Why are autopsy rates low in Japan? Views of ordinary citizens and doctors in the case of unexpected patient death and medical error

Maeda, Shoichi; Kamishiraki, Etsuko; Starkey, Jay; Ikeda, Noriaki

doi:10.1002/jhrm.21114

Cited by 19 publications

(16 citation statements)

References 14 publications

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“…In Japan, one in three people die after the age of 60 years; thus, it is possible that more patients with Down syndrome in Japan are dying from natural death compared to that observed in other countries. On the other hand, the rate of natural death is high even in the general Japanese population in Japan, and the high rate of natural death may be a reflection of the culture respecting the dead and the low postmortem examination rates (Maeda et al, 2013 ). However, there are no previous reports on the susceptibility of natural death in patients with Down syndrome compared to the general population, thus we do not know whether our findings are unique to Japan or the susceptibility has changed over the years.…”

Section: Discussionmentioning

confidence: 99%

Causes of death in patients with Down syndrome in 2014–2016: A population study in Japan

Motegi

Yamaoka

Moriichi

et al. 2021

American J of Med Genetics Pt A

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Despite the higher mortality rates in patients with Down syndrome compared with the general Japanese population, the life span has dramatically increased in Japan and other countries. We aimed to clarify recent causes of death in patients with Down syndrome in Japan. We calculated proportionate mortality and standardized mortality odds ratios (SMORs) among all deaths registered with Down syndrome as the cause of death (ICD-10 code, Q90) in the Japanese National Death Registry Database in 2014-2016. In the study period, 762 in patients with Down syndrome died. The main causes of death were pneumonia/respiratory infections (20.5%), congenital malformations of the circulatory system (11.2%), other diseases of the circulatory system (9.2%), and aspiration pneumonia (8.4%). The SMORs (95% confidence intervals) were higher for natural death, defined as death of an elderly person with no other cause of death to be mentioned (55.73 [36.92-84.12]), early-onset Alzheimer's disease, defined as Alzheimer's disease with onset <65 years of age (29.36 [16.44-52.44]), aspiration pneumonia (18.33 [14.03-23.96]), pneumonia/ respiratory infections (8.11 [6.76-9.73]), congenital malformations of the circulatory system (8.07 [5.98-10.88]), and leukemia/lymphoma (2.16 [1.55-2.99]) but lower for malignant solid tumors (0.04 [0.02-0.06]) in patients with Down syndrome. Patients with Down syndrome had the greatest relative risk of dying from natural death, early-onset Alzheimer's disease, and respiratory illnesses, highlighting the need for appropriate medical, health, and welfare services.

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Section: Discussionmentioning

confidence: 99%

Causes of death in patients with Down syndrome in 2014–2016: A population study in Japan

Motegi

Yamaoka

Moriichi

et al. 2021

American J of Med Genetics Pt A

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“…The dramatic reduction in clinical post-mortem examinations is a global phenomenon and has been reported on all continents for several decades. [21][22][23][24][25] In countries such as the United Kingdom, the number of clinical autopsies is less than 1%, although most countries show numbers that are close to the autopsy rates in Sweden, that is, 11%. Turnbull et al 25 describe the hospital autopsies in the UK 2013 as extinct in a quarter of the UK NHS Trusts and endangered in the rest.…”

Section: Discussionmentioning

confidence: 99%

Autopsies and quality of cause of death diagnoses

2021

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Objective: The consequences of a low autopsy rate are not considered in determining the cause of death. Method: We have analyzed the Cause of Death Register of the Swedish National Board of Health and Welfare since it started 1969 to and including 2016 to visualize the decline in the frequency of clinical autopsies over time and evaluated the effect on the quality of the cause of death diagnoses. Results: Over the five decades studied, the frequency of clinical autopsies declined from almost 40% to less than 5%. The rate of decline was not even. Political decisions and changes of healthcare organization in Sweden affected the slope of decline of autopsies superimposed on a linear decline over time reflecting changes in clinical routines. A request of clinical autopsies was highly dependent on the level of care at the time of death, with the lowest number of requests for persons who died in nursing homes. The age at the time of death was a major factor affecting the number of autopsies, resulting in an autopsy rate of less than 1% in the ages where most persons die. Although men were autopsied more often than women, a gender-specific difference was not seen after correction for the age of death. We also found a higher rate of unspecific and irrelevant diagnosis in the cases not autopsied and we know from earlier studies by us and other authors that the cause of death diagnoses were missed in between 30% and 50% of the cases not autopsied. Conclusion: The decline in the clinical autopsy rate reduced the value of the death certificate register. An increase in the number of autopsies performed will improve the understanding of disease and cause of death, as well as to better inform next of kin.

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“…The discrepancy between death certificate recorded cause of death and actual cause of death may have prompted the falling use of autopsy and pathological examination to be reversed (Roulson et al, 2005). However, hospital autopsy rates have been declining in the UK (Ayoub and Chow, 2008), US (Hoyert, 2011), and Japan (Maeda et al, 2013) and are at an all-time low (<6% of the US Hospital deaths). Concerns in the US about inadequate infection control and facilities to perform brain autopsy on suspected CJD patients have been suggested as factors discouraging autopsy (Lillquist et al, 2006).…”

Section: Symptomatic Patientsmentioning

confidence: 99%

Human prion diseases and the risk of their transmission during anatomical dissection

et al. 2014

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Prion diseases (or transmissible spongiform encephalopathies) are a unique group of fatal progressive neurodegenerative diseases of the central nervous system. The infectious agent is hypothesized to consist solely of a highly protease-resistant misfolded isoform of the host prion protein. Prions display a remarkable degree of resistance to chemical and physical decontamination. Many common forms of decontamination or neutralization used in infection control are ineffective against prions, except chaotropic agents that specifically disrupt proteins. Human cadaveric prosection or dissection for the purposes of teaching and demonstration of human anatomy has a distinguished history and remains one of the fundamentals of medical education. Iatrogenic transmission of human prion diseases has been demonstrated from the inoculation or implantation of human tissues. Therefore, although the incidence of human prion diseases is rare, restrictions exist upon the use of tissues from patients reported with dementia, specifically the brain and other central nervous system material. A current concern is the potential for asymptomatic variant Creutzfeldt-Jakob disease transmission within the UK population. Therefore, despite the preventative measures, the transmission of prion disease through human tissues remains a potential risk to those working with these materials. In this review, we aim to summarize the current knowledge on human prion disease relevant to those working with human tissues in the context of anatomical dissection.

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Why are autopsy rates low in Japan? Views of ordinary citizens and doctors in the case of unexpected patient death and medical error

Cited by 19 publications

References 14 publications

Causes of death in patients with Down syndrome in 2014–2016: A population study in Japan

Causes of death in patients with Down syndrome in 2014–2016: A population study in Japan

Autopsies and quality of cause of death diagnoses

Human prion diseases and the risk of their transmission during anatomical dissection

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