臺灣博碩士論文加值系統

摘要
研究動機與目的：
區域間不同的醫療資源、社經地位、環境影響因素等皆是導致健康不平等的原因，而不同性別的心臟疾病死亡率是近幾年來國內外學者討論的議題。故本研究將欲探討區域不平等對心臟疾病死亡率之影響，且進一步檢視上述影響是否會因性別不同而有差異。
方法：
本研究為回溯性生態研究，以台灣2010-2016的死因檔統計358個鄉鎮市區之男性、女性心臟疾病死亡率，輔以鄉鎮市區為單位的網站公開統計資料。以描述性統計、Kruskal-Wallis test(K-W檢定) 、Spearman相關係數觀察區域不平等的分布及相關性，最後建立多元線性迴歸分析探討各類區域不平等因素對不同性別之心臟疾病死亡率的影響。
主要研究發現：
2010至2016臺灣每10萬人口心臟病死亡率，男性為793人，女性為649人。從複迴歸中得社會經濟較不劣勢地區、數位化發展較快地區、PM2.5濃度較低地區，則男性和女性死亡率皆顯著地比較低；較低社會參與環境地區、醫院密度最低地區，則男性和女性心臟病死亡率皆顯著地比較高。不過，空氣汙染對男性死亡率有比較大的影響效果；而社會參與環境與醫院密度對女性死亡率有比較大的影響效果。回歸模型解釋力，男性達54%，女性達68%。



結論：
臺灣各鄉鎮市區心臟病死亡率存在區域不平等之性別異同因素，呼籲政府可以從區域社會經濟、數位化發展、社會參與環境和空氣汙染著手，期以降低各地區環境因素導致健康不平等。
關鍵字:心臟疾病死亡率、區域不平等、性別差異、生態研究

Abstract
Background: Differences in medical resources, socioeconomic status, and environmental factors among the regions are the causes of health inequality. The death rates of heart diseases of different genders have been discussed by scholars at home and abroad in recent years. Therefore, this study will explore the impact of regional inequality on the mortality of cardiovascular disease, and further examine whether the above-mentioned factors have varying effects according to gender.
Method: This study uses an ecological study design, using statistics from the cause of death database from 2010-2016 in Taiwan to count the death rate of heart disease among men and women in 358 townships and towns, supplemented by public statistics on websites of townships and cities. Descriptive statistics, Kruskal-Wallis test, and Spearman correlation coefficient is used to observe the distribution and correlation of regional inequalities, and multivariate linear regression analysis is conducted to investigate the effects of various regional inequality factors on the mortality of heart disease of different genders.
Results: From 2010 to 2016, the death rate of heart disease per 100,000 people in Taiwan is 793 for men and 649 for women. Regression results showed that areas with lower level of deprivation, faster development of digitalization, and the lower concentration of PM2.5, the male and female mortality rates are significantly lower; in areas with lower social participation, and low hospital density the male and female heart disease mortality rates are significantly higher. However, air pollution has a relatively high effect on male mortality while social participation and hospital density have a relatively high effect on female mortality. Regression model explanatory power, males reached 54%, females reached 68%.
Conclusion: There are gender similarities as well as differences in regional inequality in heart disease mortality among urban and rural areas in Taiwan. The government is urged to start with improving regional socio-economic progress, digital development, social participation and air pollution, in order to reduce inequalities caused by environmental factors in different regions.
Key word: Cardiovascular Disease Mortality, Geographic Disparity, Gender Differences, Ecological study

目錄
摘要……………………………………………………………………………..i
Abstract..………………………………………………………………………iii
誌謝………………………………………………………………………….... v
目錄……………………………………………………………………………vi
圖目錄……………...…………………………………………………………vii
表目錄...…………………………………………………………………….. viii
第一章　緒論 9
第一節 研究背景與動機 9
第二節 研究重要性 11
第三節 研究目的 11
第二章　文獻探討 12
第一節 不同性別之心臟疾病流行病學 12
第二節 區域社會經濟對不同性別心臟疾病之影響 16
第三節 醫療資源對不同性別心臟疾病之影響 23
第四節 不同性別心臟疾病死亡率之地理區域環境影響因素 27
第五節 文獻小結 32
第三章　研究設計與方法 33
第一節 資料來源與研究對象 33
第二節 研究架構與研究假說 35
第三節 變項操作型定義 38
第四節 統計分析方法 42
第四章　研究結果 43
第一節 描述性統計 43
第二節　雙變項分析 47
第三節　線性複迴歸分析 53
第五章 討論 57
第一節 探討不同社會經濟程度與男、女心臟疾病死亡率之相關情形 57
第二節 探討其他地理區域環境影響因素與男、女心臟疾病死亡率之相關情形 59
第三節 探討醫院密度與男、女心臟疾病死亡率之相關情形 62
第六章　結論與建議 64
第一節 結論與建議 64
第二節 研究限制 65
參考資料 66

 
圖目錄
圖2-1-1　1980-2010年各國男女冠心病及中風死亡率 14
圖3-2-1　研究架構 36

表目錄
表2-2-1　數位化程度指標 18
表2-3-1　2011-2015年不同性別之門診及住院的醫療費用 24
表3-3-1　變項操作型定義說明 39
表4-1-1　描述性統計 45
表4-2-1　社會經濟因素、區域環境影響因素、醫療資源與控制變項之相關性 49
表4-2-2　地區劣勢、區域環境影響因素、醫療資源與控制變項之相關性 49
表4-2-3　數位化程度、區域環境影響因素、醫療資源與控制變項之相關性 50
表4-2-4　不同性別之心臟疾病死亡率之雙變項分析 51
表4-2-4　不同性別之心臟疾病死亡率之雙變項分析(續) 52
表4-3-1　不同性別心臟疾病死亡率之複迴歸分析結果之一 55
表4-3-2　不同性別心臟疾病死亡率之複迴歸分析結果之二 56

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