This study analyzed the results of 747 autopsies practiced over a 3.5-year period at Hospital de San José in Bogotá, Colombia, observing an increase in the practice of this procedure and a greater number of cases to be analyzed, compared with other studies. The findings of the post-mortem diagnoses agree with data reported in other international studies, such as the study published in Cuba that included 5805 autopsies, evidencing important data such as the direct cause of death and comorbidities. The two leading causes of death, listed according to frequency, were bronchopneumonia and acute myocardial infarction; however, it must be considered these patients were 60 years or older (Martínez Rodríguez et al. 2012). In contrast with our study in which the first cause was cardiovascular disease followed by respiratory conditions. Another retrospective study conducted in SC, United States of America in which 13,227 autopsy cases in patients aged 18 years or older were compiled, half of the cases of death were non-violent, and the main post-mortem diagnosis was acute myocardial infarction regardless of age group. However, it differs from our study on other major causes of death such as acquired immune deficiency syndrome (AIDS), infections and neoplasia (Christiansen and Collins 2007).
The present study as compared with other studies made in Colombia, represents one of the biggest studies conducted during the last decade given the number of autopsies it comprises over said period of time. Pointing out a study performed at the central area, where 160 cases were recorded during 25 years, between 1966 and 1991 stressing the value of autopsy for medical training, confirming clinical diagnosis and assessing the effects of treatment given (Bernal 2013). On the other hand, a study was carried out in the north-east in 2010, which reports on 494 autopsies over a 4-year period through an analytical study of multiple diagnostic evaluations, correlating the pre-mortem clinical diagnosis and the pathological diagnosis (Diaz-Perez and Melo-Uribe 2010). Moreover, these two studies found that infectious diseases such as community-acquired pneumonia and tuberculosis are and continue to be the main causes of death in our country. These findings are similar to the results we obtained in the present study.
The most prevalent findings in fetus obits were congenital malformations, as well as, voluntary interruption of pregnancy, followed by placental abnormalities, predominantly chorioamnionitis, which are similar to those obtained by the Gynecology and Obstetrics Department of the University of Utah, where fetal death is emphasized as an important but barely studied problem which currently represents nearly 50% of overall perinatal deaths (Silver 2007). It is worth noting that the placenta was not available for pathology assessment in some cases of our study; therefore, it is most likely that if it had been available the incidence of placental pathologies would increase as a cause of fetal death. Thus, we consider it indispensable to be able to assess the fetus as well as the placenta in the total number of post-mortem studies undertaken in this age group.
Respiratory infections with onset of unspecific respiratory symptoms in the days before death are evidently the most common cause of mortality in newborns and toddlers, and as some are associated with prematurity which increases the adverse outcome risks and favors a high prevalence of serious morbidity and mortality, this contributes to the escalating costs of health care in our country. As an adequate control has not yet been achieved and they still represent a great effort for health institutions for addressing these problems, adequate improvement of nutrition, development of education strategies, access to robust health prevention programs, and community work among other is required.
The leading diagnosis identified in our study among the infants/toddlers to young adult age group was respiratory illness. It is worth noting that the central area and north-east studies performed in Colombia also identified respiratory illness as the leading cause of death, in spite, promotion and prevention programs were established; these mortality values continue to be notoriously alarming in Colombia (Diaz-Perez and Melo-Uribe 2010; Bernal 2013).
Interestingly, 26 patients in the young adult age group (18 to 40 years) died due to cardiovascular disease. 42.3% presented sudden cardiac death, constituting the first cause of death in this population (Table 2); this is an important finding given the incidence of cardiac deaths in this age group reported in the global literature is 1 per 100,000 persons/year and increases in people older than 30 years, with a second maximum peak in subjects aged between 45 and 75 years (Morentin and Audicana 2011; Farioli et al. 2015; Mesrati et al. 2017) associated with risk factors, such as cardiovascular disease, arterial hypertension, diabetes mellitus, and smoking.
The latter becomes additionally relevant if the National Statistics Department of Colombia (DANE) (Colombian Department of Statistics) analysis is reckoned, for it estimates that by 2020 the base of the population structure in the capital of the country (Bogotá) will decline due to low birth rates. This may be influenced by the fact that in the past years, young adults died predominantly because of violent causes. As our results indicate that cardiac sudden death is common in young adults and unless active promotion and prevention strategies are taken, the number of cases will progressively increase considering these individuals constitute the active workforce that establishes an opportunity environment and it may be likely that this phenomenon would affect the economic productivity of society.
Given that our research group found that sudden death is the main autopsy diagnosis in subjects 40 years and older, we recommend not only the development of effective cardiovascular diseases prevention strategies but also to stress the importance of creating heart disease awareness among people for a great number of patients in our study presented sudden onset of clinical symptoms, less than an hour before their death while in their daily activities, and did not receive medical care. Likewise, we consider it critical to count with the availability of equipment and trained personnel on basic life support skills, who may serve as first responders in high-traffic public areas, in order to reduce the mortality rate related to heart disease, as stated by the American Heart Association Guidelines for Cardiopulmonary Resuscitation which demonstrated evidence-based positive impact and benefits among patients (Olasveengen et al. 2017).