臺灣博碩士論文加值系統

背景：出生體重型態改變是瞭解群體健康的重要之參考，而出生證明書電腦檔是研究此議題的重要資料來源，可惜國內沒有以此資料進行相關之研究。
目的：本研究有三個目的：一是想評估台灣出生證明書電腦檔的資料完整性與不合理情形的年代別差異；二是以台灣資料檢視不同剔除懷孕週數與出生體重不合理配對方法，選擇最適合的方法；三是呈現1978至1997年台灣出生體重型態改變之趨勢。
材料與方法 ：台灣出生證明書電腦檔由內政部提供，年代包括1978至1997年。關於懷孕週數與出生體重變項之遺漏與不合理分析是逐年分析，其餘分析都是選其中五年分析（1978,1983,1988,1993,1997）。剔除懷孕週數與出生體重不合理配對的方法包括：兩倍75與25百分位間距法、兩個標準差法、專家法與偏離常態分布機率法。低出生體重為出生體重小於2500公克，中低出生體重為出生體重1500-2499公克，極低出生體重為出生體重小於1500公克。早產為懷孕週數小於37週，足月產為懷孕週數大於等於37週。
研究結果：一、本研究發現台灣出生證明書電腦檔資料隨著年代增加品質逐年改善，最重要的兩個變項（出生體重與懷孕週數）在一九九十年代都已經低於2000人，相對於一年三十幾萬的出生數，這些遺漏數應該不會有重要影響。過去文獻探討出生結果經常使用的相關變項（胎次、胎別、生母出生年與生母教育程度）登錄不良率都非常低，但是高危險群（高胎次、多胞胎、生母年齡小於等於14歲、生母教育年數小於七年者）登錄不良率卻相對較高。二、本研究發現兩倍75與25百分位間距法與兩倍標準差法較不適用於台灣的資料。以Alexander等建議的專家法所剔除的不合理個案數大多發生在低懷孕週數，五個分析年間也沒有顯著差異。經過剔除後的資料所繪製的胎兒成長曲線圖的確較合理。三、本研究發現台灣地區由1978年至1997年出生體重型態之改變情形為：低出生體重率上升、出生體重平均值下降、較低出生體重（≦2250公克）分布百分比增加、較重出生體重（≧3500公克）分布百分比下降。細分足月產與早產發現低出生體重率都沒有明顯上升或下降趨勢，但是因為早產者的低出生體重率遠高於足月產者，再加上早產率逐年上升，兩者共同作用造成總低出生體重率逐年上升。
結論：解釋低出生體重率趨勢改變時，除了要考慮不同年代資料品質之改變、不同年代足月產與早產比例之改變，應該進行相關因素標準化之調整。台灣早產發生率逐年增加是造成低出生體重率增加的主要因素，未來研究應該同時探討多因素，對於問題之瞭解能更清楚。

Background： Changes in pattern of birthweight is an important reference for population health and birth certificate computerized file is the most often used resource. Nevertheless, there was no study use this dataset to reveal this important topic.
Objectives：There were three objectives in this study. First, to evaluate the completeness and implausibility of items in Taiwan birth certificate computerized file by years; second, to examine the different methods for excluding the implausible gestational age and birthweigh match and determine the suitable method for Taiwan; third, to illustrate the trends of changes in pattern of birthweight in Taiwan from 1978 to 1997.
Materials & methods: Taiwan birth certificate computerized files of year 1978 to 1997 were provided by Ministry of Internal Affair. For analysis of implausible gestational age (GA) and birthweight (BW) matches we used every year. For other analysis we used only the year of 1978,1983,1988,1993 and1997. Methods for excluding implausible GA and BW matches included: two inter 75 and 25 percentiles, two standard deviation, expert opinion and deviation from normal probability plot. BW <2500 gm was defined as low birthweight (LBW), 1500 gm <= BW <= 2499 gm was defined as moderate low birthweight (MLBW), BW < 1500 gm was defined as very low birthweight (VLBW). GA < 37 weeks was defined as preterm births and GA >= 37 weeks was defined as term births.
Results： 1. The quality of birth certificate computerized files improved yearly. The missing and implausible numbers of two most important two variables (GA and BW) were less than 2000 which were trivial as compared to total number of more than three hundred thousands. Missing rates of some variables (para, order, birth date, education of mother) increased among high risk groups (high parity, multipara, mother’s age less than 14, years of education less than 7). 2. The inter 75and 25 percentile and SD methods were not very useful in Taiwan data. Expert opinion method recommended by Alexander was used for further analysis. The number and rate of implausible GA and BW matches according to Alexander method did not changed across years. The fetal growth charts depicted according to the data cleaned by Alexander method seemed more acceptable. 3. LBW rate increased by years, median BW also decreased, percentage of lower BW categories (≦2250 gm) i ncreased by years and decreased for higer BW categories (≧3500gm). There were no obvious increasing or decreasing trends of LBW rate by term and preterm births. Because the preterm LBW rates were almost twenty times higher than term LBW rates yearly and the incidence of preterm births also increased. The combination of the two factors resulted in the increasing of total LBW rate.
Conclusions: To explain the changes in pattern of birthweight across years, we should first consider the changes in the quality data itself and than understand the changes in the proportion of preterm with term births. Factor standardized adjusted LBW rate was needed for trends analysis. Increasing of incidence of preterm births was the main cause of increasing of LBW rate. Multi-factorial analysis was needed in the future to better understand this problem.

目 錄
致謝 1
中文摘要 2
英文摘要 4
目錄 7
第一部分：台灣出生證明書電腦檔資料完整性與不合理性分析
前言 9
材料與方法 9
結果 10
討論 12
參考文獻 14
表一至表七 16
第二部分：台灣出生證明書電腦檔懷孕週數與出生體重不合理配對之分析
前言 23
材料與方法 24
結果 26
討論 26
參考文獻 28
表一至表四 31
圖一至圖三 35
附錄一至附錄五 38
第三部分：台灣地區低出生體重型態改變之分析
前言 43
文獻回顧 43
材料與方法 45
結果 46
討論 47
參考文獻 49
表一至表九 52
圖一至圖七 61
口試問答紀錄 68

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第二部分
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