臺灣博碩士論文加值系統

為了了解台灣山地原住民死因及癌症發生情況，本研究分別利用標準化死亡比(SMR)及標準化發生比(SIR)來探討原住民各族別的死因及癌症發生。本研究概分三大部份：
第一部份收集1991年至1997年，七年間台灣地區30個山地鄉居民所有死亡個案共15,137位（男10,186位，女性4,951位），界定原住民種族別，分析其死因，經與台灣地區居民死亡個案（共792,722位，男性490,425位，女性302,297位）比較，計算各族別標準化死亡比及95%信賴區間。結果發現：
(1) 若不分族別及性別，其十大死因依次為意外災害、惡性腫瘤、腦血管疾病、慢性肝病及肝硬化、心臟疾病、診斷不明、結核病、支氣管炎肺氣腫及氣喘、糖尿病、肺炎。除了糖尿病無顯著差異外，其他病因死亡情形皆顯著高於台灣地區。
(2) 在男性標準化死亡比方面，泰雅、布農、魯凱、排灣四族在意外災害、結核病及慢性肝病肝硬化等病較高；泰雅與布農在自殺較高；魯凱、排灣和鄒族在支氣管炎、肺氣腫及氣喘較高，鄒族另外在敗血症及肺炎相當高，在惡性腫瘤較低，而雅美族則診斷未明很高。
(3) 在女性標準化死亡比方面，泰雅、布農、魯凱、排灣四族在結核病，慢性肝病肝硬化，支氣管炎肺氣腫及氣喘等病較高，泰雅、布農、魯凱三族在意外災害較高，泰雅及布農二族在自殺較高，雅美族在先天性畸形及診斷未明相當高，而糖尿病在排灣族較低。
由以上結果可知，原住民大致上在意外災害、慢性肝病及肝硬化、結核病，自殺，支氣管炎肺氣腫及氣喘等疾病較嚴重。雅美族無論男女，診斷未明都很高（SMR分別為5.17、6.62），顯示其醫療資源尤其不足。
第二部份收集1971年至1995年共二十五年間，台灣地區30個山地鄉居民死亡個案共45,823位（男30,046位，女15,777位），分1971~1975、1976~1980、1981~1985、1986~1990、1991~1995等五個年代區間，經與台灣地區居民死亡個案比較，計算其標準化死亡比及95%信賴區間，結果發現：意外災害、惡性腫瘤、慢性肝病肝硬化、結核病及自殺，均長期持續顯著高於台灣地區；糖尿病原本一直低於台灣地區，至1991~1995年代，已與台灣地區無差異；高血壓性疾病原本與台灣地區無差異，自1981~1985年代開始，已顯著高於台灣地區；腦血管疾病及心臟病原本也比台灣地區低，但分別在1976~1980年代及1981~1985年代已顯著高於台灣地區。
由以上結果顯示，意外災害、慢性肝病及肝硬化、結核病、自殺、惡性腫瘤等，仍是原住民極需關注的疾病。另一方面，糖尿病、高血壓性疾病、腦血管疾病及心臟疾病等文明疾病已趕上，甚至超越台灣地區，值得重視防治。
第三部份收集1987年到1994年共八年間山地鄉居民罹患癌症個案共1,911位（男1,125位、女786位）與同時期台灣地區罹患癌症個案（共159,215位，男性102,737位，女性56,478位）比較，計算標準化發生比及95%信賴區間。結果發現：
(1) 若不分族別，男性十大癌症發生順序為胃癌、肝癌、肺癌、鼻咽癌、結腸直腸癌、口腔癌、食道癌、膀胱癌、攝護腺癌、生血及網狀內皮系統癌症。女性十大癌症發生順序為子宮頸癌、胃癌、肺癌、結腸直腸癌、乳癌、肝癌、鼻咽癌、口腔癌、生血及網狀內皮系統癌症、不明原發部位癌症。男性胃癌及鼻咽癌顯著的高，全癌症(all sites)、肝癌、肺癌、結腸直腸癌、口腔癌、膀胱癌、生血及網狀內皮系統癌症則顯著的低。女性胃癌、鼻咽癌、口腔癌、食道癌顯著的高，而全癌症，結腸直腸癌、乳癌顯著的低，以外無差異。
(2) 在不同族別男性標準化發生比方面，泰雅及布農二族胃癌顯著的高，布農、排灣、魯凱三族，鼻咽癌顯著的高，全癌症在泰雅、排灣、魯凱、雅美、鄒族均顯著的低，結腸直腸癌在泰雅、布農、排灣三族顯著的低，口腔癌在泰雅族顯著的低，肺癌及肝癌在排灣族顯著的低，以外無差異。
(3) 在不同族別女性標準化發生比方面，泰雅及布農二族胃癌顯著的高，布農、排灣、魯凱三族鼻咽癌顯著的高，布農、排灣二族食道癌顯著的高，排灣族口腔癌顯著的高。全癌症在泰雅、排灣、雅美、鄒族均顯著的低，結腸直腸癌及乳癌在泰雅及排灣二族均顯著的低。
由以上結果可看出，泰雅、布農二族無論男女在胃癌都較高，而布農、排灣、魯凱三族，無論男女鼻咽癌都較高，值得進一步研究其原因。

Standardized mortality ratio (SMR) for leading cause of death and standardized incidence ratio (SIR) for malignant neoplasma were analyzed among aboriginal tribes in Taiwan. There are three parts in this study.
The first part, sex and tribe specific SMR were calculated from death certificate data and compared with the number of expected death derived from the mortality of the total population in Taiwan between 1991 and 1997. In all, 15137 cases of death in Aborigines were contrasted with 792722 cases of death in the total papulation in Taiwan and the results were shown following: The most common causes of death in Taiwan Aborigines were accidents, malignant neoplasmas, cerebrovascular disease, chronic liver disease and cirrhosis, heart disease, ill-defines, tuberculosis, bronchitis, emphysema and asthma, diabetes mellitus and pneumonia. All these ten causes of death were significantly higher than expected except diabetes mellitus. In man, the moralities due to accidents, tuberculosis, chronic liver disease and cirrhosis were significantly higher among Atayal, Bunun, Rukai and Paiwan. The mortality due to suicide was significantly higher among Atayal and Bunun. The mortality due to bronchitis, emphysema and asthma was significantly higher among Rukai, Paiwan and Tsou. In woman, the mortalities due to tuberculosis, chronic liver disease and cirrhosis, bronchitis, emphysema and asthma were higher among Atayal, Bunun, Rukai and Paiwan. The mortality due to accidents was significantly higher among Atayal, Bunun, Rukai and suicide was significantly higher among Atayal and Bunun, but diabetes millitus was significantly lower among Paiwan. The SMR for ill-defined conditions was particular significantly higher among Tao tribe (5.17 for male and 6.62 for female) and indicating insufficient medical care.
The second part, leading causes of death among Taiwan Aborigines were analyzed from 1971 to 1995, and we separated these twenty five years to five periods, including 1971-1975, 1976-1980, 1981-1985, 1986-1990 and 1991-1995. The sex specific standardized mortality ratios were also calculated from death certificate data and compared with the number of expected death derived from the mortality of the total population in Taiwan, and the results were shown following:
The mortalities due to accidents, malignant neoplasmas, chronic liver disease and cirrhosis, tuberculosis and suicide were persistent significantly higher than expected in all the five periods. In the first four periods, mortality due to diabetes millitus was lower than expected, but it was no significantly difference in the last period (1991-1995). The mortality due to hypertensive disease was no significantly difference in first two periods and significantly higher than expected since 1981-1985 periods. The moralities due to cerebrovascular disease and heart disease were both significantly lower in early periods but significantly higher than expected since 1976-1980 and 1981-1985 period respectively.
The third part, SIR of malignant neoplasmas in Taiwan Aborigines were analyzed. In all 1911 cases of cancers had been reported in thirty Taiwanese Aboriginal communities between 1987 and 1994. In the same period, 159215 cancer cases were registered in Taiwan and categorized according to race, gender, site and frequency of occurrence. Sex and tribe-specific SIR with 95% confidence interval were calculated and the results were shown following:
In male, the most common cancer sites of Taiwan Aborigines were stomach, liver, lung, nasopharynx, colorectum, oral cavity/pharynx, esophagus, urinary bladder, prostate, hematopoietic and reticuloendothelial systems. In female, the most common cancer sites were cervix uteri, stomach, lung, colorectum, breast, liver nasopharynx, oral cavity/pharynx, hematopoietic and reticuloendothelial systems, and unknown primary site. In male, the SIR of gastric cancer and nasopharyngeal cancer were significantly higher than expected and the all sites cancer, hepatoma, lung cancer, colorectal cancer, oral cavity/pharynx cancer, urinary bladder cancer, hematopoietic and reticuloendothelial systems cancer were significantly lower. In female, gastric cancer, nasophayngeal cancer, oral cavity/pharynx cancer, esophageal cancer were significant higher, and all sites cancer, colorectal cancer and breast cancer were significantly lower. In male, SIR of gastric cancer is significantly higher among Atayal and Bunun and SIR of naspharyngeal cancer was significantly higher among Bunun, Paiwan and Rukai. In female, SIR of gastric cancer was significantly higher among Atayal and Bunun, nasopharyngeal caner was significantly higher among Bunun, Paiwan and Rukai, esophageal cancer was significantly higher among Bunun and Paiwan, oral cavity/pharynx cancer was significantly higher among Paiwan.

中文摘要 ……………………………………………………….. I
英文摘要 ……………………………………………………….. V
第一章 前言…………………………………………………… 1
第二章 文獻參考………………………………………………. 4
1.有關台灣原住民平均餘命、死因及死亡率的研究… 5
2.有關台灣原住民癌症發生比及死亡比的研究……… 6
3.原住民重要死因之個別研究………………………… 6
4.原住民重要癌症之個別研究…………………………10
第三章 材料與方法…………………………………………….14
第一節 原住民死因分析(1991-1997)………………………..15
第二節 原住民死因分析(1971-1995)………………………..19
第三節 原住民癌症標準化發生比分析(1987-1994)………..20
第四章 結果…………………………………………………….23
第一節 原住民死因分析(1991-1997) ………………………..23
1.三十個山地鄉原住民整體之分析………………….23
2.泰雅族……………………………………………….24
3.布農族……………………………………………….26
4.排灣族……………………………………………….27
5.魯凱族……………………………………………….28
6.達悟族（原雅美族）……………………………….29
7.鄒族………………………………………………….30
第二節 原住民死因分析(1971-1995)…………………………33
第三節 原住民癌症發生率之分析(1987-1994)………………36
1.三十個山地鄉原住民整體之分析………………….36
2.泰雅族……………………………………………….37
3.布農族……………………………………………….38
4.排灣族……………………………………………….39
5.魯凱族……………………………………………….40
6.達悟族（原雅美族）……………………………….41
7.鄒族………………………………………………….42
第五章 討論…………………………………………………….44
第一節 研究方法及資料限制的討論…………………………44
第二節 山地原住民死因分析的討論…………………………46
第三節 山地原住民癌症發生率的討論………………………50
參考文獻 ………………………………………………………52
圖表 ……………………………………………………………59

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