Autopsy rates in the United States reached a new low of 7.4% in 2020, reflecting an ongoing decline since 1972 when the rate was 19.1%, according to a May 24 National Vital Statistics Report from the Centers for Disease Control and Prevention’s (CDC) Division of Vital Statistics.

As would be expected, the autopsy rate varied by age, cause and place of death. The rate for those aged 15-24 years was 62.6% and then decreased with increasing age. Deaths occurring in settings such as hospital inpatient, hospice facility and nursing home or long-term care were lease likely to be autopsied compared with other locations.

The rate was highest for decedents where place of death was recorded as being dead on arrival at hospital (30.5%), followed by other place (28.9%) and unknown place (25.9%). The rate at hospital outpatient settings or emergency room was 20.9%.

External causes, such as assault (homicide) were among the most frequently autopsied causes of death (98.7%) while the rate for deaths due to illness was 3%. Among diseases, the autopsy rate for the leading causes of death – heart disease, cancer and COVID-19 – was 6.5%, 0.8% and 0.9%, respectively.

Changes in the autopsy rate over time have changed the profile of those being autopsied. In 1972, 79% of autopsies were performed for deaths due to diseases and 19% for deaths due to external causes. By 2020, 37% of autopsies were performed for deaths due to diseases and 60% due to external causes.

In 2020, although the number of deaths increased with age after 1 year of age, autopsy rates peaked for those aged 15-24 years and declined for decedents as they aged. The autopsy rate was 31.6% for those under 1 year of age, 55.4% for those aged 1-4 and 46.8% for those aged 5-14. The rate fell to 56.1% for those aged 25-34, 41% for 35-44, 22.1% for 45-54, 10.3% for 55-64, 3.9% for 65-74, 1.5% for 75-84 and 0.6% for those 85 and over.

The report did not make a direct connection between the low autopsy rate in 2020 and COVID-19 although it did acknowledge that autopsies typically were not done for those who died of COVID. In fact, the autopsy rate has been consistently falling over the past 50 years, it said.

“Most of this report focuses on 2020,” states the DVS. “However, 2020 was also the first year of the COVID-19 pandemic, which changed the environment in which people were living and dying. Aside from introducing a large number of deaths from a new cause of death that was infrequently autopsied, the findings in this report are consistent with previous findings.”