Decreasing autopsy rate in Sweden reflects changing attitudes among clinicians

Area of Science:

• Medical Examiner and Autopsy Procedures
• Public Health and Epidemiology
• Clinical Pathology

Background:

• The autopsy rate in Sweden has declined over the past two decades, currently standing at approximately 30%.
• Clinical autopsies account for about 18% and medico-legal autopsies for over 10%, with geographical variations noted, particularly in clinical autopsy rates.
• Differences in autopsy frequency between males and females are largely attributed to a higher number of medico-legal autopsies performed on males.

Purpose of the Study:

• To investigate the reasons behind the declining autopsy rate in Sweden.
• To analyze trends in autopsy rates across different hospital types and sizes.
• To identify factors influencing the variation in autopsy rates between departments and wards.

Main Methods:

• A comparative study of autopsy rates in 1986 and 1991 was conducted in three Swedish hospitals: one university hospital and two community hospitals of varying sizes.
• Autopsy data was analyzed across different departments and wards within these institutions.
• Factors such as the Autopsy Act of 1976 and patient relatives' consent were considered.

Main Results:

• The overall clinical autopsy rate decreased between 1986 and 1991 in all three studied hospitals, with the most significant decline observed in the university and larger community hospital.
• Departments actively engaged in clinico-pathological research maintained or increased their autopsy rates during the study period.
• Autopsy rates exhibited considerable variation, ranging from 0% to 100% across different hospital departments and wards.

Conclusions:

• Neither the 1976 Autopsy Act nor reluctance from relatives adequately explains the general decline in autopsy rates.
• A significant shift in clinicians' attitudes and a diminished interest in autopsy activities appear to be the primary factors contributing to the observed decrease in autopsy frequency.
• Maintaining active clinico-pathological research is associated with sustained or increased autopsy rates, highlighting the importance of research integration.