臺灣博碩士論文加值系統

目標：國內外研究顯示父母-子女可能罹患相同疾病。於相同家庭環境和遺傳下，父母一方罹病，子女亦患病之機率隨之提高；此相同疾病之疾病種類及風險因素極需完整探究。隨著論人計酬與家庭責任醫師制度之政策推動，以家庭群聚角度進行共同疾病之檢視與預防更是不容小覷。本研究欲探討父母-子女罹患相同系統性疾病種類及相關因素，並檢視其盛行率。目前台灣此類全國性研究闕如，應可增進疾病理論及照護實務應用。
方法：採回溯性世代研究。以2002至2011年健保資料庫百萬抽樣歸人檔，擷取11,242對父母-子女(22,484人)樣本，經性別及年齡配對產生研究組及對照組(非父母-子女)為11,242對(共22,484人)。本研究以SAS 9.3進行卡方檢定、McNemar’s Test、二項式與多項式邏輯斯迴歸及集群分析(Cluster Analysis)。
結果：父母-子女易罹患傳染、精神、神經、泌尿、皮膚及骨骼系統性疾病；罹患相同疾病之相關因素有年齡、性別、投保身分別、投保金額、投保區域、都市化程度、疾病嚴重度等。配對結果發現父母-子女較非父母-子女顯著易罹患相同疾病。
結論：父母-子女易罹患相同疾病符合家庭生態系統理論。預防疾病更需朝向以家庭為單位，政府相關衛生單位與醫療機構應針對高風險家庭成員介入規劃與擬訂措施，達到疾病防治效益。

Purposes:Prior research reported that parent-child might suffer from concordant diseases. Family members share common risks from their living environments and also heredity, therefore, if one of parents suffers from illness, the odds of children for illness will be escalating. A comprehensive investigation on the varieties of concordant diseases and the risk factors among parent-child is certainly needed. In the midst of the implementation of the capitation reimbursement scheme and Family Physician System, prevention for concordant diseases with the approach of family cluster becomes extraordinarily important. This study sought to examine the concordant systemic diseases and the associated factors as well as the prevalence of concordant diseases among parent-child. There is a dearth of nationally-representative study on this domain in Taiwan. Study results can provide valuable information for advancing preventive medicine and healthcare practices on family units.
Methods: In a retrospective cohort design, the current study analyzed the medical claims data extracted from 1,000,000 randomly sampled beneficiaries recorded in the 2002-2011 Taiwan National Health Insurance Research Database, which include 11,242 parent-child (22,484individuals) identified. The study and control groups (nonparent-child) were matched to 11,242 pairs (total 22,484 individuals) by identical gender and age. Analysis methods include Chi-square, McNemar’s test, binomial and multinomial logistic regression, and cluster analysis performed in SAS 9.3.
Results:Concordant systemic diseases among parent-child include infection, psychiatry, neurology,uropathy, dermatology, and orthopedics. The factors associated with the concordance include age,sex,beneficiary category, premium, region, urbanization, and severity of illness. The results of matching indicated that parent-child was more likely to encounter concordant diseases than non parent-child did.
Conclusion:That parent-child tends to suffer from concordant diseases echoes with the Ecological System Theory.Disease prevention may need to emphasize more on the family-based practices.The authorities and healthcare organizations should target family members of high risk, in endeavoring to establish intervention plans and related measures for preventing concordant diseases effectively.

摘要 i
Abstract ii
誌謝 iv
目錄 v
表目錄 vii
圖目錄 xx
第一章 緒論 1
第一節、研究背景與動機 1
第二節、研究重要性 4
第三節、研究目的 5
第二章 文獻探討 6
第一節、家庭群聚之疾病 6
第二節、父母與子女罹患相同疾病之疾病種類 6
第三節、罹患相同疾病之原因與理論 11
第四節、相關因素 17
第五節、文獻小結 19
第三章 研究設計與方法 22
第一節、研究架構 22
第二節、研究對象與資料來源 28
第三節、研究工具 33
第四節、研究變項操作型定義 33
第五節、分析方法 36
第四章 研究結果 41
第一節、被依附人及子女罹患相同疾病之描述性分析 41
第二節、卡方獨立性檢定 60
第三節、McNemar’s Test 126
第四節、邏輯斯迴歸分析 139
第五節、集群分析 351
第五章 討論 360
第一節、父母-子女罹患相同系統性疾病種類之盛行率 360
第二節、父母-子女共同罹患之疾病 364
第三節、父母-子女罹患相同系統性疾病種類之相關因素 367
第四節、父母-子女罹患相同系統性疾病種類之原因與理論 370
第六章 結論與建議 373
第一節、結論 373
第二節、貢獻 375
第三節、建議 376
第四節、研究限制 378
英文參考文獻 379
中文參考文獻 384

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Arteche, A., & Murray, L. (2011). Maternal Affective Disorder and Children''s Representation of Their Families. Journal of Child & Family Studies, 20(6), 822-832.
Bayless, T. M., Tokayer, A. Z., Polito, J. M., 2nd, Quaskey, S. A., Mellits, E. D., & Harris, M. L. (1996). Crohn''s disease: concordance for site and clinical type in affected family members--potential hereditary influences. Gastroenterology, 111(3), 573-579.
Bener, A., Janahi, I. A., & Sabbah, A. (2005). Genetics and environmental risk factors associated with asthma in schoolchildren. Eur Ann Allergy Clin Immunol, 37(5), 163-168.
Bengtson, M. B., Solberg, C., Aamodt, G., Jahnsen, J., Moum, B., Sauar, J., & Vatn, M. H. (2009). Clustering in time of familial IBD separates ulcerative colitis from Crohn''s disease. Inflamm Bowel Dis, 15(12), 1867-1874.
Bermejo, J. L., & Hemminki, K. (2005). Familial Risk of Cancer Shortly After Diagnosis of the First Familial Tumor. Journal of the National Cancer Institute, 97(21), 1575-1579.
Bjerg, A., Hedman, L., Perzanowski, M. S., Platts-Mills, T., Lundback, B., & Ronmark, E. (2007). Family history of asthma and atopy: in-depth analyses of the impact on asthma and wheeze in 7- to 8-year-old children. Pediatrics, 120(4), 741-748.
Borch-Johnsen, K., Olsen, J. H., & Sorensen, T. I. (1994). Genes and family environment in familial clustering of cancer. Theor Med, 15(4), 377-386.
Cantani, A., & Micera, M. (2011). A study on 300 asthmatic children, 300 controls and their parents confirms the genetic transmission of allergy and asthma. Eur Rev Med Pharmacol Sci, 15(9), 1051-1056.
Chang, K. D., Steiner, H., & Ketter, T. A. (2000). Psychiatric phenomenology of child and adolescent bipolar offspring. J Am Acad Child Adolesc Psychiatry, 39(4), 453-460.
Czene, K., & Hemminki, K. (2002). Kidney cancer in the Swedish Family Cancer Database: Familial risks and second primary malignancies. Kidney International, 61(5), 1806-1813.
Deyo, R. A., Cherkin, D. C., & Ciol, M. A. (1992). Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal Of Clinical Epidemiology, 45(6), 613-619.
Dong, G-H., Wang, D., Yang, Z-H., Zhang, P-F., Ren, W-H., Zhao, Y-D., & He, Q-C. (2011). Gender-specific differences in effects of prenatal and postnatal environmental tobacco smoke exposure on respiratory symptoms in 23,474 children with and without allergic predisposition: results from 25 districts of northeast China. International Journal of Environmental Health Research, 21(3), 173-188.
Duse, M., Donato, F., Porteri, V., Pirali, F., Spinoni, V., Tosoni, C., Vettore, M.,&Lombardi, C. (2007). High prevalence of atopy, but not of asthma, among children in an industrialized area in North Italy: The role of familial and environmental factors – a population-based study. Pediatric Allergy & Immunology, 18(3), 201-208.
Eva D-D., Yolanda B., Tomas A., Magdalena H., Alberto F. d. S., &Silvia d. S. (2005). Family clustering of blood cancers as a risk factor for lymphoid neoplasms. haematologica/the hematology journal, 90(3), 416-418.
Ericson, K., Nilbert, M., Bladstrom, A., Anderson, H., Olsson, H., & Planck, M. (2004). Familial risk of tumors associated with hereditary non-polyposis colorectal cancer: a Swedish population-based study. Scandinavian Journal of Gastroenterology, 39(12), 1259-1265.
Faraone, SV., & Doyle, AE. (2000). Genetic influences on attention deficit hyperactivity disorder. Current Psychiatry Reports, 2(2), 143-146.
Gomez-Garcia, A., Rangel-Garcia, L., & Alvarez-Aguilar, C. (2012). Estudio transversal para evaluar el riesgo cardiovascular en los hijos de padres con diabetes mellitus o hipertension arterial. SEMERGEN - Medicina de Familia, 38(5), 278-284.
Gilman, E. A., Wilson, L. M., Kneale, G. W., & Waterhouse, J. A. (1989). Childhood cancers and their association with pregnancy drugs and illnesses. Paediatric And Perinatal Epidemiology, 3(1), 66-94.
Hatakka, K., Piirainen, L., Pohjavuori, S., Poussa, T., Savilahti, E., & Korpela, R. (2009). Allergy in day care children: prevalence and environmental risk factors. Acta Paediatrica, 98(5), 817-822.
Hatfield, E., Cacioppo, J T., & Rapson, R L. (1993). Emotional Contagion. Current Directions in Psychological Science (Wiley-Blackwell), 2(3), 96-99.
Hemminki, K., Sundquist, J., & Ji, J. (2007). Familial risk for gastric carcinoma: an updated study from Sweden. British Journal of Cancer, 96(8), 1272-1277.
Hemminki, K., Sundquist, J., & Bermejo, J. L. (2008). How common is familial cancer? Ann Oncol, 19(1), 163-167.
Hoti, F., Tuulio-Henriksson, A., Haukka, J., Partonen, T., Holmstrom, L., & Lonnqvist, J. (2004). Family-based clusters of cognitive test performance in familial schizophrenia. BMC Psychiatry, 4, 20-13.
Jasperson, KW., Tuohy, T M., Neklason, DW., & Burt, RW. (2010). Hereditary and familial colon cancer. Gastroenterology, 138(6), 2044-2058.
Jonsson, S., Thorsteinsdottir, U., Gudbjartsson, DF., Jonsson, HH., Kristjansson, K., Arnason, S., Gudnason, V., Isaksson, H J., Hallgrimsson, J., Gulcher, JR., Amundadottir, LT. , Kong, A., Stefansson, K. (2004). Familial Risk of Lung Carcinoma in the Icelandic Population. Journal of the American Medical Association, 292(24), 2977-2983.
Landman-Peeters, KM. C., Ormel, J., Van Sonderen, EL. P., Den Boer, JA., Minderaa, RB., & Hartman, CA. (2008). Risk of emotional disorder in offspring of depressed parents: gender differences in the effect of a second emotionally affected parent. Depression & Anxiety (1091-4269), 25(8), 653-660.
Langton, EG., Collishaw, S., Goodman, R., Pickles, A., & Maughan, B. (2011). An Emerging Income Differential for Adolescent Emotional Problems. Journal of Child Psychology and Psychiatry, 52(10), 1081-1088.
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