Implementation of post-mortem examinations within a large population-based cohort: results from the Hamburg City...

Full post-mortem examinations (conventional autopsies) are a valuable tool for understanding disease mechanisms but are commonly rare, especially in epidemiological research. This study aimed to (1) assess conventional autopsy implementation in the Hamburg City Health Study (HCHS), (2) identify factors associated with conventional autopsy performance, and (3) compare conventional autopsy findings with presumed (clinical) causes of death.

We assessed the implementation of conventional autopsies and the collection of related data within the HCHS, a population-based cohort of 16,411 individuals aged 45-74, enrolled since 2016. Conventional autopsy data were obtained through death and autopsy certificates over an up to 7-year follow-up period (spring 2016 to spring 2023). Descriptive analyses were performed, including baseline characteristics and causes of death.

During a median follow-up of 4.33 years, 354 participants (2.3% of the cohort) died. Death certificates were available for 275 cases, and 23 individuals underwent conventional autopsy (autopsy rate: 6.5%). In 10 cases (43.5%), the conventional autopsy confirmed the hypothesized cause of death, while in four cases (17.4%), there was a discrepancy or ambiguity between the death certificate and conventional autopsy findings. In the remaining nine cases (39.1%), no evident causal chain could be established based on external examination alone, which constituted the reason for conventional autopsy. Factors associated with a higher likelihood of conventional autopsy included unknown or non-natural causes of death (as judicial autopsy order) and prolonged hospitalization prior to death.

Conducting systematic conventional autopsies in large, population-based cohorts is feasible but presents logistical and ethical challenges. Conventional autopsies often confirmed clinical diagnoses. Still, relevant discrepancies and ambiguities remained, in which conventional autopsy findings added relevant information for crucial clarification. Incorporating conventional autopsy findings enhances the accuracy of mortality data and strengthens epidemiological outcome assessments.