Trends in Pathological Autopsy in Japan From 1958 to 2023

Pathological autopsies are essential for medical education and medical progress, yet their numbers have been declining globally. Annual of the Pathological Autopsy Cases in Japan (APAC-J), established in 1958, is a comprehensive nationwide database of autopsies performed in Japan. This study analyzed APAC-J data from 1958 to 2023, encompassing over 1.49 million cases. The number of autopsies peaked at 40,680 in 1985 but declined significantly to 10,020 in 2019, and further to 6,557 in 2022 largely due to the COVID-19 pandemic. Autopsy rates declined after the medical school conflicts in the late 1960s, with temporary increases following the introduction of board certification for pathologists. The number of data-reporting facilities rose to 934 by 2019. Since 2000, the proportion of brain dissections has slightly increased, while limited autopsies have decreased (24% and 3.9%, respectively, in 2023). The male-to-female ratio is over 2.0, and average ages of autopsy cases remain over 10 years younger than Japanese life expectancy. Autopsy rates were higher among individuals from childhood to middle age. This study demonstrates that social dynamics and healthcare system reforms have influenced autopsy practices. Interpretation of autopsy case groups must consider demographic characteristics and shifts in autopsy implementation over time.