1. Autopsy rates have significantly declined over time, though the rates of autopsy among Black persons was significantly higher than those among White persons.
2. Among several possibilities, this may illustrate racial health disparities related to precision and extent of diagnostic workups prior to death.
Evidence Rating Level: 2 (Good)
Clinical autopsy rates have declined over time, potentially due to overconfidence in antemortem diagnostic improvements and financial constraints. However, autopsy rates between racial groups have not been fully examined to determine whether or not health disparities are at play. This retrospective cohort study included individuals 18 years of age or older between 2008 and 2017 with data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Those excluded were deaths from suicide, homicide, accidents, and those with unknown autopsy status. A total of 23,670,006 decedents were eligible for analysis following exclusions (73.9% aged > 65 years, 49.6% female, 85.7% White). With an overall autopsy rate of 7.9%, the rate was higher among Black persons (12.7%, 95% CI 12.7 to 12.8) compared to their White counterparts (7.3%, 95% CI 5.4 to 5.5). These rates were also higher in deaths related to cirrhosis (6.7%) and cardiovascular disease (7.6%) compared to kidney disease (1.5%) and cancer (0.9%). Across all available conditions, Black persons had significantly higher autopsy rates compared with White persons (difference 0.9% for cancer, 5.6% for cardiovascular disease). Autopsies for all causes of death, except for diabetes-related deaths, declined across the study period (p < 0.01). Overall, this study suggests that several factors may be influencing this decline in autopsies, including the fact that they are expensive and rarely reimbursed. Further, this may reflect racial health disparities, resulting from less aggressive diagnostic workups among Black patients and, thus, questionable causes of death.
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