Targonski P, Jacobsen S J, Weston S A, Leibson C L, Pfeifer E, Nemetz P, Roger V L
Division of Community Internal Medicine and Geriatrics, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Ann Epidemiol. 2001 May;11(4):264-70. doi: 10.1016/s1047-2797(00)00220-9.
Autopsy studies can provide insight into disease trends and their determinants, including data on the prevalence of atherosclerosis. However, such studies are subject to autopsy bias, which limits their generalizability to the source population. The impact of this bias on autopsy based estimates of time trends in heart disease prevalence is unknown. To report on the trends over time in autopsy rates in Olmsted County, MN, to examine the association between clinical diagnoses of cardiovascular diseases (CVDs) and referral to autopsy and how this association may have changed over time.
We examined the trends in autopsy rates between 1979 and 1994 in Olmsted County, and the association between antemortem characteristics including cardiovascular diagnoses and autopsy referral.
From 1979 to 1994, a total of 9110 residents died in Olmsted County. The average annual autopsy rate was 30%. Autopsy rates declined from 36% in 1979 to 23% in 1994, corresponding to an average decline of 0.6%/year (p < 0.01). Referral to autopsy was positively associated with younger age, male sex, in-hospital place of death, antemortem diagnoses of myocardial infarction (MI) or peripheral vascular disease (PVD), and earlier calendar period. There was no evidence of an interaction between calendar period and any of these predictor variables. Antemortem diagnosis of heart failure was associated with a decrease in the odds of referral to autopsy over time as compared to persons without such diagnosis.
In Olmsted County, autopsy rates, although declining over time, have remained on average approximately 30%. Antemortem diagnoses of MI or PVD are associated with autopsy referral but this association did not change over time. While the greater decline overtime in the use of autopsy observed among decedents with an antemortem diagnosis of congestive heart failure (CHF) deserves further studies, the present findings reduce the concern for bias of time trends in the prevalence of atherosclerosis by changes in the clinical characteristics of decedents referred to autopsy.
尸检研究能够深入了解疾病趋势及其决定因素，包括动脉粥样硬化患病率的数据。然而，此类研究存在尸检偏倚，这限制了它们对源人群的普遍适用性。这种偏倚对基于尸检的心脏病患病率时间趋势估计的影响尚不清楚。报告明尼苏达州奥尔姆斯特德县尸检率随时间的变化趋势，研究心血管疾病（CVD）的临床诊断与尸检转诊之间的关联以及这种关联如何随时间变化。
我们研究了1979年至1994年奥尔姆斯特德县尸检率的变化趋势，以及生前特征（包括心血管诊断）与尸检转诊之间的关联。
1979年至1994年，奥尔姆斯特德县共有9110名居民死亡。平均年尸检率为30%。尸检率从1979年的36%下降到1994年的23%，平均每年下降0.6%（p<0.01）。尸检转诊与年龄较轻、男性、院内死亡地点、生前心肌梗死（MI）或外周血管疾病（PVD）诊断以及较早的日历时期呈正相关。没有证据表明日历时期与这些预测变量中的任何一个之间存在相互作用。与没有心力衰竭诊断的人相比，生前心力衰竭诊断与随着时间推移尸检转诊几率的降低相关。
在奥尔姆斯特德县，尸检率虽然随时间下降，但平均仍保持在约30%。生前MI或PVD诊断与尸检转诊相关，但这种关联并未随时间变化。虽然生前诊断为充血性心力衰竭（CHF）的死者中尸检使用随时间的更大下降值得进一步研究，但目前的研究结果降低了因转诊进行尸检的死者临床特征变化而导致动脉粥样硬化患病率时间趋势偏倚的担忧。
