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  • 學位論文

臺灣老年人口疾病壓縮現象之研究

Compression of morbidity in the elderly Taiwanese population

指導教授 : 黃偉堯

摘要


研究背景:臺灣人口平均餘命顯著增加,代表著人可以活得更久、更老。在老化的過程中,讓人感覺較為虛弱、病態。又目前國人疾病以慢性病為主,使得疾病可能伴隨至終身,對醫療照護服務的需求更高以及消耗更多醫療資源、花費更龐大的醫療費用。如能使疾病延後發生,使得人遭受病痛的時期越少,將對於老化帶來「樂觀」的態度。 研究目的:以「發病時點」為主要觀察時點,「罹病期」為主要測量指標,觀察慢性病發病的時點是否延後,使得罹病期壓縮,來探討是否有疾病壓縮現象的存在。 研究設計:本研究為縱貫性研究設計,計算其個人好發年齡視為發病的起點,並針對當年度發病年齡取其平均數是為年度發病時點。並以個人平均餘命視為發病終點,計算出個人罹病期,再將個人罹病期計算出平均年數,視為年度罹病期。針對2001年及2006年的平均發病年齡與平均罹病期均使用獨立樣本t檢定進行統計分析。 研究對象:2000年至2006年,糖尿病、肝硬化、腦中風及高血壓性疾病之新病患。 資料來源:採次級資料分析法,資料庫使用是以國家衛生研究院全民健康保險研究資料庫2005年承保抽樣歸人檔之門診處方及治療明細檔。平均餘命則取自內政部統計處所公佈之臺閩地區簡易生命表。 結果測量:糖尿病、肝硬化、腦中風及高血壓性疾病之年度發病時點以及年度罹病期。 主要結果: 一、各疾病發病時點之檢測結果:糖尿病及肝硬化新病患之平均發病時點有延後之趨勢,其糖尿病新病患發病平均年齡從2001年的52.75歲延後至2006年54.11歲;肝硬化新病患之平均發病時點亦呈現延後趨勢,從2001年的44.48歲延後至2006年的47.51歲。腦中風及高血壓性疾病新病患之平均發病時點有提前之趨勢,其中腦中風新病患之平均發病時點從2001年的65.08歲往前至2006年的62.45歲;高血壓性疾病新病患之平均發病時點,從2001年的55.74歲提早至53.17歲。 在2001年及2006年,糖尿病與腦中風新病患之平均發病時點並無顯著差異性;除此之外,在2001年及2006年肝硬化與高血壓性疾病新病患之平均發病時點具有顯著差異性。 二、各疾病罹病期之檢測結果:糖尿病與肝硬化新病患之平均罹病期有壓縮之趨勢。從2001到2006年,糖尿病新病患之平均罹病年數為28.71年縮短至2006年為28.47年;肝硬化新病患平均罹病年數為35.59年至33.86年。腦中風及高血壓性疾病新病患之罹病年數呈現擴張之趨勢。從2001年至2006年,腦中風新病患之平均罹病年數從20.57年延長至21.29年;高血壓性疾病新病患之平均罹病期從26.25年延長至28.81年。 在2001年及2006年,糖尿病與腦中風新病患之平均罹病期並無顯著差異性;除此之外,在2001年及2006年肝硬化與高血壓性疾病新病患之平均罹病期具有顯著差異性。 結論:糖尿病及肝硬化新病患之平均發病時點可被延後發生;相反地,腦中風及高血壓性疾病新病患之平均發病時點是被提前。觀察四大疾病之罹病期變化情形,糖尿病及肝硬化呈現罹病期壓縮之現象;腦中風及高血壓性疾病罹病其呈現擴張之現象。

關鍵字

疾病壓縮 發病時點 罹病期

並列摘要


Background: Life expectancy in Taiwan has increased significantly indicating that people can live longer and older. Nevertheless, during the aging process, people may become feebler and more pathological. Consequently, chronic diseases have gradually become the major cause of illness among Taiwanese. To deal with the long-duration or even life-long diseases, people need to put forth a higher level of demand for health care services and thus incur a larger amount of health expenditures. If the occurrence of chronic diseases could be postponed and the period of life duration suffering from chronic diseases shortened, people may have a more "optimistic" attitude toward the inevitable aging stage. Objective: The onset of chronic infirmity and the period from the onset of chronic infirmity until death, morbid period, are the major two indicators. To examine whether are the onset of chronic infirmity can be postponed and the morbid period can be compressed. It follows that we had a discussion about whether is compression of morbidity exist. Designs: Longitudinal study. We counted the personal onset of chronic infirmity and the annual average onset of chronic infirmity. The life expectancy is the end of chronic infirmity that we counted the personal morbid period and the annual average morbid period. We also used the Independent-Sample t test to analyze the annual average onset of chronic infirmity and annual average morbid period in 2000 and 2006. Subjects: The new cases of diabetes, cirrhosis, stroke and hypertensive disease from 2000 to 2006 in Taiwan. Data: This is a secondary data analysis. The data derived from National Health Insurance Research Database. The basic background of patient was from the ambulatory care expenditures by visits. The life expectancy of life table was counted from the department of statistics of the Ministry of the Interior. Main outcome measures: The annual average onset of chronic infirmity and the annual average morbid period of diabetes, cirrhosis, stroke and hypertensive disease. Results: 1.The annual average onset of chronic infirmity: The diabetes and cirrhosis annual average onset of chronic infirmity were postponed. From2001 to 2006, the diabetes annual average onset of chronic infirmity was increased from 52.57 to 54.11; and the cirrhosis annual average onset of chronic infirmity was increased from 44.48 to 47.51.The stroke and hypertensive disease annual average onset of chronic infirmity were advanced. From2001 to 2006, the stroke annual average onset of chronic infirmity was from 65.08 to 62.45; and the hypertensive disease annual average onset of chronic infirmity was increased from 55.74 to 53.17. To 2001 and 2006, there was no significant between the diabetes and stoke annual average onset of chronic infirmity. Besides, the cirrhosis and hypertensive disease annual average onset of chronic infirmity in 2001 and 2006 was significantly. 2.The annual average morbid period: There was compressed into diabetes and cirrhosis annual average morbid period. From2001 to 2006, there was compressed into the diabetes annual average morbid period from 28.71 to 28.47; there was also compressed into the cirrhosis annual average onset of chronic infirmity from 35.59 to 33.86. The stroke and hypertensive disease annual average morbid period were expanded. From2001 to 2006, the stroke annual average morbid period was expanded from 20.57 to 21.29; hypertensive disease annual average morbid period expanded from 26.25 to 28.81. There was no significant between the diabetes and stoke annual average morbid period in 2001 and 2006. Besides, the cirrhosis and hypertensive disease annual average morbid period in 2001 and 2006 was significantly. Conclusion: The diabetes and cirrhosis annual average onset of chronic infirmity can be postponed; on the contrary, the stroke and hypertensive disease onset of chronic infirmity can be advanced. The diabetes and cirrhosis annual average morbid period can be compressed, yet the cirrhosis and hypertensive disease annual average morbid period were expanded.

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