15283-B-Blokker

21 Autopsy rates in the Netherlands: 35 years of decline 2 35 years, we stratified the years into three time periods of 12, 12 and 11 years (1977- 1988, 1989-2000 and 2001-2011). For other analyses we created age subgroups (e.g. ±20-year groups). RESULTS General overview From 1977 to 2011, 4,539,619 adults died in the Netherlands (mean: 129,703 per year, 95%CI: 110,093;142,355). The overall death counts have steadily increased with a mean of 805 per calendar year (95%CI: 640;971) and a total increase of 23.3%. The overall autopsy rates declined with 0.3% per year (Fig 1-A). Each year approximately one third of these overall deceased adults died in hospitals (mean: 44,075 per year, 95%: 36,601;48,341). The percentage of in-hospital deceased shows an overall decline of 0.2% per calendar year (95%CI: -0.003;-0.002). On 249,178 of the in-hospital deceased patients autopsies were performed (mean: 7119 per year, 95%CI: 2,820;12,209). In 35 years, the absolute number of performed clinical autopsies decreased with an average of 4% per year, to less than a quarter of the former number; each year, 282 fewer autopsies were performed (95%CI: -295;- 268). Per additional calendar year, the odds of performing an autopsy on an in-hospital deceased adult patient were reduced by 5% (95%CI: 0.950;0.950). The clinical autopsy rate decreased with a mean of 0.7% per calendar year, from 31.4% in 1977 to 7.7% in 2011 (Fig 1-B). When divided into the three time periods, we observed the steepest decline in the earliest period (1977-1988, Table 1). Only a small number of deaths each year was due to external causes (mean: 5335, 95%CI: 4,783;6,104), over the years this number decreased with 13 per year (95%CI: -23;-3). Forensic autopsy was performed in 8.5% (95%CI: 6.4-10.6, Fig 1-C). The trend of forensic autopsy rates is not significant, but when divided into the three time periods we observed an increase followed by a decrease (Table 1). Sex of the deceased The mean increase of overall deaths per calendar year was 705 among women (95%CI: 600;811) and 100 among men (95%CI: 37;163). Regardless of this trend, the majority of in-hospital deceased patients (54.7%, 95%CI: 52.7-57.0) and deaths due to external causes (57.9%, 95%CI: 55.0;60.0) was always male.