臺灣博碩士論文加值系統

目的：評估不同型態抽菸、喝酒和嚼檳榔習慣之全死因死亡率與平均餘命的差異。
方法：本研究結合兩個長期追蹤世代，居住在員山等19個鄉鎮市且年齡在30歲以上之社區居民，包括25,188名男性及15,445名女性，在追蹤11-19年後，經由與全國死亡檔作資料聯結，以評估單有抽菸、單有喝酒、單有嚼檳榔、合併有抽菸和喝酒、合併有抽菸和嚼檳榔、合併有喝酒和嚼檳榔及合併有抽菸、喝酒和嚼檳榔等不同型態之習慣組合的全死因死亡率和平均餘命的差異，並以Cox proportional hazards model來計算相對危險性和95%信賴區間。
結果：在11-19年之追蹤期間，男性有4,700名死亡個案，女性則有1,289名死亡個案。經統計分析發現，有抽菸習慣者比無抽菸習慣者，全死因相對危險性在男性為1.36倍(95%信賴區間：1.22-1.52)、女性為1.48倍(95%信賴區間：1.07-2.03)；有喝酒習慣者比無喝酒習慣者，全死因相對危險性在男性為1.3倍(95%信賴區間：1.17-1.45)、女性為0.87倍(95%信賴區間：0.61-1.24)；有嚼檳榔習慣者比無嚼檳榔習慣者，全死因相對危險性在男性為1.17倍(95%信賴區間：1.01-1.37)、女性為0.53倍(95%信賴區間：0.20-1.44)。而男性抽菸、喝酒和嚼檳榔三種習慣皆有者相對於三種習慣皆無者，其相對危險性為2.16倍(95%信賴區間：1.72-2.70)。平均餘命之分析結果顯示，在30歲時，男性抽菸者比從未抽菸者少了17%的壽命，有喝酒習慣者比無喝酒習慣者少了9%的壽命，而有嚼檳榔習慣者比無嚼檳榔習慣者少了5%的壽命。
結論：無論使用何種健康指標去評估上述不良習慣之危害，抽菸習慣對於台灣地區社區居民所造成之衝擊最大，更勝於喝酒和嚼檳榔習慣，故去除抽菸習慣應是對於維護健康最有效益的預防方法。

Objective：This study was aiming to examine the all-cause mortality and life expectancy in relation to different habitual patterns of cigarette smoking, alcohol drinking, and betel-nut chewing in Taiwan.
Methods：The present study was based on study populations from two prospective studies conducted in 19 townships in Taiwan including 25,188 men and 15,445 women aged above 30 years. The vital status of study subjects was assessed by data linkage with National Death Certification System during the follow-up period between 1982 and 2001. Cox proportional hazards model was used to calculate relative risks (RRs) and 95% confidence intervals (CIs).
Results：During the follow-up period, 4,700 men and 1,289 women died. The statistical analyses showed that the adjusted RR for all-cause mortality between smokers and nonsmokers was 1.34 (95% CI: 1.22-1.52) for men and 1.48 (95% CI: 1.07-2.03) for women. The adjusted RR between drinkers and nondrinkers was 1.3 (95% CI: 1.17-1.45) for men and 0.87 (95% CI: 0.61-1.24) for women. The adjusted RR between betel nut chewers and non-chewers was 1.17 (95% CI: 1.01-1.37) for men and 0.53 (95% CI: 0.20-1.44) for women. In men, as compared to subjects who were non-smoking, non-drinking, and non-betel nut chewing, individuals who were smoking, drinking, and betel nut chewing had 2.16 times (95% CI: 1.72-2.70) higher risk of all-cause mortality. In terms of life expectancy, compared with nonsmokers, smokers at age 30 had a 17% shorter life expectancy. Compared with nondrinkers, drinkers at age 30 had a 9% shorter life expectancy. Compared with betel nut non-chewers, chewers at age 30 had a 5% shorter life expectancy.
Conclusions：The study results indicate a more deleterious health effect of cigarette smoking than alcohol drinking and betel-nut chewing. From public health viewpoint, smoking cessation would prevent smoking-attributable premature deaths.

中文摘要 i
Abstract ii
第一章 前言 1
第一節 研究背景 1
第二節 研究目的 2
第二章 文獻探討 3
第一節 抽菸之危害與其所導致疾病之相關研究 3
第二節 喝酒之危害與其所導致疾病之相關研究 8
第三節 嚼檳榔之危害與其所導致疾病之相關研究 12
第三章 材料與方法 17
第一節 研究對象 17
第二節 統計分析 19
第四章 結果 22
第一節 研究個案基本人口學特徵與抽菸、喝酒、嚼檳榔習慣之分布 22
第二節 基本人口學特徵與全死因危險性單變項分析 26
第三節 抽菸、喝酒和嚼檳榔習慣與全死因危險性單變項分析 30
第四節 男性研究個案抽菸、喝酒和嚼檳榔習慣之全死因危險性合併分析 37
第五節 研究個案抽菸習慣與身體質量指數對於全死因死亡危險性之合併效應 39
第六節 全死因危險性之多變項分析 41
第七節 抽菸、喝酒和嚼檳榔習慣之平均餘命分析 45
第八節 累積死亡率分析 53
第五章 討論 55
參考文獻 70

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