Referral to autopsy: Effect of antemortem cardiovascular disease - A population-based study in Olmsted County, Minnesota
Referral to autopsy: Effect of antemortem cardiovascular disease - A population-based study in Olmsted County, Minnesota
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DOI：
10.1016/s1047-2797(00)00220-9
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发表时间：
2001-05-01
影响因子：
5.6
通讯作者：
Roger, VL
中科院分区：
文献类型：
--
作者：
Targonski, P;Jacobsen, SJ;Roger, VL
目的：尸检研究可以提供疾病趋势及其决定因素的洞察力，包括动脉粥样硬化患病率的数据。然而，这些研究受到尸检偏倚的影响，这限制了它们对来源人群的普遍性。这种偏倚对基于尸检的心脏病患病率时间趋势估计的影响尚不清楚。报告明尼苏达州奥姆斯特德县尸检率随时间变化的趋势，以检查心血管疾病（CVD）临床诊断与尸检转诊之间的关系，以及这种关系如何随时间变化。我们研究了1979年至1994年奥姆斯特德县尸检率的趋势，结果：从1979年到1994年，奥姆斯特德县共有9110名居民死亡。年平均尸检率为30%。尸检率从1979年的36%下降到1994年的23%，相当于平均每年下降0.6%（p < 0.01）。尸检与年轻、男性、院内死亡地点、心肌梗死（MI）或周围血管疾病（PVD）的死前诊断以及较早的日历期呈正相关。没有证据表明日历期间与任何这些预测变量之间存在相互作用。心脏衰竭的死前诊断与随着时间的推移，转诊到尸检的几率下降相比，没有这样的diagnosis.CONCLUSIONS：在奥姆斯特德县，尸检率，虽然随着时间的推移下降，平均保持在30%左右。MI或PVD的死前诊断与尸检转诊相关，但这种相关性并不随时间而改变。虽然更大的下降随着时间的推移，在使用尸检中观察到的死者与生前诊断充血性心力衰竭（CHF）值得进一步研究，目前的研究结果减少了关注的时间趋势的偏差动脉粥样硬化的患病率的变化，死者的临床特征的尸检。Ann Epidemiol 2001;11：264-270。(C)2001 Elsevier Science Inc. All rights reserved.
PURPOSE: Autopsy studies can provide insight into disease trends and their determinants, including data on the prevalence of atherosclerosis. However, such studies are subject to autopsy bias, which limits their generalizability to the source population. The impact of this bias on autopsy based estimates of time trends in heart disease prevalence is unknown. To report on the trends over time in autopsy rates in Olmsted County, MN, to examine the association between clinical diagnoses of cardiovascular diseases (CVDs) and referral to autopsy and how this association may have changed over time.METHODS: We examined the trends in autopsy rates between 1979 and 1994 in Olmsted County, and the association between antemortem characteristics including cardiovascular diagnoses and autopsy referral.RESULTS: From 1979 to 1994, a total of 9110 residents died in Olmsted County. The average annual autopsy rate was 30%. Autopsy rates declined from 36% in 1979 to 23% in 1994, corresponding to an average decline of 0.6%/year (p < 0.01). Referral to autopsy was positively associated with younger age, male sex, in-hospital place of death, antemortem diagnoses of myocardial infarction (MI) or peripheral vascular disease (PVD), and earlier calendar period. There was no evidence of an interaction between calendar period and any of these predictor variables. Antemortem diagnosis of heart failure was associated with a decrease in the odds of referral to autopsy over time as compared to persons without such diagnosis.CONCLUSIONS: In Olmsted County, autopsy rates, although declining over time, have remained on average approximately 30%. Antemortem diagnoses of MI or PVD are associated with autopsy referral but this association did not change over time. While the greater decline overtime in the use of autopsy observed among decedents with an antemortem diagnosis of congestive heart failure (CHF) deserves further studies, the present findings reduce the concern for bias of time trends in the prevalence of atherosclerosis by changes in the clinical characteristics of decedents referred to autopsy. Ann Epidemiol 2001;11:264-270. (C) 2001 Elsevier Science Inc. All rights reserved.