, Hospitalization, Humans, Infant, Male, Meningococcal Infections, Middle Aged, Quality of Health Care, Sex Factors, Time Factors, United Kingdom, Young Adult