Nelson Dean M, Rowe Stephanie J, Trytell Adam, Fahy Louise, Freedman Kelila, Pflaumer Andreas, Stub Dion, La Gerche Andre, Paratz Elizabeth D
Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
Heart, Exercise and Research Trials, St Vincent's Institute, Melbourne, Victoria, Australia.
Heart Rhythm O2. 2025 May 22;6(8):1165-1174. doi: 10.1016/j.hroo.2025.05.020. eCollection 2025 Aug.
Autopsy, the gold standard for determining the cause of death, is declining globally. Significant differences exist between clinical diagnoses and those revealed at autopsy. Evidence of disparities in autopsy rates between different patient groups has previously been reported.
To describe contemporary trends and disparities in autopsy rates according to sex, race, and urbanization, with particular attention to patients who have died because of cardiovascular disease (CVD).
We accessed the Center for Disease Control Wide-Ranging Online Data for Epidemiological Research "Underlying Cause of Death" dataset for 2003 to 2020, to assess trends in autopsy rates in all-comers and for different subgroups stratified by sex, race, and degree of urbanization. Further primary and subgroup analysis was performed independently by the International Classification of Diseases, Tenth Revision cause of death criteria by chapter, subchapter, and specific diseases of interest. Linear regression was used to assess trends over time, with a significant coefficient considered evidence of temporal trend.
Annual autopsy rates decreased across the time period in all-comers, with an average autopsy rate of 3.66% ( .001); however, this relationship was not demonstrated in CVDs. Men undergo autopsy more frequently than women, though autopsy rates in women with CVD are increasing ( .011). Patients of non-White ethnicity and in metropolitan areas undergo autopsy at higher rates. Increasing autopsy rates are seen in ischemic heart disease ( .001).
Autopsy is decreasing in the United States; however, trends differ depending on patient factors (sex, ethnicity), social factors (degree of urbanization), and disease factors.
尸检作为确定死因的金标准，在全球范围内正呈下降趋势。临床诊断与尸检结果之间存在显著差异。此前已有报道不同患者群体尸检率存在差异的证据。
描述根据性别、种族和城市化程度划分的当代尸检率趋势及差异，尤其关注因心血管疾病（CVD）死亡的患者。
我们获取了疾病控制中心2003年至2020年的广泛在线流行病学研究“根本死因”数据集，以评估所有患者以及按性别、种族和城市化程度分层的不同亚组的尸检率趋势。通过国际疾病分类第十版按章节、子章节和感兴趣的特定疾病的死因标准进行进一步的主要分析和亚组分析。使用线性回归评估随时间的趋势，显著系数被视为时间趋势的证据。
在此期间，所有患者的年度尸检率均下降，平均尸检率为3.66%（.001）；然而，在心血管疾病中未显示出这种关系。男性接受尸检的频率高于女性，尽管患有心血管疾病的女性尸检率在上升（.011）。非白人种族患者和大城市地区患者的尸检率较高。缺血性心脏病的尸检率在上升（.001）。
在美国，尸检率正在下降；然而，趋势因患者因素（性别、种族）、社会因素（城市化程度）和疾病因素而异。
