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| Autopsies by Age in the United States - 2011 |
#15,246
One of the frequent topics in this blog has been the difficulty in determining how many people die from influenza each year, or from any cause for that matter. The CDC estimates the number of flu deaths each year - based on data from sentinel sites - but no one is actually counting every death.
Death certificates are a surprisingly bad gauge, as many people die at home and without having a recent doctor's visit.Despite what you might see on TV, post mortem tests or autopsies are a rarity. Most physicians make a guess - based on the patient's age and medical history - of the cause of death (COD). In 2011, the CDC released The Changing Profile of Autopsied Deaths in the United States, 1972–2007, which found:
The percentage of deaths for which an autopsy was performed declined more than 50 percent from 1972 through 2007, from 19.3 percent to 8.5 percent.As the chart at the top of this blog illustrates, unless there is some obvious external non-natural cause of death, anyone over the age of 65 is extremely unlikely to be autopsied in this country.
Not so many years ago my mother - who was a two-pack-a-day smoker for nearly 60 years - died (age 78) in her home in Missouri. She was phobic about seeing a doctor, and had not seen one in decades. In many jurisdictions, her `unattended' death would be reviewed by a medical examiner.
But in this case, the county coroner (who was not a doctor) asked me what he should put down as the cause of death. And no, he didn't know my history of being a paramedic when he asked.As a paramedic, I've called hundreds of doctors to notify them that one of their patients had died at home, to ask if they would sign the death certificate (in order to release the body to a funeral home).
Some might ask me what I thought the cause of death was, but most of the time they were quite willing sign off on `natural causes', putting down `heart attack' or `stroke' as the COD sight unseen.While a cynic might call that `burying their mistakes', most of the time it was done as a kindness to the bereaved family. In either event, it limits the usefulness of death certificates in tracking deaths by a specific cause.
During this COVID-19 pandemic, getting a reasonably accurate tally of COVID-19 deaths is a big challenge, since testing remains sparse, and old habits surrounding filling out death certificates are hard to break.In hopes of bringing more uniformity to the process, the CDC yesterday released a brief tutorial on how doctors should fill out death certificates. Assuming it is followed, it should help, but without post-mortem testing, many cases are still likely to go uncounted.
New YouTube Video with Guidance for Certifying Deaths Due to COVID-19
New Resource
To supplement the published guidance and webinars on filling out death certificates for deaths due to COVID-19, the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS) has released a short video via the NCHS YouTube channel. The video runs about three minutes and can be accessed here.
The Emergency Risk Communication Branch in the Division of Emergency Operations, Center for Preparedness and Response is responsible for the management of all COCA Products.
For more on the difficulty in counting cases and/or deaths in an outbreak, you may wish to revisit:
Tracking H7N9: A Game Of Very Incomplete Information
Lancet: Estimating Global 2009 Pandemic Mortality
The Measure Of A Pan
CDC Updates Estimates Of Infections, Hospitalizations, and Deaths From H1N1
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