臺灣博碩士論文加值系統

隨著文明的進步，工商業的發達，日趨嚴重的環境污染，生活環境與飲食習慣的改變，讓過敏這種文明病，在已開發和開發中國家皆呈現增加的趨勢。因國內對於異位性皮膚炎與蕁麻疹之醫療服務利用相關研究仍較缺乏，故本研究欲對我國異位性皮膚炎與蕁麻疹病患之醫療服務利用進行探討。
本研究運用全民健康保險資料庫2000至2004年之承保抽樣歸人檔第一組至第四組共二十萬人為樣本基礎，並以國際疾病診斷分類第九版臨床修正版(ICD-9-CM)出現為691.8和692.9兩者定義為異位性皮膚炎之本研究對象，及前三碼為708者定義為蕁麻疹之本研究對象。2000至2004年曾就醫治療之異位性皮膚炎病患共52,092人、蕁麻疹病患共29,778人。 研究結果發現2000至2004年異位性皮膚炎的盛行率為6%-14%、蕁麻疹的盛行率則為2%-7%，且兩病患者同樣以四歲之前為盛行率的高峰期，而盛行率最高地區為離島的澎湖縣。
2000至2004年之間，異位性皮膚炎病患的平均每人總醫療費用為2,731.98元、總藥品費970.07元。而異位性皮膚炎患者的藥品費用亦佔總醫療費用的35.5%，相較2000至2004年全國的健保藥品費佔總醫療費用比例24%-25%還高。羅吉斯迴歸分析顯示異位性皮膚炎患者在年齡、投保地區健保分局、投保金額級別，及患有合併症等相關因子與總就醫次數多寡有顯著的差異存在；總醫療費用高低則與異位性皮膚炎患者的性別、年齡、投保地區健保分局、投保金額級別、及患有合併症等相關因子有顯著的差異存在。
2000至2004年，蕁麻疹病患平均每人的總醫療費用為1,841.29元、總藥品費490.46元。但蕁麻疹患者的藥品費用僅佔總醫療費用的26.6%，並無明顯高於2000至2004年全國的健保藥品費佔總醫療費用的比例。羅吉斯迴歸分析顯示蕁麻疹患者的年齡、投保金額級別、及患有合併症等相關因子與總就醫次數多寡有顯著的差異存在。另外總醫療費用高低則與蕁麻疹患者的年齡、投保地區健保分局、投保金額級別、及患有合併症等相關因子有顯著的差異存在。

Atopic dermatitis and urticaria are two of the most common allergic skin diseases. As the progressing of civilization, the developing of business, the increasing of serious environmental pollution and the changing of life style, prevalence of atopic dermatitis and urticaria are increasing in developed and developing countries.
The purpose of this study is to explore the use of medical services for atopic dermatitis and urticaria patients. This study utilized databases of Taiwan National Health Insurance registry for beneficiaries claims to analyze allergic skin patient’s utilization of health care services from 2000 to 2004. Two codes in ICD-9-CM 691.8 and 692.9 were defined to identify atopic dermatitis patients, and the first three of the code as 708 was defined to identify urticaria patients.
The average prevalence of atopic dermatitis and urticaria were about 6%-14% and 2%-7%, respectively. The peak prevalence of both diseases was found in patients with age 0-4 from 2000 to 2004. The highest prevalence was occurred in the Penghu country.
The average of total medical fees per atopic dermatitis patient from 2000 to 2004 was NT$2,731.98 and the average of total drug fees was NT$970.07. The proportion of drug fees for the atopic dermatitis patient was 35.5% which was higher than the proportion 24%-25% of drug fees for the total of National Health Insurance (NHI).
Age, health insurance covered regional, the level of insured amount and the patient with complications were significantly related to the consultation of medical services by the logistic regression.
The total medical fees were significantly affected by gender, age, health insurance covered regional, the level of insured amount and the patient with the complications. The average of total medical fees of per urticaria patient was NT$1,841.29 and the average of total drug fees was NT$490.46 from 2000 to 2004. In the logistic regression model, the total consultation of medical services for urticaria patients were affected by age, the level of insured amount and the patient with the complications. Age, health insurance covered regional, the level of insured amount and the patient with the complications were also related to the total medical fees.

中文摘要..................................................................I
Abstract ...............................................................III
誌謝 .....................................................................V
目錄 ...................................................................VII
表目錄 ...................................................................X
圖目錄 ..................................................................XV
第一章 緒論 ..............................................................1
1-1 研究背景與動機 .....................................................1
1-2 研究目的 ...........................................................4
第二章 文獻探討 ..........................................................5
2-1-1 異位性皮膚炎概述 .................................................5
2-1-2 異位性皮膚炎的致病轉機與臨床症狀 .................................5
2-1-3 異位性皮膚炎的危險因子 ...........................................6
2-1-4 盛行率 ...........................................................8
2-1-5 異位性皮膚炎之醫療照護成本 ......................................10
2-2-1 蕁麻疹概述 ......................................................14
2-2-2 蕁麻疹的致病轉機與臨床症狀 ......................................15
2-2-3 蕁麻疹的危險因子.................................................17
2-2-4 盛行率 ..........................................................18
2-2-5 蕁麻疹之醫療照護成本 ............................................19
2-3 醫療服務利用行為模式 ..............................................20
第三章 研究材料與方法....................................................26
3-1 研究架構 ..........................................................26
3-2 研究假說 ..........................................................27
3-3 研究因子與操作型定義 ..............................................28
3-4 研究材料及研究對象 ................................................30
3-5 資料處理與分析 ....................................................32
第四章 研究結果 .........................................................37
4-1-1 異位性皮膚炎之盛行率 ............................................37
4-1-2 異位性皮膚炎病患各相關因子與就醫型態之探討 ......................43
4-1-3 異位性皮膚炎病患之醫療服務利用情形 ..............................46
4-1-4 異位性皮膚炎病患各相關因子與醫療服務利用之相關性 ................49
4-2-1 蕁麻疹之盛行率 ..................................................68
4-2-2 蕁麻疹病患各相關因子與就醫型態之探討 ............................74
4-2-3 蕁麻疹病患之醫療服務利用情形 ....................................77
4-2-4 蕁麻疹病患各相關因子與醫療服務利用之相關性 ......................80
第五章 討論 ............................................................100
5-1 異位性皮膚炎......................................................100
5-2 蕁麻疹 ...........................................................104
5-3 研究限制 .........................................................107
5-4 結論..............................................................107
參考文獻................................................................109

1. Leung R., Jenkins M. : Asthma, allergy and atopy in southern Chinese school
students. Clinics and Experimental Allergy; 24(4): 353-358, 1994.
2. Levy R.M., Gelfand J.M., Yan A.C. : The epidemiology of atopic dermatitis.
Clinics in Dermatology; 21(2): 109-115, 2003.
3. Prescott-Clarke P., Primatesta P., eds. : The health survey for England
1996. The Stationery Office, London, 1998.
4. Bajekal M., Primatesta P., Prior G., eds. : The health survey for England
2001: Respiratory symptoms, atopic conditions and lung function. The
Stationery Office, London, 2003.
5. Sproston K., Primatesta P., eds. : The health survey for England 2002: The
health of children and young people. The Stationery Office, London, 2003.
6. Lue K.H., Hsieh K.H. : A survey of the prevalence of allergic diseases in
school children in Taipei city-changes in the past 11 years. Acta
Paediatrica Sinica; 29(2): 104-109, 1988.
7. 江伯倫，為什麼過敏性疾病越來越多？健康世界，193, pp. 6-9，2002。
8. 蕭瑞麟，絕對防治過敏兒，初版，台灣，台視文化事業股份有限公司，2004。
9. 陳明豐，過敏常識問答，健康世界，232, pp. 45-46，2005。
10. Williams H., Robertson C., Stewart A. and et al. : Worldwide variations in
the prevalence of symptoms of atopic eczema in the international study of
asthma and allergies in childhood. The Journal of Allergy and Clinical
Immunology; 103(1): 125-138, 1999.
11. 謝貴雄，氣喘病流行病學及危險因子之研究—多醫學中心五年垂直研究，行政院衛生
署八十六年度委託研究計畫。
12. 楊曜旭、江伯倫，全國學童過敏疾病盛行率與飲食習慣、營養狀況關係研究，行政院
衛生署九十一年度科技研究發展計畫。
13. Wang W.C., Lue K.H., Sheu N.J. : Allergic diseases in preschool children
in Taichung city. Acta Paediatrica Sinica; 39(5): 314-318, 1998.
14. 呂曜卿，中國人皮膚病圖譜第一輯，三版，台灣，橘井文化事業股份有限公司，民國
75年。
15. 吳克恭，蕁麻疹，台灣兒童過敏氣喘及免疫學會學會通訊，2(3), pp. 3-5，2001。
16. 萬玉鳳，蕁麻疹，台灣中醫臨床醫學雜誌，11(3), pp. 191-195，2005。
17. Zuberbier T. : Urticaria. European Journal of Allergy and Clinical
Immunology; 58(12): 1224-1234, 2003.
18. 李俊杰、蘇世斌，慢性蕁麻疹，基層醫學，18(2), pp. 39-41，2003。
19. Baxi S., Dinakar C. : Urticaria and angioedema. Immunology and Allergy
Clinics of North America; 25(2): 353-367, 2005.
20. 高宗桂、梁淑梅、章永紅、吳承玉，溼疹、蕁麻疹與異位性皮膚炎的中醫療法，台灣
中醫科學雜誌，2(1), pp. 68-75，2007。
21. Simons F.E.R. : Prevention of acute urticaria in young children with
atopic dermatitis. Journal of Allergy and Clinical Immunology; 107: 703-
706, 2001.
22. 歐良修，以小兒科的角度看異位性皮膚炎，台灣兒童過敏氣喘及免疫學會學會通訊，6
(3), pp. 2-3，2005。
23. Spergel J.M., Paller A.S. : Atopic dermatitis and the atopic march. The
Journal of Allergy and Clinical Immunology; 112(6): s118-127, 2003.
24. Kemp A.S. : Cost of illness of atopic dermatitis in children: a societal
perspective. PharmacoEconomics; 21: 105-113, 2003.
25. Ellis C.N., Drake L.A., Prendergast M.M. and et al. : Cost of atopic
dermatitis and eczema in the United States. Journal of the American
Academy of Dermatology; 46(3): 361-70, 2002.
26. Weldon D.R. : Quality of life in patients with urticaria. Allergy and
Asthma Proceedings; 27: 96-99, 2006.
27. 吳克恭，異位性皮膚炎，台灣兒童過敏氣喘及免疫學會學會通訊，1(3), pp. 3-6，
2000。
28. 楊佳懿、王莉芳，異位性皮膚炎，台灣醫學，3(4), pp. 423-429，1999。
29. 蔡呈芳，跑錯地方的皮膚病 談異位性皮膚炎，健康世界，181, pp. 107-112，2001。
30. 朱家瑜，異位性皮膚炎，初版，台灣，健康文化事業股份有限公司，pp. 14-16，
2004。
31. 林于燦，金黃色葡萄球菌超級抗原造成異位性皮膚炎過敏性發炎反應之持續與惡化的
分子轉機。台北：國立台灣大學醫學院臨床醫學研究所博士論文，2005。
32. Laughter D., Istvan J.A., Tofte S.J. and et al. : The prevalence of atopic
dermatitis in Oregon schoolchildren. Journal of the American Academy of
Dermatology; 43(4): 649-55, 2000.
33. 顧明修、呂克桓，異位性皮膚炎，台灣兒童過敏氣喘及免疫學會學會通訊，5(1),
pp. 10-11，2004。
34. 黃鉅惠、林應然，異位性皮膚炎(過敏性溼疹)，台灣兒童過敏氣喘及免疫學會學會通
訊，3(3), pp. 9-10，2002。
35. 王文正，照顧異位性皮膚炎 穩定患童情緒是首要，台灣兒童過敏氣喘及免疫學會學會
通訊，5(1), pp. 19-20，2004。
36. 于鴻仁、楊崑德，異位性皮膚炎的致病性與防治現況，臺灣兒科醫學會，45(s), pp.
11-23，2004。
37. Williams H.C. : Epidemiology of atopic dermatitis. Clinical and
Experimental Dermatology; 25(7): 522-529, 2000.
38. Yan D.C., Ou L.S., Tsai T.L. and et al. : Prevalence and severity of
symptoms of asthma, rhinitis, and eczema in 13- to 14-year-old children in
Taipei, Taiwan. Annals of Allergy, Asthma and Immunology; 95(6): 579-85,
2005.
39. Laio M.F., Huang J.L., Chang L.C. and et al. : Prevalence of asthma,
rhinitis, and eczema from ISAAC survey of schoolchildren in central
Taiwan. Journal of Asthma; 42: 833-837, 2005.
40. Van De Ven M.O.M., Van Den Eijnden R.J.J.M., Engels R.C.M.E. : Atopic
diseases and related risk factors among Dutch adolescents. The European
Journal of Public Health; 16(5): 549-558, 2006.
41. Thomas L., Diepgen T.L., Maria Blettner. : Analysis of familial
aggregation of atopic eczema and other atopic diseases by odds ratio
regression models. Journal of Investigative Dermatology; 106, 977–981,
1996.
42. Mortz C.G., Lauritsen J.M., Bindslev-Jensen C. and et al. : Prevalence of
atopic dermatitis, asthma, allergic rhinitis, and hand and contact
dermatitis in adolescents. The Odense adolescence cohort study on atopic
diseases and dermatitis. British Journal of Dermatology; 144: 523-532,
2001.
43. Lee Y.L., Li C.W., Sunq F.C. and et al. : Increasing prevalence of atopic
eczema in Taiwanese adolescents from 1995 to 2001. Clinical and
Experimental Allergy; 37(4): 543-51, 2007.
44. 葉國偉，皮膚的過敏反應 異位性皮膚炎，健康世界，245, pp. 16-20，2006。
45. National Institute of Arthritis and Musculoskeletal and Skin Diseases. :
Handout on health: atopic dermatitis. U.S. Department of Health and Human
Services, 2003.
46. Rhodes H.L., Thomas P., Sporik R. and et al. : A birth cohort study of
subjects at risk of atopy twenty-two-year follow-up of wheeze and atopic
status. American Journal of Respiratory and Critical Care Medicine; 165
(2): 176-180, 2002.
47. Rhodes H.L., Sporik R., Thomas P. and et al. : Early life risk factors for
adult asthma: A birth cohort study of subjects at risk. Journal of Allergy
and Clinical Immunology; 108(5): 720-5, 2001.
48. Sampson H.A. : Food allergy. Part1: Immunopathogenesis and clinical
disorders. Journal of Allergy and Clinical Immunology; 103: 717-28, 1999.
49. Faulstich M.E., Williamson D.A. : An overview of atopic dermatitis: toward
a bio-behavioural integration. Journal of Psychosomatic Research; 29(6):
647-54, 1985.
50. Absolon C.M., Cottrell D., Eldridge S.M. and et al. : Psychological
disturbance in atopic eczema: the extent of the problem in school-aged
children. British Journal of Dermatology; 137(2): 241-245, 1997.
51. Paller A.S., McAlister R.O., Doyle, J.J. and et al. : Perceptions of
physicians and pediatric patients about atopic dermatitis, its impact and
its treatment. Clinical Pediatrics; 41: 323-32, 2002.
52. 石佳琦、余幸司，異位性皮膚炎與小兒過敏，高醫醫訊月刊，20(7)， 2000。
53. Takahi Kusunoki, Kouichi Asai, Masashi Harazaki and et al. : Moth of birth
and prevalence of atopic dermatitis in schoolchildren: Dry skin in
early infancy as a possible etiologic factor. Journal of Allergy and
Clinical Immunology; 103(6): 1148-52, 1999.
54. Tariq S.M., Arshad S.H., Matthews S.M. and et al. : Elevated cord serum
IgE increases the risk of aeroallergen sensitization without increasing
respiratory allergic symptoms in early childhood. Clinical and
Experimental Allergy; 29: 1042–1048, 1999.
55. Schultz-Larsen F., Hanifin J.M. : Secular change in the occurrence of
atopic dermatitis. Acta Dermato-Venereologica Suppl (Stockh); 176: 7-12,
1992.
56. Kay J., Gawkrodger D.J., Mortimer M.J. and et al. : The prevalence of
childhood atopic eczema in a general population. Journal of the American
Academy of Dermatology; 30: 35-39, 1994.
57. Dotterud L.K., Kvammen B., Bolle R. and et al. : A study of atopic
diseases among school children in Sor-Varanger community. Acta Dermto-
Venereology Suppl (Stockh); 74: 124-128, 1994.1
58. Schultz-Larsen F., Diepgen T., Svensson A. : The occurrence of atopic
dermatitis in North Europe: an international questionnaire study. Journal
of the American Academy of Dermatology; 34: 760-764, 1996.
59. Osterziel K.J., Strohm O., Schuler J. and et al. : Worldwide variation in
prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic
eczema: ISAAC. The Lancet; 351: 1225-1232, 1998.
60. Asher M., Montefort S., Bj�宁kst�聲 B. and et al. : Worldwide time trends in
the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and
atopic eczema in childhood: ISAAC Phases One and Three repeat multicountry
cross-sectional surveys. The Lancet; 368: 733-43, 2006.
61. Kwong G.N.M., Proctor A., Billing C. and et al. : Increasing prevalence of
asthma diagnosis and symptoms in children is confined to mild symptoms.
Thorax; 56: 312-314, 2001.
62. Kuehni C.E., Davis A., Brooke A.M. and et al. : Are all wheezing disorders
in very young (preschool) children increasing in prevalence?. The Lancet;
357(9271): 1821-1825, 2001.
63. Tay Y.K., Kong K.H., Khoo L. and et al. : The prevalence and descriptive
epidemiology of atopic dermatitis in Singapore school children. British
Journal of Dermatology; 146: 101-106, 2002.
64. Carroll C.L., Balkrishnan R., Feldman S.R. and et al. : The burden of
atopic dermatitis: Impact on the patient, family, and society. Pediatric
Dermatology; 22(3): 192-199, 2005.
65. Blaiss M.S. : Medical and economic dimensions linking allergic rhinitis
and asthma. Allergy and Asthma Proceedings; 23(4): 223-7, 2002.
66. Gupta R., Sheikh A., Strachan D.P. and et al. : Burden of allergic disease
in the UK: secondary analysis of national database. Clinical and
Experimental Allergy; 34(4): 520-26, 2004.
67. Barbean M., Bpharm H.L. : Burden of atopic dermatitis in Canada.
International Journal of Dermatology; 45: 31-36, 2006.
68. Su J.C., Kemp A.S., Varigos G.A. and et al. : Atopic eczema: its impact on
the family and financial cost. Archives of Disease in Childhood; 76: 159-
162, 1997.
69. Verboom P., Roijen Hakkaart-Van L., Sturkenboom M. and et al. :
Epidemiology and health services research the cost of atopic dermatitis in
the Netherlands: An international comparison. British Journal of
Dermatology; 147(4): 716-724, 2002.
70. Ehlken B., Mohrenschlager M., Kugland B. and et al. : Cost-of-illness
study in patients suffering from atopic eczema in Germany. Hautarzt; 56
(12): 1144-51, 2005.
71. Lapidus C.S., Schwarz D.F., Honig, P.J. : Atopic dermatitis in children:
Who cares? Who pays?. Journal of the American Academy of Dermatology; 28:
699-703, 1993.
72. Fivenson D., Arnold R.J., Kaniecki D.J. and et al. : The effect of atopic
dermatitis on total burden of illness and quality of life on adults and
children in a large managed care organization. The American Journal of
Managed Care: Pharmacy Benefits Management; 8: 333-342, 2002.
73. Emerson R.M., Williams H.C., Allen B.R. : What is the cost of atopic
dermatitis in preschool children?. British Journal of Dermatology; 144:
514-522, 2001.
74. Zuberbier T., Orlow S.J., Paller, A.S. and et al. : Patient perspectives
on the management of atopic dermatitis. The Journal of Allergy and
Clinical Immunology; 118(1): 226-232, 2006.
75. Zuberbier T., Maurer M. : Urticaria: current opinions about etiology,
diagnosis and therapy. Acta Dermato-Venereologica; 87(3): 196-205, 2007.
76. Zuberbier T., Chantraine-Hess S., Hartmann K. and et al. : Pseudoallergen-
free diet in the treatment of chronic urticaria. A prospective study. Acta
Dermato-Venereologica Suppl (Stockh); 75: 484-487, 1995.
77. 賴慶嶺、徐世達，兒童慢性蕁麻疹，台灣兒童過敏氣喘及免疫學會學會通訊，4(1),
pp. 7-8，2000。
78. Annals of Allergy, Asthma and Immunology. : Part 1: Acute
urticaria/angioedema. Amertican Collerge of Allergy, Asthma, and
Immunology; 85(6): sup. 1, 525-531, 2000.
79. Pigatto P.D., Valsecchi, R.H. : Chronic urticaria: A mystery. European
Journal of Allergy and Clinical Immunology; 55: 306-308, 2000.
80. Ormerod A.D. : Urticaria and angioedema. British Medical Journal (Clin Res
Ed); 289(6449): 903-906, 1984.
81. Champion R.I., Roberts S.O.B., Carpenter R.G. and et al. : Urticaria and
angioedema a review of 554 patients. British Journal of Dermatology; 81:
588–597, 1969.
82. Gaig P., Olona M., Lejarazu M. and et al. : Epidemiology of urticaria in
Spain. Journal of Investigational Allergology and Clinical Immunology; 14
(3): 214-220, 2004.
83. Varadarajulu S. : Urticaria and angioedema. Controlling acute episodes,
coping with chronic cases. Postgraduate Medicine; 117(5): 25-31, 2005.
84. Hellgren L. : The prevalence of urticaria in the total population. Acta
Allergologica; 27: 236-240, 1972.
85. Weldon D.R. : Quality of life in patients with urticaria. Allergy and
Asthma Proceedings; 27: 96-99, 2006.
86. 葉國樑，健康行為科學理論~應用於健康教育的調查實驗研究，翰林文教雜誌，17,
pp. 8-21，2001。
87. Andersen R.M. : Revisiting the behavioral model and access to medical
care: Does it matter?. Journal of Health and Social Behavior; 36(1): 1-10,
1995.
88. 國家衛生研究院，全民健康保險資料庫之承保抽樣歸人檔簡介，
http://www.nhri.org.tw/nhird/date_cohort.htm。
89. 王振宇、賴志昇、陳冠宇、鄭裕文、陳文杰，高雄縣與澎湖縣國小學童異位性皮膚炎
盛行率之分析比較，中華皮膚科醫學雜誌，24(2), pp. 94-101，2006。
90. 高雅惠，全民健保門診用藥型態之分析研究，行政院衛生署八十七年度委託研究計
畫。
91. 陳威仁，全民健保實施對台灣製藥產業的影響，公勞健保制度對藥事經濟發展的影響
研討會一：支付制度對產業及執業藥師的影響研討會資料，2006。
92. Henderson R.L. Jr, Fleischer A.B Jr, Feldman S.R. : Allergists and
dermatologists have far more expertise in caring for patients with
urticaria than other specialists. Journal of the American Academy of
Dermatology; 43(6): 1084-91, 2000.
93. O’Donnell B.F., Lawlor F., Simpson J. and et al. : The impact of chronic
urticaria on the quality of life. British Journal of Dermatology; 136(2):
197-201, 1997.
94. Poon E., Seed P.T., Greaves M.W. and et al. : The extent and nature of
disability in different urticarial conditions. British Journal of
Dermatology; 140(4): 667-671, 1999.
95. Baiardini I., Giardini A., Pasquali M. and et al. : Quality of life and
patients’satisfaction in chronic urticaria and respiratory allergy.
Allergy; 58(7): 621-623, 2003.
96. Staubach P., Eckhardt-Henn A., Dechene M. and et al. : Quality of life in
patients with chronic urticaria is differentially impaired and determined
by psychiatric comorbidity. British Journal of Dermatology; 154(2): 294-
298, 2006.