Inpatient autopsy rate and associated factors in a Chinese megacity: a population-based retrospective cohort study
Objectives This study investigated the autopsy rate of hospital deaths in Shenzhen megacity and identified factors that may impact the decision to perform an autopsy in hospital deaths.Design This is a population-based retrospective cohort study.Setting Shenzhen is a megacity in China with a populat...
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| Format: | Article |
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/1/e090430.full |
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| author | Yu Wang Jiming Zhu Zihan Wang Dachun Zhao Hange Li Yanrong He Xidong Guo Hanbo Zhang Huatang Zeng |
| author_facet | Yu Wang Jiming Zhu Zihan Wang Dachun Zhao Hange Li Yanrong He Xidong Guo Hanbo Zhang Huatang Zeng |
| author_sort | Yu Wang |
| collection | DOAJ |
| description | Objectives This study investigated the autopsy rate of hospital deaths in Shenzhen megacity and identified factors that may impact the decision to perform an autopsy in hospital deaths.Design This is a population-based retrospective cohort study.Setting Shenzhen is a megacity in China with a population of more than 17 million and a total of 151 hospitals. The official dataset of the inpatient medical record home page was used. Demographic, clinical and hospital information was extracted.Participants All the 35 272 inpatient deaths between 2016 and 2022 with known autopsy status were included to calculate the overall autopsy rate. Among them, a total of 34 577 cases with complete data, classified hospital and Chinese nationality, were included for further multivariable rare events logistic regression and Poisson pseudo maximum likelihood regression.Outcome measures Whether the inpatient death was autopsied or not.Results The autopsy procedure was performed in 0.9% (319/35 272) of hospital deaths. The autopsy decision was significantly and positively associated with being married (OR= 1.60, 95% CI: 1.16 to 2.21), self-paying (OR=1.56, 95% CI: 1.07 to 2.26), death due to external causes of injury and poisoning (OR=1.69, 95% CI: 1.02 to 2.81) and pregnancy (OR=13.58, 95% CI: 4.94 to 37.36), but negatively associated with age (OR=0.97, 95% CI: 0.96 to 0.98), emergency admission (OR=0.66, 95% CI: 0.49 to 0.88), referral (OR=0.47, 95% CI: 0.25 to 0.88), neoplasms (OR=0.35, 95% CI: 0.22 to 0.56), respiratory diseases (OR=0.49, 95% CI: 0.26 to 0.95) and for-profit hospitals (OR=0.45, 95% CI: 0.23 to 0.91). There were no statistically significant differences in autopsy rates between large teaching hospitals and other hospitals.Conclusions The autopsy rate of hospital deaths was extremely low, largely due to healthcare providers. Even large teaching hospitals do not request more autopsies compared with other hospitals, after controlling for the patient characteristics. More efforts are urged to encourage hospitals and healthcare providers to proactively request autopsies, helping to revive this important procedure. |
| format | Article |
| id | doaj-art-ca2c47b454a445bfb23c3799eb4a8eaf |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-ca2c47b454a445bfb23c3799eb4a8eaf2025-01-09T15:30:08ZengBMJ Publishing GroupBMJ Open2044-60552025-01-0115110.1136/bmjopen-2024-090430Inpatient autopsy rate and associated factors in a Chinese megacity: a population-based retrospective cohort studyYu Wang0Jiming Zhu1Zihan Wang2Dachun Zhao3Hange Li4Yanrong He5Xidong Guo6Hanbo Zhang7Huatang Zeng81 Vanke School of Public Health, Tsinghua University, Beijing, China1 Vanke School of Public Health, Tsinghua University, Beijing, China1 Vanke School of Public Health, Tsinghua University, Beijing, China3 Department of Pathology, Peking Union Medical College Hospital, Beijing, China1 Vanke School of Public Health, Tsinghua University, Beijing, China1 Vanke School of Public Health, Tsinghua University, Beijing, China1 Vanke School of Public Health, Tsinghua University, Beijing, China4 Institute for Hospital Management, Tsinghua University, Beijing, China1 Vanke School of Public Health, Tsinghua University, Beijing, ChinaObjectives This study investigated the autopsy rate of hospital deaths in Shenzhen megacity and identified factors that may impact the decision to perform an autopsy in hospital deaths.Design This is a population-based retrospective cohort study.Setting Shenzhen is a megacity in China with a population of more than 17 million and a total of 151 hospitals. The official dataset of the inpatient medical record home page was used. Demographic, clinical and hospital information was extracted.Participants All the 35 272 inpatient deaths between 2016 and 2022 with known autopsy status were included to calculate the overall autopsy rate. Among them, a total of 34 577 cases with complete data, classified hospital and Chinese nationality, were included for further multivariable rare events logistic regression and Poisson pseudo maximum likelihood regression.Outcome measures Whether the inpatient death was autopsied or not.Results The autopsy procedure was performed in 0.9% (319/35 272) of hospital deaths. The autopsy decision was significantly and positively associated with being married (OR= 1.60, 95% CI: 1.16 to 2.21), self-paying (OR=1.56, 95% CI: 1.07 to 2.26), death due to external causes of injury and poisoning (OR=1.69, 95% CI: 1.02 to 2.81) and pregnancy (OR=13.58, 95% CI: 4.94 to 37.36), but negatively associated with age (OR=0.97, 95% CI: 0.96 to 0.98), emergency admission (OR=0.66, 95% CI: 0.49 to 0.88), referral (OR=0.47, 95% CI: 0.25 to 0.88), neoplasms (OR=0.35, 95% CI: 0.22 to 0.56), respiratory diseases (OR=0.49, 95% CI: 0.26 to 0.95) and for-profit hospitals (OR=0.45, 95% CI: 0.23 to 0.91). There were no statistically significant differences in autopsy rates between large teaching hospitals and other hospitals.Conclusions The autopsy rate of hospital deaths was extremely low, largely due to healthcare providers. Even large teaching hospitals do not request more autopsies compared with other hospitals, after controlling for the patient characteristics. More efforts are urged to encourage hospitals and healthcare providers to proactively request autopsies, helping to revive this important procedure.https://bmjopen.bmj.com/content/15/1/e090430.full |
| spellingShingle | Yu Wang Jiming Zhu Zihan Wang Dachun Zhao Hange Li Yanrong He Xidong Guo Hanbo Zhang Huatang Zeng Inpatient autopsy rate and associated factors in a Chinese megacity: a population-based retrospective cohort study BMJ Open |
| title | Inpatient autopsy rate and associated factors in a Chinese megacity: a population-based retrospective cohort study |
| title_full | Inpatient autopsy rate and associated factors in a Chinese megacity: a population-based retrospective cohort study |
| title_fullStr | Inpatient autopsy rate and associated factors in a Chinese megacity: a population-based retrospective cohort study |
| title_full_unstemmed | Inpatient autopsy rate and associated factors in a Chinese megacity: a population-based retrospective cohort study |
| title_short | Inpatient autopsy rate and associated factors in a Chinese megacity: a population-based retrospective cohort study |
| title_sort | inpatient autopsy rate and associated factors in a chinese megacity a population based retrospective cohort study |
| url | https://bmjopen.bmj.com/content/15/1/e090430.full |
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