ArticleJournal of forensic sciences2026
Death-certificate-recorded autopsy utilization in U.S. intoxication deaths, 2003-2023: National trends, benchmark comparison, and state heterogeneity.
Article in Journal of forensic sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Drug intoxication deaths increasingly fall under medicolegal jurisdiction, yet national trends in death-certificate-recorded autopsy utilization for community intoxication deaths are not well characterized. Using CDC WONDER MCOD tabulations (2003-2023), we performed a retrospective cross-sectional analysis. Primary analyses were restricted to a community/emergency department (Community/ED) subset (home; dead on arrival; outpatient/ER; other; or unknown). The outcome was intoxication autopsy utilization among deaths with known autopsy status (Yes/[Yes+No]), modeled with Joinpoint regression. We also described Community/ED autopsy workload proxy and intoxication share, estimated a national historical-baseline gap in intoxication autopsies under a 2006-2011 baseline utilization rate, and compared state changes between 2018-2019 and 2022-2023. Total all-place intoxication deaths increased from 348,082 (2003-2012) to 411,446 (2020-2023). In the Community/ED subset, autopsy utilization declined from 84.74% (2003) to 69.78% (2023), with a joinpoint in 2018 and a steeper decline during 2018-2023 (annual percent change, -3.09%/year); the largest year-to-year decrease was 2019-2020 (-5.01 percentage points). The homicide autopsy benchmark (all places) remained 98.06%-98.82%. All-cause Community/ED autopsies increased from 128,494 (2003) to 216,842 (2023), and the intoxication deaths share rose from 12.56% to 30.15%. The historical-baseline gap reached 13,867 fewer intoxication autopsies than expected in 2023. From 2018-2019 to 2022-2023, age-adjusted intoxication mortality increased in 49 states while Community/ED autopsy utilization declined in 33. Death-certificate-recorded community intoxication autopsy utilization declined amid rising intoxication burden, with substantial state heterogeneity and widening historical-baseline gaps, highlighting implications for medicolegal capacity and death-certificate autopsy documentation.
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