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研究生:葉宏明
研究生(外文):Horng-Ming Yeh
論文名稱:高危險群老人接種流行性感冒疫苗對死亡率的影響評估
論文名稱(外文):Risk Difference in Mortality Between Influenza Vaccinated and Non-vaccinated High Risk Cohort
指導教授:汪忠川汪忠川引用關係
指導教授(外文):Chong-Shan Wang
學位類別:碩士
校院名稱:國立成功大學
系所名稱:公共衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2002
畢業學年度:90
語文別:中文
論文頁數:69
中文關鍵詞:高危險群老人流感疫苗
外文關鍵詞:eldershigh risk goupflu vaccine
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流行性感冒是常見的傳染病,併發症常造成死亡,對於老年人口眾多的台灣,潛藏危機令人憂慮。流行性感冒引起的疾病負擔,不容易完全加以探知,在亞熱帶的台灣,也尚未經由流行病學方法確實的研究。衛生署在疑慮及雜音之下,辦理高危險群老人流行性感冒疫苗注射計畫。本研究是由民國88年10月高雄縣11,046位曾因糖尿病、心肺疾病住院的高危險群老人,注射後追蹤至民國89年12月底,研究接受流感疫苗注射與否對死亡率的影響。結果發現,接種組與未接種組在總死因死亡率的相差危險性-9.06%,95%信賴區間(-10.27%,-7.85%),相對危險0.45, 95%信賴區間(0.41, 0.51),預防分量55%。在糖尿病、心臟病、肺炎、慢性阻塞性肺病、腦中風、癌症等個別死因死亡率,也有顯著的差異。以先前住院的主或次診斷來區分,糖尿病患接種流感疫苗與否,對死亡率的相差危險性、相對危險, 預防分量,都有顯著意義的差別;先前住院診斷為心臟病、肺炎或慢性阻塞性肺病者,接種與否,死亡率也有顯著的差別。多變項對數複回歸分析發現,年齡、性別、與接種疫苗﹐是影響總死因死亡率的顯著因素。以糖尿病、心肺疾病等個別住院診斷來區分,接種疫苗與否,在對數複回歸分析,都有顯著意義的差別,而以腦中風和肺炎病患接種疫苗的保護效果最好。根據各月份死亡人數,以Kaplan-Meier曲線畫成存活分布圖,log-rank test檢驗發現接種與未接種組有顯著意義差異。
本研究證實,曾住院的高危險群,接種流感疫苗後,可顯著減少死亡率。這個結果對其他尚未推行流感注射計畫的國家,可望提供流行病學證據;醫護人員亦可據此結果,向民眾推廣,以求提高流感疫苗的注射率。
Free influenza vaccine program aimed at high risk cohort was implemented in Kaohsiung County, Taiwan, Oct 99, followed for 15 months. The purpose of the study was to compare the risk difference and risk ratio in mortality between influenza vaccinated and non-vaccinated high risk discharge patients. We collected data by retrospective cohort study. Subjects who had been admitted due to diabetic or cardiopulmonary diseases in previous 5 years was defined as high risk cohort, 5732 among them received influenza vaccination, and 5314 had not. We follow the high risk cohort from 1999 Oct to 2000 Dec by using mortality archives from national mortality statistics. Kaplan-Meier curves were used to demonstrate survival distribution and log-rank test showed significant difference. Risk difference of mortality from all possible causes between groups was —9.06% and risk ratio 0.45. The risk ratios and preventive fractions of cause-specific mortality due to malignant neoplasms, diabetics, cardiovascular diseases, cerebrovascular diseases, pneumonia, COPD, between the vaccinated and unvaccinated groups were significant. According to the major discharge diagnosis in previous discharge, diabetic subjects showed greatest difference in mortality between vaccinated and unvaccinated groups. Logistic regression analysis revealed that age, and vaccination were significant factors for all-cause mortality. High risk elders who had been admitted due to diabetic or cardiopulmonary diseases benefit substantially from influenza vaccination in reducing mortality.
第一章 序論
第一節問題背景 2
第二節研究動機 5
第三節研究目的 6
第四節論文架構 7
第五節研究假設 8
第二章 材料與方法
第一節流感疫苗接種計畫 9
第二節研究對象 10
第三節資料收集 11
第四節研究流程 12
第五節資料統計與分析 13
第六節住院及死因診斷分類定義 14
第三章 研究結果
第一節基本資料 16
第二節接種組與未接種組各月存活情形 19
第三節死亡者的基本資料 21
第四節各項死因別死亡率的差異 23
第五節對數複回歸分析 28
第六節依據先前住院主診斷接種疫苗與否死於同樣疾病的差異 30
第七節住院主或次診斷對死亡影響的對數複回歸分析 33
第四章 討論
第一節總論 34
第二節疫苗接種政策 37
第三節針對高危險群(出院病患)的接種策略 40
第四節疫苗接種率 42
第五節通知系統 44
第六節流感疫苗與個別疾病的關係 46
第七節研究限制 55
第八節結論與建議 58

參考文獻 60
附錄 66
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