Journal List > Korean J Leg Med > v.41(4) > 1088003

Na, Park, Lee, and Lee: Discrepancy of the Cause of Death in Autopsy Cases of Cardiovascular Disease with a Focus on Cause of Death Statistics

Abstract

Determining the cause of death (COD) is important not only as personal information, but also as social statistical data. An autopsy is the gold standard for investigating death and determining the COD. CODs determined by an autopsy in countries with low autopsy rates, such as Korea, can serve as important data in constructing nationwide statistics. We compared and analyzed cases of CODs corresponding with the same cases of cardiovascular disease determined by autopsy and CODs from Statistics Korea. Among autopsies performed in Korea during 2015, the present study selected 1,920 cases of cardiovascular disease as the COD and analyzed 1,468 of those that could be confirmed by Statistics Korea. Main CODs included ischemic heart disease, acute myocardial infarction, sudden cardiac death, intracerebral hemorrhage, subarachnoid hemorrhage, aortic aneurysm and dissection, pulmonary embolism, and esophageal varix. Among these, COD by autopsy was confirmed with Statistics Korea data in more than 90% of cases involving acute myocardial infarction, intracerebral hemorrhage, subarachnoid hemorrhage, and aortic aneurysm and dissection, whereas cases involving ischemic heart disease, sudden cardiac death, pulmonary embolism, and esophageal varix showed a relatively wide variety of CODs from Statistics Korea. It is believed that forensic autopsies should be effectively reflected for more accurate COD statistics. Thus, final CODs from Statistics Korea should be determined based on careful discussions between the forensic pathologist and staff in charge at Statistics Korea, and a systematic upgrade that would allow for reconfirmation of the final COD is necessary.

REFERENCES

1.Levy B. Informatics and autopsy pathology. Surg Pathol Clin. 2015. 8:159–74.
crossref
2.Park JH., Na JY., Lee BW, et al. A statistical analysis on forensic autopsies performed in Korea in 2015. Korean J Leg Med. 2016. 40:104–18.
crossref
3.Turnbull A., Martin J., Osborn M. The death of autopsy? Lancet. 2015. 386:2141.
crossref
4.Kim HG., Park JW., Cho WY, et al. The discrepancy of the cause and manner of death between death certificates and autopsy reports. Korean J Leg Med. 2014. 38:139–44.
crossref

Table 1.
COD according to autopsy reports and cases of cardiac disease from Statistics Korea
CODs on the autopsy report CODs by Statistics Korea No. (%)
Ischemic heart disease (n=421) Non-insulin dependent diabetic mellitus 2 (0.5)
  Acute myocardial infarction 30 (7.1)
  Other acute ischemic heart disease 2 (0.5)
  Chronic ischemic heart disease 365 (86.7)
  Cardiac arrest 3 (0.7)
  Heart failure 1 (0.2)
  Complications and ill-defined descriptions of heart disease 2 (0.5)
  Cerebral infarction 2 (0.5)
  Polyarteritis nodosa and related conditions 1 (0.2)
  Other sudden death, cause unknown 1 (0.2)
  Unattended death 5 (1.2)
  Other ill-defined and unspecified cause of mortality 5 (1.2)
  Other and unspecified effects of external causes 2 (0.5)
Sudden cardiac death (n=284) Benign neoplasm of brain and other parts of central nervous system 1 (0.4)
  Non-insulin-dependent diabetes mellitus 4 (1.4)
  Essential hypertension 1 (0.4)
  Hypertensive heart disease 1 (0.4)
  Angina pectoris 1 (0.4)
  Acute myocardial infarction 5 (1.8)
  Chronic ischemic heart disease 8 (2.8)
  Acute pericarditis 1 (0.4)
  Cardiomyopathy 5 (1.8)
  Other conduction disorders 1 (0.4)
  Cardiac arrest 216 (76.1)
  Other cardiac arrhythmias 2 (0.7)
  Complications and ill-defined descriptions of heart disease 8 (2.8)
  Atherosclerosis 1 (0.4)
  Alcoholic liver disease 1 (0.4)
  Other diseases of digestive system 1 (0.4)
  Other congenital malformations of heart 1 (0.4)
  Other sudden death, cause unknown 2 (0.7)
  Unattended death 8 (2.8)
  Other ill-defined and unspecified causes of mortality 15 (5.3)
  Injuries to unspecified part of trunk, limb, or body region 1 (0.4)
Acute myocardial infarction (n=272) Non-insulin-dependent diabetes mellitus 2 (0.7)
  Unspecified diabetes mellitus 1 (0.4)
  Acute myocardial infarction 256 (94.1)
  Chronic ischemic heart disease 2 (0.7)
  Other diseases of pericardium 4 (1.5)
  Heart failure 1 (0.4)
  Other symptoms and signs involving the circulatory and respiratory systems 1 (0.4)
  Other sudden death, cause unknown 1 (0.4)
  Other ill-defined and unspecified causes of mortality 3 (1.1)
  Injuries to unspecified part of trunk, limb, or body region 1 (0.4)
  Chronic ischemic heart disease 23 (82.1)
  Cardiac arrest 1 (3.6)
  Atherosclerosis 1 (3.6)
  Systemic lupus erythematosus 1 (3.6)
Cardiomyopathy (n=21) Cardiomyopathy 16 (76.2)
  Cardiac arrest 5 (23.8)
Cardiac disease (n=18) Complications and ill-defined descriptions of heart disease 18 (100)
  Acute myocarditis 6 (35.3)
Myocarditis (n=17) Cardiomyopathy 2 (11.8)
  Complications and ill-defined descriptions of heart disease 9 (52.9)
  Multiple valve diseases 1 (25.0)
Valvular disease (n=4) Non-rheumatic mitral valve disorder 1 (25.0)
  Non-rheumatic aortic valve disorder 1 (25.0)
  Endocarditis, valve unspecified 1 (25.0)
Conduction disorder (n=3) Other conduction disorders 1 (33.3)
  Other cardiac arrhythmia 2 (66.7)
Heart failure (n=2) Heart failure 2 (100)
Hypertensive heart disease (n=2) Hypertensive heart disease 1 (50.0)
  Complications and ill-defined descriptions of heart disease 1 (50.0)
Pericarditis (n=1) Other diseases of pericardium 1 (100)
Infective endocarditis (n=1) Acute and subacute endocarditis 1 (100)
Cardiomegaly (n=1) Cardiomyopathy 1 (100)

COD, cause of death.

Table 2.
COD according to autopsy reports and cases of vascular disease from Statistics Korea
CODs on the autopsy record CODs by Statistics Korea No. (%)
Intracerebral hemorrhage (n=144) Malignant neoplasm of liver and intrahepatic bile ducts 1 (0.7)
  Acute myocardial infarction 1 (0.7)
  Subarachnoid hemorrhage 4 (2.8)
  Intracerebral hemorrhage 135 (93.8)
  Other non-traumatic intracranial hemorrhage 1 (0.7)
  Other ill-defined and unspecified causes of mortality 1 (0.7)
  Other and unspecified effects of external causes 1 (0.7)
Subarachnoid hemorrhage (n=93) Subarachnoid hemorrhage 85 (91.4)
  Intracerebral hemorrhage 1 (1.1)
  Other non-traumatic intracranial hemorrhage 5 (5.4)
  Aortic aneurysm and dissection 1 (1.1)
  Injuries to the head 1 (1.1)
Aortic aneurysm and dissection (n=62) Essential hypertension 1 (1.6)
  Cardiac arrest 1 (1.6)
  Aortic aneurysm and dissection 57 (91.9)
  Other ill-defined and unspecified causes of mortality 2 (3.2)
  Toxic effects of substances chiefly non-medicinal as to source 1 (1.6)
Pulmonary embolism (n=44) Malignant neoplasm of liver and intrahepatic bile ducts 1 (2.3)
  Unspecified diabetes mellitus 1 (2.3)
  Pulmonary embolism 26 (59.1)
  Internal derangement of knee 1 (2.3)
  Obstetric embolism 4 (9.1)
  Injuries to the head 1 (2.3)
  Injuries to the abdomen, lower back, lumbar spine, and pelvis 1 (2.3)
  Injuries to the hip and thigh 2 (4.5)
  Injuries to the knee and lower leg 2 (4.5)
  Injuries involving multiple body regions 2 (4.5)
  Injuries to unspecified part of trunk, limb, or body region 2 (4.5)
  Complications of surgical and medical care, NEC 1 (2.3)
Esophageal varix (n=43) Malignant neoplasm of liver and intrahepatic bile ducts 1 (2.3)
  Mental and behavioral disorders due to psychoactive substance use 2 (4.7)
  Esophageal varices 12 (27.9)
  Alcoholic liver disease 10 (23.3)
  Fibrosis and cirrhosis of liver 16 (37.2)
  Other diseases of liver 1 (2.3)
  Other diseases of digestive system 1 (2.3)
Subdural hemorrhage (n=2) Other non-traumatic intracranial hemorrhage 2 (100)
Dissection of artery (n=2) Chronic ischemic heart disease 1 (50.0)
  Other aneurysm and dissection 1 (50.0)
Arteriovenous malformation (n=1) Subarachnoid hemorrhage 1 (100)
Cerebral infarction (n=1) Cerebral infarction 1 (100)
Ischemic of mesentery artery (n=1) Vascular disorders of intestine 1 (100)

COD, cause of death; NEC, not elsewhere classified.

TOOLS
Similar articles