DETERMINANTS OF THE AUTOPSY DECISION - A STATISTICAL-ANALYSIS

Our goal was to use cross-sectional national mortality data to provide a multivariable statistical analysis of the factors that contribute t o the decision of whether an autopsy will be performed. The identifica tion of determinants of the autopsy is an important prerequisite for f inding cost-effective alternatives for arresting or reversing the decl ine of autopsy rates in the circumstances in which the autopsy can con tinue to make a crucial contribution to clinical medicine and public h ealth. The source of the data was 1986 National Center for Health Stat istics (Washington, DC) mortality data tapes for Kentucky, Maryland, M innesota, and Washington for the 1986 calendar year. Separate multiple logistic regressions were conducted on these data on a state-by-state basis, with a total of 139,063 individual mortality records as the un it of analysis. The dependent variable in all models was autopsy (yes/ no). Odds ratios for selected explanatory variables were estimated for all four states, and the relative contribution of each explanatory va riable was studied in a detailed analysis of one state. In general, th e following independent variables had a statistically significant posi tive relationship with whether an autopsy will be performed: male sex; nonwhite ethnicity; death due to ill-defined or unknown cause; death due to accident, suicide, or homicide; presence of a nationally recogn ized medical center in the county of death; and death occurring in a s tandard metropolitan statistical area. In general, the following indep endent variables had a statistically significant negative relationship with whether an autopsy will be performed: older age at death; higher income level of the decedent; death in a nursing home; death at home; and residency in the county of death. The two most important variable s influencing the autopsy decision were age at death (especially old a ge) and death due to accident, homicide, or suicide.