Age trends in autopsy rates. Striking decline in late life

Age-related autopsy rates were computed from 99,145 death certificates and disclosed a striking decline with advancing age, the peak (82.5%) occurring in the third decade of life, the nadir (2.4%) by age 90 years. The trend was the same for both sexes, although at all ages men were more likely to undergo autopsies than women. There was a significant decline in late life for medical examiner (ME) and non-ME cases. Rates varied according to immediate cause of death. The only causes of death in which there was no significant age-associated decline were homicide, suicide, and transport accidents, where autopsy is mandated by law. For other causes of death analyzed, rates declined significantly with age in both sexes, for ME as well as for non-ME cases. We conclude that low autopsy rates in late life are not artifactual but represent an overall phenomenon deserving closer scrutiny.