臺灣博碩士論文加值系統

本研究旨在探討若型2糖尿病患者於確診前一年患有共病症病史，對未來癌症發生率之影響。希望能有利於保險公司更了解糖尿病患者之共病症與癌症之間的關係，而對不同族群之患者實施差別訂價，達到讓保險公司設計出更具保費競爭力商品之效果。使用全民健康保險研究資料庫之「糖尿病人抽樣歸人檔」及「重大傷病證明明細檔」擷取資料。共病症定義採用Romano et al. (1993)整理歸納之查爾森共病症分群。並將45歲以上糖尿病患區間分為三個年齡組探討，定義之危險因子包含首次罹病年齡、性別及查爾森共病症。本研究之研究方法為利用 Kaplan-Meier product limit estimator 估計不同年齡組之癌症發生率，再以 Log-Rank Test 檢定可能之危險因子，最後利用 Cox proportional hazards model 建立危險函數模型。由研究結果可知，「45歲至54歲」及「55歲至64歲」年齡層中，男性之罹癌風險都較女性較大，可酌量調整保費。而「45歲至54歲」糖尿病患、無潰瘍性疾病病史，但曾患有中度或嚴重肝臟疾病或腎臟疾病之患者罹癌風險較高，可考慮將其拒保。「55歲至64歲」年齡層中之患者，不論是否曾患有潰瘍性疾病，只要曾患有腎臟疾病之患者罹癌風險皆較高，亦可酌量對保戶之保費進行調整。「65歲以上」年齡層之患者，須對男女進行不同之收費標準。其中，女性患者若曾患有腎臟疾病及潰瘍性疾病之患者，可予以加費。希望本研究之結果能提供保險公司透過健康告知書之資訊，了解需加費或拒保處理之患者，進而使得承保之糖尿病患者未來癌症發生率降低也可設計出更具保費競爭力之保險商品；對於糖尿病患者而言則可享有較公平合理之保費。

The purpose of this study is to explore the impact of comorbidities diagnosed a year before on the incidence rate of cancer in patients with type 2 diabetes. It is hoped that the study could help insurance companies to better understand the relationship between comorbidities and cancer in diabetic patients, and implement differential pricing for patients with different baseline illness, therefore allowing insurance companies to design products that are more competitive. We used the "Diabetes dataset (DM) " and "Registry for catastrophic illness Patients (HV)" from the National Health Insurance Research Database (NHIRD) in Taiwan. The definition of comorbidities in this study follow those of Romano et al. (1993)’s. Patients with diabetes were attributed to three different age groups. Risk factors included age, gender, and the Charlson comorbidity. We used the Kaplan-Meier Product Limit Estimator to estimate cancer incidences in three age groups, then log-rank test to identify possible risk factors. Finally, the Cox proportional hazards model for hazard function model. Based on our results, the risk of men suffering from cancer is greater than those in women in the age group of "45 to 54" and "55 to 64", suggesting that the premium can be adjusted accordingly. In the age group of "45 to 54", patients with no history of ulcer diseases, but with moderate or severe liver or renal diseases have a higher risk of suffering from cancer, suggesting that rejection to insured may be considered. In the "55-64" age group, patients who have suffered from renal diseases have higher incidence rate of cancer, regardless of history of ulcer diseases, therefore charging higher premium may be reasonable in this group of patients. Patients in the "65+" age group should be charged differently according to their gender. Among them, female patients who have suffered from renal diseases and ulcer diseases may be charged with higher premium. We hope that the results of this study can provide insurance companies guidance on identifying those who require higher premium or those that are more reasonable to reject, in order to establish products that are more competitive for patients with diabetes and low future incidence rate of cancer. In establishing more reasonable pricing, it is also fairer and give better protection to patients with type 2 diabetes.

第一章 緒論 ----------------------------------1
第二章 資料來源與名詞定義 -----------------------4
第一節 資料來源 --------------------------------4
第二節 名詞定義 --------------------------------5
第三章 研究方法 -------------------------------10
第一節Kaplan-Meier估計量及Log-Rank 檢定 -------10
第二節 Cox proportional hazards model --------10
第四章 研究結果 -------------------------------13
第一節 危險因子分析結果 ------------------------13
第二節 危險比率檢定 ----------------------------17
第三節 危險函數模型 ----------------------------24
第四節 基本存活函數 ----------------------------32
第五節 存活函數 --------------------------------33
第六節 保費試算 --------------------------------34
第五章 結論與討論 ------------------------------36
參考文獻 --------------------------------------38
附錄一 ----------------------------------------40
附錄二 ----------------------------------------45
附錄三 ----------------------------------------50

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