title: Autopsy rate in suicide is low among elderly in Denmark compared with Finland.
abstract: National differences in the legislation on cause and manner of death investigation are reflected in a high autopsy rate in suicides in Finland and a low corresponding rate in Denmark. The consequences for mortality statistics of these different investigation practices on deaths classified as suicides in Denmark and Finland, respectively, are not known in detail. The aim of this article was to analyse autopsy rates in deaths classified as suicides, and to identify any differences in investigation practices in deaths with a comparable cause of death, but classified as unnatural deaths other than suicide. Data from the mortality registries were summarised for the years 2000, 2005 and 2010. Autopsy rates (total, forensic and medical) were analysed with regard to deaths classified as suicide, and they were compared for three age groups (1-50 years, 51-70 years and ≥71 years) and for causes of death. Deaths classified as suicide were compared with other unnatural classifications, and comparable causes of death were coded into six subgroups: poisonings, suffocations/strangulations, firearm discharges, drowning/submersions, explosions/flames and other/unspecified causes. The total autopsy rate for suicides was 99.8% in Finland and 13.2% in Denmark. Almost all of these autopsies were conducted as forensic autopsies. In the age group ≥71 years, Danish suicides outnumbered Finnish suicides (410 versus 283). The total autopsy rate was lower in the more senior age group in Denmark (19.5%, 9.9%, 5.6%), whereas it was consistently high in Finland (99.8%, 99.9%, 99.6%). Among Danish deaths due to poisonings, the autopsy rate was 89.5% when these were classified as accidents, but only 20.7% for cases classified as suicides. The number of deaths in the two Danish subgroups was comparable (550 versus 553). In Denmark, the decision regarding the need, if any, for a forensic autopsy is made during the external forensic examination of the body. Our study showed that the limited use of forensic autopsy to confirm the cause of death in deaths classified as suicides raises doubts about the accuracy of the Danish suicide mortality statistics. Our finding is emphasised by those cases in which the cause of death was registered as intentional self-poisoning. The high number of suicides among the elderly in Denmark is striking and begs further investigation and research. Overall, our data from Finland and Denmark reveal striking differences between the two countries and warrant further comparative studies on the subject in other countries.
authors.affiliation: Department of Forensic Medicine, Aarhus University, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark. Electronic address: sys@retsmedicin.au.dk.
authors.forename: Seija
authors.initials: S
authors.lastname: Ylijoki-Sørensen
authors.affiliation: ADBOU, Institute of Forensic Medicine, University of Southern Denmark, Lucernemarken 20, 5260 Odense S, Denmark. Electronic address: jboldsen@health.sdu.dk.
authors.forename: Jesper Lier
authors.initials: JL
authors.lastname: Boldsen
authors.affiliation: Department of Forensic Medicine, Aarhus University, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark. Electronic address: lwb@retsmedicin.au.dk.
authors.forename: Lene Warner Thorup
authors.initials: LW
authors.lastname: Boel
authors.affiliation: Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 3-209, 9220 Aalborg, Denmark. Electronic address: boggild@hst.aau.dk.
authors.forename: Henrik
authors.initials: H
authors.lastname: Bøggild
authors.affiliation: National Institute for Health and Welfare, Forensic Medicine Unit, Helsinki Kytösuontie 11, 00300 Helsinki, Finland. Electronic address: kaisa.lalu@thl.fi.
authors.forename: Kaisa
authors.initials: K
authors.lastname: Lalu
authors.affiliation: Department of Forensic Medicine, Hjelt Institute, Helsinki University, Kytösuontie 11, 00014 Helsinki, Finland; Institute of Applied Genetics, Department of Molecular and Medical Genetics, University of North Texas Health Science Center, Ft. Worth, TX, USA. Electronic address: antti.sajantila@helsinki.fi.
authors.forename: Antti
authors.initials: A
authors.lastname: Sajantila
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001344:Autopsy / Q000706:statistics & numerical data*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003718:Denmark / Q000453:epidemiology; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008875:Middle Aged; D012042:Registries; D013405:Suicide / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Autopsy rate; Cause of death; Forensic autopsy; Manner of death; Mortality statistics; Suicide