State Variation in Autopsy Rates for Injury Deaths

Hedegaard, Holly B

BACKGROUND:

Researchers and epidemiologists frequently use information from death certificates to monitor trends and populations at risk for injury. However, many factors, including whether the decedent was autopsied, can affect the completeness and specificity of death certificate information. To better understand the implications of using death data for injury research, we studied the variation in autopsy rates for injury deaths by decedent characteristics, injury mechanism and intent, and decedent’s state of residence.

METHODS:

We used mortality data from the National Vital Statistics System to identify and categorize injury deaths from 2008-2010 by autopsy status (yes, no or unknown). The percent of injury deaths with autopsy was then determined for various subgroups.

RESULTS:

Nationally, approximately 55% of all injury deaths are autopsied, 39% are not autopsied and 6% have unknown autopsy status. Autopsy rates are higher for males (57.2%) than females (48.2%), and for younger age groups than for older age groups (high of 90.8% for infants under age 1 to low of 10.9% for older adults age 85+). Autopsy rates also vary by state and by mechanism and intent of injury. Among states, the autopsy rates for suicide deaths ranges from 10.0% to 97.9%, for poisoning deaths (all intents) from 32.5% to 95.2%, for transportation deaths (all intents) from 10.7% to 96.0%, for fall deaths (all intents) from 5.5% to 34.7% and for injury deaths of undetermined intent from 46.0% to 100%. In all states, 90% or more of homicide deaths are autopsied.

CONCLUSIONS: Autopsy rates for injury deaths vary significantly by age, sex and state of residence of the decedent, and by the mechanism and intent of injury. The findings from an autopsy can enhance the completeness and specificity of the information provided on the death certificate, particularly for multiple cause of death data. Researchers and epidemiologists should consider the impact of variations in autopsy rates when conducting comparison studies using data from death certificates.