NCHS Data Brief ■ No. 67 ■ August 2011

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

The Changing Profile of Autopsied Deaths in 

the United States, 1972–2007

Donna L. Hoyert, Ph.D.

Key findings

Data from the National 

Vital Statistics System, 

Mortality

• 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.

• External causes accounted 

for 9 of the 10 most frequently 

autopsied causes of death.

• The percentage autopsied 

declined with age after ages 

15–24: from 60 percent at 

15–24, to 11 percent at 55–64, 

to less than 5 percent at 65–74.

• In 1972, 79 percent of 

autopsies were performed for 

deaths due to disease conditions 

and 19 percent for deaths due 

to external causes. By 2007, the 

respective percentages were 46 

percent and 50 percent.

• While the age distribution 

of deaths shifted to older 

ages from 1972 through 

2007, autopsied deaths were 

increasingly concentrated in the 

age groups 1–34 and 35–64.

An autopsy, the medical examination of a deceased person, may confirm 

clinical findings, provide more complete information to describe cause of 

death, or uncover conditions not recognized clinically prior to death (1). Two 

types are performed in the United States: a) hospital or clinical autopsies, 

which family or physicians request to clarify cause of death or assess care, 

and b) medicolegal autopsies, which legal officials order to further investigate 

the circumstances surrounding a death (2). The autopsy rate, or percentage 

of deaths that received this final assessment, was stable from the 1950s until 

the beginning of the 1970s, when the autopsy rate began to decrease (3). This 

report uses mortality data from the National Vital Statistics System (NVSS) 

over a 35-year period to examine changes in the autopsy rate and in the 

distribution of those autopsied by age and cause. Variation in autopsy patterns 

has implications for which deaths may have a more complete and conclusive 

cause-of-death determination.

Keywords: autopsy • autopsy rate • cause of death • National Vital Statistics 

System

Autopsy rates declined more than 50 percent from 1972 

through 2007.

Figure 1. Trend in the autopsy rate: United States, 1972–2007

NOTES: Includes data for 46 states and the District of Columbia (excludes data for Florida, Minnesota, New Mexico, and 

Pennsylvania). The 46 states and the District of Columbia accounted for 86 percent to 87 percent of all deaths in the United States. 

No data are available for 1995–2002 because the states did not provide that item to the National Center for Health Statistics for 

those years.

SOURCE: CDC/NCHS, National Vital Statistics System, Mortality.

1972 1976 1980 1984 1988 1992 1995 2002 2007

Year

0

10

20

30

40

50

60

Percent of deaths autopsied

External causes

Ill-defined causes

Total

Diseases

43.6

26.4

19.3

16.9

55.4

29.1

8.5

4.3
NCHS Data Brief ■ No. 67 ■ August 2011

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In 1972, almost 1 out of 5 deaths were autopsied. From 1972 through 2003, however, the autopsy 

rate dropped 58 percent from 19.3 percent to 8.1 percent. Although the autopsy rate has increased 

slightly since 2003, only 8.5 percent, or fewer than 1 out of 10 deaths, were autopsied in 2007 

(Figure 1). 

The autopsy rate can also be examined with respect to the cause of death: whether death was 

due to a disease such as heart disease or cancer; an external cause such as unintentional injury, 

homicide, or suicide; or an ill-defined condition such as unknown cause or sudden infant death 

syndrome (SIDS). Autopsies either confirm or alter the original cause-of-death determination.

From 1972 through 2007 autopsy rates declined for deaths from disease conditions from 16.9 

percent to 4.3 percent and generally increased from 43.6 percent to 55.4 percent for deaths from 

external causes. The rates for deaths from ill-defined conditions were 26.4 percent in 1972 and 

29.1 percent in 2007; however, this was variable over time.

Deaths due to external causes were more likely to be determined by 

autopsy than deaths due to diseases or ill-defined conditions.

Although 91 percent of deaths in the United States in 2007 were due to a disease condition, 

these were less likely to be autopsied than deaths due to external causes (Figure 2). Deaths due 

to complications of pregnancy, childbirth, and the puerperium was the only disease condition 

among the 10 causes of death most often autopsied. Slightly more than one-half of deaths due 

Figure 2. Ten most commonly autopsied causes: United States, 2007

NOTES: Includes data for 46 states and the District of Columbia (excludes data for Florida, Minnesota, New Mexico, and Pennsylvania). The 46 states and the 

District of Columbia accounted for 86 percent of all deaths.

SOURCE: CDC/NCHS, National Vital Statistics System, Mortality.

0 20 40 60 80 100

Percent of deaths autopsied

97.1

89.7

80.8

79.0

74.3

67.6

61.5

59.9

54.5

50.9

Assault

Legal intervention

Events of undetermined intent

Accidental poisoning

Accidental drowning and submersion

Accidental discharge of firearms

Accidental exposure to

smoke, fire, and flames

Suicide by other and unspecified means

Pregnancy, childbirth, and

the puerperium

Water, air and space, and other

and unspecified transport accidents
NCHS Data Brief ■ No. 67 ■ August 2011

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to complications of pregnancy, childbirth, and puerperium were autopsied in 2007. Of the 

external causes of death, the highest percentages autopsied in 2007 were 97.1 percent for assault 

(homicide) deaths, 89.7 percent for legal intervention deaths, and 80.8 percent for events of 

undetermined intent.

Autopsy rates declined with increasing age after ages 15–24. 

Although the number of deaths increased with age after age 1, autopsy rates declined in 2007 

after ages 15–24. The percentage of deaths autopsied was highest for those deaths at ages 15–24 

(60.3 percent), falling to 55.8 percent of deaths autopsied at ages 25–34. By age 65, only 4.2 

percent of deaths were autopsied and less than 1 percent of deaths to persons aged 85 and over 

were autopsied (Figure 3).

Disease conditions were more likely to be the cause of death for older persons in contrast to 

external causes, which were more likely to be the cause of death at earlier ages. Ill-defined 

conditions were also likely to be the cause of death for older persons, but were also not 

uncommon among infants (e.g., SIDS).

Figure 3. Autopsy rate, by age: United States, 2007

NOTES: Includes data for 46 states and the District of Columbia (excludes data for Florida, Minnesota, New Mexico, and Pennsylvania). The 46 states and the 

District of Columbia accounted for 86 percent of all deaths.

SOURCE: CDC/NCHS, National Vital Statistics System, Mortality.

32.6

Under 1 1–4 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84 85 and

over

54.9

43.2

60.3

55.8

40.5

24.1

11.0

4.2

2.0 0.8

Percent of deaths autopsied

Age in years

0

10

20

30

40

50

60

70
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The cause-of-death distribution of autopsied deaths has changed over 

time.

Cause-of-death distributions were similar in 1972 and 2007, with approximately 91 percent of 

all deaths due to diseases, 8 percent due to external causes, and 1 percent caused by ill-defined 

conditions. The distribution of autopsied deaths, however, changed substantially (Figure 4). While 

in 1972, 79 percent of autopsied deaths were deaths caused by disease conditions, in 2007 only 

46 percent of autopsied deaths were due to disease conditions. In contrast, 50 percent of autopsied 

deaths in 2007 were external cause deaths compared with 19 percent in 1972. Ill-defined 

conditions accounted for 2 percent of autopsied deaths in 1972 and 4 percent in 2007.

Figure 4. Percent distribution of cause of death for autopsied deaths: United States, 1972 and 2007

NOTES: Includes data for 46 states and the District of Columbia (excludes data for Florida, Minnesota, New Mexico, and Pennsylvania). The 46 states and the 

District of Columbia accounted for 86 percent to 87 percent of all deaths.

SOURCE: CDC/NCHS, National Vital Statistics System, Mortality.

1972 2007

Diseases

79%

Ill-defined

conditions

4%

Ill-defined

conditions

2%

Diseases

46%

External causes

50%

External

causes

19%
NCHS Data Brief ■ No. 67 ■ August 2011

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The age distribution of autopsied deaths has changed over time.

From 1972 through 2007, the age distribution of all deaths shifted to older ages, so that more 

deaths were concentrated among persons aged 65 and over. For example, 63 percent of deaths 

occurred to persons aged 65 and over in 1972 compared with 72 percent in 2007. In contrast, 

autopsied deaths have become increasingly concentrated among decedents in the age groups 1–34 

and 35–64 during this period (Figure 5). As a result, the age distribution of autopsied deaths was 

very different than for deaths in general in 1972 and was even more so in 2007. For example, 

while only 23 percent of all deaths in 2007 were to persons aged 35–64, 54 percent of those 

autopsied were from this age group.

Figure 5. Percent distribution of age for autopsied deaths: United States, 1972 and 2007

NOTES: Includes data for 46 states and the District of Columbia (excludes data for Florida, Minnesota, New Mexico, and Pennsylvania). The 46 states and the 

District of Columbia accounted for 86 percent to 87 percent of all deaths.

SOURCE: CDC/NCHS, National Vital Statistics System, Mortality.

1972 2007

Under

age 1

7%

1–34

years

15%

35–64

years

41%

64 years

and over

37%

Under

age 1

5%

1–34

years

24%

35–64

years

54%

64 years

and over

17%
NCHS Data Brief ■ No. 67 ■ August 2011

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Summary

Potential influences on the autopsy rate over the 1972–2007 period include hospital accreditation 

standards, state laws and regulations about which deaths should be investigated, and sudden 

and unexplained infant death protocols (2–5). The laws and regulations about investigations of 

deaths have changed little over time, although protocols for sudden and unexplained infant deaths 

that address autopsy practices have been developed since 1972 (6). However, in 1971 the Joint 

Commission on Accreditation of Hospitals dropped a hospital accreditation standard requiring a 

20 percent to 25 percent autopsy rate for deaths occurring in hospitals (3). Findings that shifts in 

autopsy patterns result in an increasing percentage of autopsies among external cause deaths and 

persons under age 65 from 1972 through 2007 are consistent with declining trends in hospital 

autopsies and stable or increasing trends for medicolegal autopsies (2). With fewer autopsies 

being done on persons with characteristics typical of most deaths, cause-of-death determinations 

for important disease conditions or for deaths to those over age 65 are based on diagnoses and 

examinations prior to death and are not reviewed or confirmed by autopsy. 

Definitions

Autopsy: Refers to an examination after death for medical, legal, or scientific reasons such as to 

establish medical conditions and the reason for death occurring when it did (1,2). 

Autopsy rate: Refers to the number of deaths receiving an autopsy per all deaths, expressed per 

100 deaths.

Hospital autopsy: Refers to an autopsy often performed at a hospital after being requested by 

family or medical personnel for reasons such as education, quality assessment, and establishing a 

cause of death (2,5).

Medicolegal autopsy: Refers to an autopsy often performed at a medical examiner’s office upon 

the order of a legal authority to determine the causes and circumstances of death for sudden, 

unexpected, unexplained, unattended, or nondisease deaths (2,5).
NCHS Data Brief ■ No. 67 ■ August 2011

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Data source and methods

Data presented in this report were based on information from death certificates filed in states and 

the District of Columbia and subsequently compiled into national data, also known as the NVSS, 

by the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics 

(NCHS) for years 1972–1994 and 2003–2007 (7). Autopsy data were not available in the national 

data for the period 1995–2002 because, as agreed to by NCHS and the states, the item was 

not among those that the states provided to NCHS for those years. The item was restored to the 

national data in 2003 but not all 50 states and the District of Columbia provided the data to NCHS 

every year for the period 2003–2007. In order to compare the same states throughout the time 

period, data for 46 states and the District of Columbia were used and data for Florida, Minnesota, 

New Mexico, and Pennsylvania were excluded from this analysis. The 46 states and the District 

of Columbia accounted for 86 percent to 87 percent of all deaths in the United States from 1972 

through 2007.

About the author

Donna L. Hoyert is with the CDC’s NCHS, Division of Vital Statistics, Mortality Statistics 

Branch.

References

1. Hanzlick R. Case of the month: Wrapping things up. Arch Intern Med 160(20):3029–31. 2000.

2. Wood MJ, Guha AK. Declining clinical autopsy rates versus increasing medicolegal autopsy 

rates in Halifax, Nova Scotia. Arch Pathol Lab Med 125(7):924–30. 2001.

3. Hoyert DL, Kung HC, Xu J. Autopsy patterns in 2003. National Center for Health Statistics. 

Vital Health Stat 20(32). 2007.

4. Scordi-Bello IA, Kalb TH, Lento PA. Clinical setting and extent of premortem evaluation do 

not predict autopsy discrepancy rates. Mod Pathol 23(9):1225–30. 2010.

5. Godwin TA. End of life: Natural or unnatural death investigation and certification. Dis Mon 

51(4):218–77. 2005.

6. Centers for Disease Control and Prevention. Sudden unexpected infant death and sudden 

infant death syndrome. Available from: http://www.cdc.gov/SIDS/index.htm [Accessed 3/25/11].

7. Xu JQ, Kochanek KD, Murphy SL, Tejada-Vera B. Deaths: Final data for 2007. National vital 

statistics reports; vol 58 no 19. Hyattsville, MD: National Center for Health Statistics. 2010.
NCHS Data Brief ■ No. 67 ■ August 2011

Suggested citation

Hoyert DL. The changing profile of 

autopsied deaths in the United States, 1972–

2007. NCHS data brief, no 67. Hyattsville, 

MD: National Center for Health Statistics. 

2011.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Edward J. Sondik, Ph.D., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Vital Statistics

Charles J. Rothwell, M.S., Director

U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

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Hyattsville, MD 20782

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