Elsevier

Heart Rhythm

Volume 20, Issue 4, April 2023, Pages 607-613
Heart Rhythm

Contemporary Review
A systematic review of global autopsy rates in all-cause mortality and young sudden death

https://doi.org/10.1016/j.hrthm.2023.01.008Get rights and content

Autopsy is the gold standard method for determining cause of death. Young sudden death (SD) is a prototype condition in which autopsy is universally recommended. The aim of this review was to quantify real-world global rates of autopsy in either all-cause death or young SD. A systematic review was conducted. Rates of autopsy in all-cause death and in young SD were determined in each country using scientific and commercial search engines. In total, 59 of 195 countries (30.3%) reported autopsy rates in all-cause death, with rates varying from 0.01%–83.9%. Almost all of these figures derived from academic publications rather than governmental statistics. Only 16 of 195 countries (8.2%) reported autopsy rates in the context of young SD, with reported rates ranging from 5%–100%. The definition of “young” was heterogeneous. No governmental statistics reported autopsy rates in young SD. Risks of bias included inability to verify reported figures, heterogeneity in reporting of clinical vs medicolegal autopsies, and the small number of studies identified overall, resulting in the consistent exclusion of low- and middle-income countries. In conclusion, most countries globally do not report autopsy rates in either all-cause death (69.7%) or in SD (92.8%). Without transparent reporting of autopsy rates, global burdens of disease and rates of sudden cardiac death cannot be reliably calculated.

Section snippets

Background

Autopsy, the study of a body after death, is derived from the Greek word autopsia, meaning “to see for oneself.”1,2 Clinical (hospital) autopsy rates have been falling worldwide across recent decades3 due to multiple factors, including elimination of minimum autopsy requirements for accreditation, costs of autopsy, decreasing clinician request for autopsies, and increasing family and religious objection to autopsy.1,4, 5, 6 Forensic (medicolegal) autopsies, performed to investigate sudden or

Search strategy

A list of all countries of the world (n = 195) was obtained. Each country name and the search terms “autopsy,” “rate of autopsy,” “young sudden death,” and “young sudden death autopsy” were searched (Figure 1). Searches were conducted in PubMed and commercial search engines. Citation tracking also was utilized.

Inclusion criteria

Any document format was eligible for inclusion, including journal articles, publicly available governmental datasets, press releases, newspaper articles, and annual reports. Included data

Results

All 195 countries in the world were assessed for reports of autopsy rate in sudden cardiac death or overall death (Supplemental Table 3).

Discussion

This study identified that, despite the central role of the autopsy in determining cause of death, global rates of autopsy are very poorly understood. Over two-thirds of countries do not provide any publicly accessible data regarding their autopsy rates, and >90% of countries provide no information regarding autopsy rates in young SD. Without clear reporting of autopsy rates, any comparison of reported global causes of death is inherently flawed.

Conclusion

Although autopsy is the gold standard method of determining cause of death, most countries globally do not report autopsy rates in either all-cause death (69.7%) or in SD (92.8%). Without transparent reporting of autopsy rates, global burden of disease and rates of sudden cardiac death cannot be reliably calculated.

References (71)

  • M. Nagata et al.

    Temporal trends in sudden unexpected death in a general population: the Hisayama study

    Am Heart J

    (2013)
  • M. Ceelen et al.

    Sudden death victims <45 years: agreement between cause of death established by the forensic physician and autopsy results

    J Forensic Leg Med

    (2015)
  • A. Atreya et al.

    Forensic medicine in Nepal: past, present, and future

    J Forensic Leg Med

    (2022)
  • C.X. Wong et al.

    Epidemiology of sudden cardiac death: global and regional perspectives

    Heart Lung Circ

    (2019)
  • L.S.G. Du Toit-Prinsloo

    Performance of autopsies in South Africa: selected legal and ethical perspectives

    Continuing Medical Education

    (2012)
  • K.G. Shojania et al.

    The vanishing nonforensic autopsy

    N Engl J Med

    (2008)
  • D. Zangpo et al.

    Forensic Medicine in South Asia: comparison to the developed countries

    Yonago Acta Med

    (2022)
  • C. Basso et al.

    Autopsy in the era of advanced cardiovascular imaging

    Eur Heart J

    (2022)
  • J.P. Park et al.

    Changes in clinical and legal autopsy rates in Korea from 2001 to 2015

    J Korean Med Sci

    (2019)
  • T. Adair et al.

    Monitoring progress with national and subnational health goals by integrating verbal autopsy and medically certified cause of death data

    BMJ Glob Health

    (2021)
  • J. Banner et al.

    Autopsy examination in sudden cardiac death: a current perspective on behalf of the Association for European Cardiovascular Pathology

    Virchows Arch

    (2021)
  • N.D. Kapusta et al.

    Declining autopsy rates and suicide misclassification: a cross-national analysis of 35 countries

    Arch Gen Psychiatry

    (2011)
  • K.G. Shojania et al.

    Changes in rates of autopsy-detected diagnostic errors over time: a systematic review

    JAMA

    (2003)
  • K.G. Shojania et al.

    Overestimation of clinical diagnostic performance caused by low necropsy rates

    Qual Saf Health Care

    (2005)
  • A. Rosendahl et al.

    Autopsies and quality of cause of death diagnoses

    SAGE Open Med

    (2021)
  • C. Basso et al.

    Guidelines for autopsy investigation of sudden cardiac death: 2017 update from the Association for European Cardiovascular Pathology

    Virchows Arch

    (2017)
  • K. Zeppenfeld et al.

    2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

    Eur Heart J

    (2022)
  • A. Paratz E van Heusden et al.

    Causes, circumstances and potential preventability of cardiac arrest in the young: insights from a state-wide clinical and forensic registry

    Europace

    (2022)
  • Z.H. Tseng et al.

    Prospective countywide surveillance and autopsy characterization of sudden cardiac death: POST SCD study

    Circulation

    (2018)
  • R.D. Bagnall et al.

    A prospective study of sudden cardiac death among children and young adults

    N Engl J Med

    (2016)
  • M. Campbell et al.

    Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline

    BMJ

    (2020)
  • Autopsy Rate (%) for All Deaths

  • Statistics Canada. Table 13-10-0716-01. Deaths Subject to Autopsy

  • Coroners Statistics 2019: England and Wales

  • VIFM Annual Report 2019–20

  • Cited by (0)

    Funding Sources: Dr Paratz is supported by an NHMRC/NHF co-funded Postgraduate Scholarship, RACP JJ Billings Scholarship, and PSA Cardiovascular Scholarship. Dr La Gerche is supported by an NHF Future Leadership Fellowship and NHMRC Career Development Fellowship. Dr Stub is supported by an NHF Future Leadership Fellowship. Disclosures: The authors have no conflicts of interest to disclose.

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