We risk overlooking serious diseases, accidents and homicides by not carrying out more autopsies. Danish practice with few autopsies creates unreliability to the Danish register of causes of death. This is the result of new research from Aarhus University.

2015.03.10 | Henriette Stevnhøj

Far too few deceased people are autopsied in Denmark, while autopsies of elderly people are virtually non-existent unless there is a suspicion of crime.

This is the conclusion of a new PhD study done by forensic pathologist Seija Ylijoki-Sørensen from Aarhus University. She has researched data from the Finnish and Danish registers of causes of death and carried out a comparison between the rates of autopsies in the two countries.

The results show that Danish practice with few autopsies gives an inadequate register of causes of death. According to Seija Ylijoki-Sørensen, this is worrying as the register also forms the basis for how we work with prevention of accidents including traffic accidents, drug and alcohol abuse, and suicides.

A Danish register full of holes

Danish autopsy practice differs significantly from Finland, which has approximately as many annual deaths as Denmark. Almost 30 per cent of all Finns are autopsied after death, while in the case of Danes; only around four per cent are autopsied.

"A forensic autopsy can, in the vast majority of cases, clarify the cause of death. It is natural for the relatives to receive an explanation, but it is also of great importance for society that we know the cause of death," says Seija Ylijoki-Sørensen. In her PhD study she documents that 2,000 Danes are annually buried without anyone knowing what they died of. By comparison, fewer than 130 people in Finland are laid to rest with an unknown cause of death.

"This leads to major shortcomings in the register. Behind these deaths could be accidents, alcohol poisonings or homicides that we will never be discovered, because we do not perform autopsies," says Seija Ylijoki-Sørensen.

Elderly deaths are a blank

The PhD study also reveals that autopsies are virtually never carried out on elderly people, unless there is a suspicion of homicide. 

"It looks like we lose interest in determining the cause of death, the older people are. This can seem strange as relatives likely also need to know the truth about the cause of death, even though the deceased was an elderly. Also, information from the autopsy report is important for the insurance companies, where it is crucial to know if the manner of death is an accident, suicide, homicide or illness. In cases where the cause of death is unknown, there is a risk that the relatives have difficulties of receiving compensation from the insurance companies, if there is confusion between a natural death, suicide or an accident," says Seija Ylijoki-Sørensen. 

Research demonstrates the same trend in autopsies concerning suicides. In Finland, 99 per cent of suicides are forensically examined – irrespective of the age of the deceased. In Denmark, the rate of autopsies falls from 20 per cent for the group under the age of 50 to less than five per cent of elderly people above the age of 71.

Financial aspect

In her research, Seija Ylijoki-Sørensen has examined the financial aspect of autopsy practices. Increasing the number of forensic autopsies will cost more, even though the unit cost per autopsy would fall considerably. But the researcher can still see the gain.

"More autopsies will result in a more precise Danish Register of Causes of Death and thus provide a more secure basis for taking health-policy decisions," says Seija Ylijoki-Sørensen.

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FACTS:

Autopsies in Denmark

Danish autopsy practice differs particularly in the case of autopsies of persons who die suddenly and unexpectedly. In the year 2010, 2.4 per cent of the total 2,039 Danes who died suddenly and unexpectedly were subsequently autopsied. In Finland, the corresponding per cent was 88.

Alcohol poisonings are practically non-existing according to the Danish Register of Causes of Death. But, if anything, this is connected to the fact that the deceased people with an alcohol abuse are not systematically examined forensically in Denmark.

When a person dies in Denmark, a medical doctor fills out a death certificate with information about the cause and manner of death. This information forms the basis for the Danish Register of Causes of Death, which is used for research and public health monitoring.

Forensic autopsies are carried out at the University Departments of Forensic Medicine. Danish police requests a forensic autopsy in cases of suspicion of a crime, if the manner of death is unresolved, or the cause of death is unknown and further forensic investigation is needed.  

In natural causes of death, medical autopsies can be performed by clinical pathologists at the hospitals. 

Source: Forensic pathologist Seija Ylijoki-Sørensen
PhD project: Autopsy in unresolved deaths and accuracy of mortality statistics; analysis of cause of death investigation in Finland and in Denmark.

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Further information

Forensic pathologist, PhD Seija Ylijoki-Sørensen
Aarhus University, Department of Forensic Medicine
Sys@forens.au.dk
+45 30 42 56 71 

(27.2: Henriette Stevnhøj, communication: 20 37 30 86)