Autopsies in Poland 1971–2023

Since WHO study [7] does not include data from Poland, our research on Polish data covering the years 1971–2023 allows us to fill this gap and draw conclusions regarding long-term trends in the percentage of autopsies in our country. The first three figures show the size of the entire population of Poland in the studied time period (Figure 1), the number of deaths (Figure 2) and the percentage of deaths in relation to the total population (Figure 3). Figure 1 shows a nearly linear increase in population from the initial level of about 33 million to about 38 million, lasting until about 1990. This increase is the result of the so-called mid-20th-century baby boom, i.e., a significant and persistent increase in fertility rates in many countries, especially in the western world, generally considered to have started immediately after World War II [9]. After this period, there was a multiyear stabilization, followed by a slight decrease in the years 2020–2022 caused by the COVID-19 pandemic. An almost mirror image of these phenomena is also visible in Figure 2, where after an initial increase in mortality correlated with the increase in population size, we see further multiyear stabilization, disrupted only in 2020–2022 by the COVID-19 pandemic. The increased number of deaths was, on the one hand, caused directly by the pandemic in connection with SARS-CoV-2 infections, but also indirectly due to difficulties in access to health care, restrictions introduced (not always rational), fatigue and overwork of health care workers, which facilitated medical errors, or deterioration of health resulting from the stress and anxiety that accompanied everything at that time. In the last year under review (2023), mortality returned to the prepandemic level. A similar almost mirror image is also visible in Figure 3, where mortality expressed as a percentage of the entire population fluctuated around 1% for many years of stabilisation, and larger deviations from this value occurred only in the baby boom period (less value) and during the pandemic period (greater value). These three figures were needed to proceed to the analysis of the percentage of autopsies because it must be embedded in the realities of the population. The next two figures show the number of autopsies and its trend in absolute values (Figure 4) and the percentage of autopsies in relation to all deaths and its trend (Figure 5). These graphs have a completely different course than the previous ones. Both the number of autopsies in absolute values and the percentage of autopsies in relation to all deaths show a nearly linear decline throughout the study period. Figure 4 shows that from the initial level of about 46 thousand autopsies per year there was an almost 3-fold decline to a level of only about 17 thousand per year, despite the fact that the population increased from about 33 to about 38 million, i.e., by about 15%. This trend is even more clearly visible in Figure 5, where the percentage of autopsies in relation to all deaths fell about 4-fold from the initial level of approximately 16% to only approximately 4%. An inconvenience of this study is the lack of possibility of dividing the number of autopsies we received for analysis into forensic and clinical. However, this results from the way statistical data is collected in Poland. Despite this inconvenience, we believe that the presented analysis is of great practical importance, as it shows how much the number and percentage of autopsies have decreased over the course of more than half a century. This decreasing trend is consistent with trends in other countries. For example, WHO data indicate that the number of autopsies is decreasing in the Baltic and Scandinavian countries, the Czech Republic and Slovakia, while the number of autopsies has increased in Russia (in 2020, 70% of the deceased were autopsied). Unfortunately, many large countries in Europe do not provide such data, including Germany, France, Spain and Italy [7]. It can be assumed to be mainly due to the decrease in the number of clinical autopsies and, to a lesser extent forensic autopsies [1,10,11]. The reasons for this phenomenon are probably different, but it seems that the most important is the emergence of new diagnostic methods that allow a departure from the very invasive procedures necessary in classical autopsy, produced and developed in many respects in 19th-century Germany [1]. Herat et al. summed it up: “In the 21st century, most questions raised by the family, clinicians, the coroner (medical examiner), courts, and law enforcement agencies can be answered with a complete external examination of the body, a total body CT scan +/− magnetic resonance imaging, and a targeted dissection or minimally invasive approach incorporated with sample collection for further testing. This is cost-effective and can produce reviewable data” [12]. This is true, and the world will probably go in this direction. In Poland, current regulations do not require clinical autopsy (which can, but does not have to, be performed in certain cases), while forensic autopsy is still obligatory and must consist of external examination, as well as of ‘opening the body’. However, it is enough that the relevant article of the Polish Code of Criminal Procedures instead of ‘opening the body’ receive the more general wording of ‘examination of the body’ and the way to abandon 19th-century procedures will be wide open.