Declining Autopsy Rates and Diagnosis of Myocardial Infarction-Reply

Abstract

In Reply.— Dr Altman has raised an interesting question regarding the possible association between trends in cardiovascular mortality and the declining trend in autopsies, as revealed in vital statistics data. This is a subject in which we have considerable interest, as reflected in our recent publication of an annotated bibliography of cause-of-death validation studies. 1 While National Center for Health Statistics data on trends in autopsies and in cardiovascular mortality are consistent with those reported by Dr Altman, as shown in the Table, I do not believe they support his interpretation. Reductions in mortality for major cardiovascular diseases between 1972 and 1980 far exceed what could reasonably be explained by the decline in the changing rate of autopsies during this period. 2 The death rate (ageadjusted) for major cardiovascular diseases during this period dropped by almost 23%, and for all causes combined by more than 16%. An example may illustrate