臺灣博碩士論文加值系統

研究動機與背景 隨著社會型態、經濟結構及生活環境的轉變，台灣的人口結構與疾病型態亦同時發生轉變。慢性病在近年來，已經成為台灣地區十大死因的疾病類型。在抽菸、喝酒等危害行為越來越受民眾重視，且有減少的趨勢下，飲食與疾病的關係將倍受重視。因此本篇探討社會經濟地位與飲食型態的關係，以及和疾病的相關。
研究方法 使用1993-1996年台灣地區國民營養狀況變遷調查，排除缺漏的資料後共4042人（男性2017人，女性2025人）。飲食型態是以集群分析方法，作為飲食型態的分群。社經地位與飲食型態的關係，以多重類別邏輯斯迴歸來分析；疾病危險性則是以邏輯斯迴歸來分析。
研究結果 個人社經地位較高飲食型態也比較健康，地區收入高的比較不容易有健康的飲食型態。教育年數、地區失業率高的人都有同樣的趨勢，即攝取較高油脂類的食物，但同時亦多攝取蔬菜水果。居住在地區收入高的人，其慢性病罹患率高於地區收入低的的人。
建議 研究者建議，將來有關社經地位與飲食型態的研究，可以加入個人收入、地區都市化程度，以及食物購買能力及取得的便利性，這樣關於飲食型態以及社經地位的討論，將更加完整。

Objective:
This study aimed to investigate relationship between the socioeconomic status (SES), dietary patterns and chronic disease.
Method:
By using data from Nutrition and Health Survey in Taiwan (NAHSIT) 1993-1996, 4042 samples were analyzed with aged 18 to 64. Educational level and occupational status were used as indicators of individual level socioeconomic status, area unemployment rate and area household income were used as indicators of area level socioeconomic status. Dietary pattern was measured using food frequency (weekly) by cluster analysis. Socioeconomic status and dietary pattern were assumed to affect chronic disease, and the effects were examined by multinomial logistic regression and logistic regression.

Result:
Individual-base level socioeconomic status higher, dietary pattern more health, and the higher of ‘area household income’ the less healthy dietary pattern. The people with high education level and living in high area unemployment rate have the conflict dietary patterns, that is, they liked to eat fat and meat, at the same time also liked to eat vegetable and fruit.

Conclusion and Suggestion:
We suggest that the individual income, development of city, food purchasing ability and access to food should be the independent factors in the future study model, to clarify the relationship between socioeconomic status and dietary pattern.

第一章、 前言 1
第二章、 文獻探討 3
第一節、社經地位 3
第二節、飲食型態 7
第三節、社經地位、飲食型態與健康的關係 11
第三章、 研究方法 18
第一節、研究架構 18
第二節、研究材料 19
第三節、抽樣工具 21
第四節、資料分析 23
第五節、研究變項操作型定義 25
第六節、研究目的與研究假設 32
第四章、 研究結果 33
第一節、基本人口學特質 34
第二節、飲食型態集群分析結果 36
第三節、人口學特性、飲食方面、疾病狀況之雙變項分析 39
第四節、邏輯斯迴歸 53
第五章、 結論與討論 62
第一節、結論 62
第二節、討論 66
第三節、研究限制 75
第四節、建議 76
參考文獻 77
































表目錄
表1-1、研究對象的基本特性分佈n=4042 82
表1-2、研究對象的飲食相關分佈n=4042 83
表1-3、研究對象的疾病狀況部分n=4042 84
表2-1、慢性病與人口特質分佈n=4039 85
表2-2、心血管疾病罹患百分比與人口特質分佈n=4041 86
表2-3、糖尿病罹患百分比與人口特質分佈n=4042 87
表2-4、腸胃道疾病罹患百分比與人口特質分佈n=4041 88
表2-5、肝臟疾病罹患百分比與人口特質分佈n=4041 89
表2-6、腎臟疾病罹患百分比與人口特質分佈n=4042 90
表3-1、營養知識分數與人口特質分佈n=3950 91
表3-2、飲食型態集群與基本分佈n=4042 92
表3-3、飲食型態集群與健康相關雙變項分析n=4042 93
表3-5、地區收入與健康相關行為之雙變項分析 95
表4-1、飲食型態集群之多重類別邏輯模式分析n=3832 96
表4-2、慢性病有無之邏輯斯迴歸 98
表4-3、心血管疾病有無邏輯斯迴歸 99
表4-4、糖尿病之邏輯斯迴歸 100
表4-5、腸胃道疾病之邏輯斯迴歸 101
表4-6、肝臟疾病之邏輯斯迴歸 102
表4-7腎臟疾病之邏輯斯迴歸 103
附錄 104

一、英文文獻
Beaudry, M., Galibois, I., & Chaumette, P. (1998). Dietary patterns of adults in quebec and their nutritional adequacy. Can J Public Health, 89(5), 347-351.
Brancati, F. L., Whelton, P. K., Kuller, L. H., & Klag, M. J. (1996). Diabetes mellitus, race, and socioeconomic status. A population-based study. Ann Epidemiol, 6(1), 67-73.
Chen, E., Martin, A. D., & Matthews, K. A. (2006). Socioeconomic status and health: Do gradients differ within childhood and adolescence? Soc Sci Med, 62(9), 2161-2170.
Chuang SY, Chan CH, Tsai ST, Chou P(2004). Clinical identification of the metabolic syndrome in Kimmen. Acta Cardiol Sin. 18: 16-23, 2002.
Kant, A. K. Dietary patterns and health outcomes. J Am Diet Assoc, 104(4), 615-635.
Dominguez-Berjon, F., Borrell, C., Rodriguez-Sanz, M., & Pastor, V. (2006). The usefulness of area-based socioeconomic measures to monitor social inequalities in health in southern europe. Eur J Public Health, 16(1), 54-61.
Fonseca, M. J., Chor, D., & Valente, J. G. (1999). [eating habits among employees of a state-owned bank: Food consumption profile]. Cad Saude Publica, 15(1), 29-39.
Fukuda, Y., Nakamura, K., & Takano, T. (2005). Socioeconomic pattern of smoking in japan: Income inequality and gender and age differences. Ann Epidemiol, 15(5), 365-372.
Hu, F. B. (2002). Dietary pattern analysis: A new direction in nutritional epidemiology. Curr Opin Lipidol, 13(1), 3-9.
Hulshof, K. F., Brussaard, J. H., Kruizinga, A. G., Telman, J., & Lowik, M. R. (2003). Socio-economic status, dietary intake and 10 y trends: The dutch national food consumption survey. Eur J Clin Nutr, 57(1), 128-137.
Kant, A. K. (2004). Dietary patterns and health outcomes. J Am Diet Assoc, 104(4), 615-635.
Klatsky, A. L., Armstrong, M. A., & Friedman, G. D. (1990). Risk of cardiovascular mortality in alcohol drinkers, ex-drinkers and nondrinkers. Am J Cardiol, 66(17), 1237-1242.
Klatsky, A. L., Armstrong, M. A., & Kipp, H. (1990). Correlates of alcoholic beverage preference: Traits of persons who choose wine, liquor or beer. Br J Addict, 85(10), 1279-1289.
Knoops, K. T., de Groot, L. C., Kromhout, D., Perrin, A. E., Moreiras-Varela, O., Menotti, A., et al. (2004). Mediterranean diet, lifestyle factors, and 10-year mortality in elderly european men and women: The hale project. Jama, 292(12), 1433-1439.
Krieger, N., Chen, J. T., & Ebel, G. (1997). Can we monitor socioeconomic inequalities in health? A survey of u.S. Health departments' data collection and reporting practices. Public Health Rep, 112(6), 481-491.
Laaksonen, M., Prattala R, V, H., A, U., & E, L. (2003). - income and health behaviours. Evidence from monitoring surveys among finnish adults. Journal of Epidemiology & Community Health. 57(9):711 7, 2003 Sep.
Larrea, C., & Kawachi, I. (2005). Does economic inequality affect child malnutrition? The case of ecuador. Soc Sci Med, 60(1), 165-178.
Lee TK, Huang ZS, Ng SK, Chan KWA, Wang YS, (1995). Impact of alcohol consumption and cigarette smoking on stroke among the elderly inTaiwan. Stroke. 26: 790-794.
Macintyre, S. (1997). The black report and beyond: What are the issues? Soc Sci Med, 44(6), 723-745.
Martikainen, P. B. E. M. M. (2003). - socioeconomic differences in dietary patterns among middle-aged men and women. Social Science & Medicine. 56(7):1397 410, 2003 Apr.
Millen, B. E., Quatromoni, P. A., Pencina, M., Kimokoti, R., Nam, B. H., Cobain, S., et al. (2005). Unique dietary patterns and chronic disease risk profiles of adult men: The framingham nutrition studies. J Am Diet Assoc, 105(11), 1723-1734.
Milligan, R. A., Burke, V., Beilin, L. J., Dunbar, D. L., Spencer, M. J., Balde, E., et al. (1998). Influence of gender and socio-economic status on dietary patterns and nutrient intakes in 18-year-old australians. Aust N Z J Public Health, 22(4), 485-493.
Moreira, P. A., & Padrao, P. D. (2004). Educational and economic determinants of food intake in portuguese adults: A cross-sectional survey. BMC Public Health, 4, 58.
Moss, N. (1997). The body politic and the power of socioeconomic status. Am J Public Health, 87(9), 1411-1413.
Pollard, J., Greenwood, D., Kirk, S., & Cade, J. (2001). Lifestyle factors affecting fruit and vegetable consumption in the uk women's cohort study. Appetite, 37(1), 71-79.
Renaud, S. C., Gueguen, R., Conard, P., Lanzmann-Petithory, D., Orgogozo, J. M., & Henry, O. (2004). Moderate wine drinkers have lower hypertension-related mortality: A prospective cohort study in french men. Am J Clin Nutr, 80(3), 621-625.
Rozin, P., Fischler, C., Imada, S., Sarubin, A., & Wrzesniewski, A. (1999). Attitudes to food and the role of food in life in the u.S.A., japan, flemish belgium and france: Possible implications for the diet-health debate. Appetite, 33(2), 163-180.
Ruidavets, J. B., Bataille, V., Dallongeville, J., Simon, C., Bingham, A., Amouyel, P., et al. (2004). Alcohol intake and diet in france, the prominent role of lifestyle. Eur Heart J, 25(13), 1153-1162.
Slattery, M. L., Boucher, K. M., Caan, B. J., Potter, J. D., & Ma, K. N. (1998). Eating patterns and risk of colon cancer. Am J Epidemiol, 148(1), 4-16.
Steenland, K., Henley, J., Calle, E., & Thun, M. (2004). Individual- and area-level socioeconomic status variables as predictors of mortality in a cohort of 179,383 persons. Am J Epidemiol, 159(11), 1047-1056.
Trudeau, E., Kristal, A. R., Li, S., & Patterson, R. E. (1998). Demographic and psychosocial predictors of fruit and vegetable intakes differ: Implications for dietary interventions. J Am Diet Assoc, 98(12), 1412-1417.
Tucker, K. L., Dallal, G. E., & Rush, D. (1992). Dietary patterns of elderly boston-area residents defined by cluster analysis. J Am Diet Assoc, 92(12), 1487-1491.
Turrell, G., Blakely, T., Patterson, C., & Oldenburg, B. (2004). A multilevel analysis of socioeconomic (small area) differences in household food purchasing behaviour. J Epidemiol Community Health, 58(3), 208-215.
Turrell, G., & Kavanagh, A. M. (2006). Socio-economic pathways to diet: Modelling the association between socio-economic position and food purchasing behaviour. Public Health Nutr, 9(3), 375-383.
Ursin, G., Ziegler, R. G., Subar, A. F., Graubard, B. I., Haile, R. W., & Hoover, R. (1993). Dietary patterns associated with a low-fat diet in the national health examination follow-up study: Identification of potential confounders for epidemiologic analyses. Am J Epidemiol, 137(8), 916-927.
Wamala, S. P., Lynch, J., & Kaplan, G. A. (2001). Women's exposure to early and later life socioeconomic disadvantage and coronary heart disease risk: The stockholm female coronary risk study. Int J Epidemiol, 30(2), 275-284.
Williams, J. M., Currie, C. E., Wright, P., Elton, R. A., & Beattie, T. F. (1997). Socioeconomic status and adolescent injuries. Soc Sci Med, 44(12), 1881-1891.
Winkleby, M. A., Jatulis, D. E., Frank, E., & Fortmann, S. P. (1992). Socioeconomic status and health: How education, income, and occupation contribute to risk factors for cardiovascular disease. Am J Public Health, 82(6), 816-820.
二、中文文獻
行政院衛生署(2002)。衛生統計。台北市：行政院衛生署。
行政院衛生署(2003)。衛生統計。台北市：行政院衛生署。
李 蘭、潘文韓、葉文婷（1999）。1993-1996 年台灣民眾之營養飲食知識及飲食行為調查結果：國民營養現況：1993-1996 國民營養健康狀況變遷調查結果（修訂版）。行政院衛生署；131-144。
李宜家(2003)。地區剝奪程度、個人社經地位與臺灣男性成人的吸菸行為。台灣公共衛生雜誌，22(1)；10-16
林姿伶(2000)。台灣地區18-64歲國人飲食型態研究。未出版之碩士論文，國立臺灣大學衛生政策與管理研究所，台北市。
林師模、陳苑欽(2003)。多變量分析。台北：雙葉書廊。
郝立智(2005)。美國糖尿病學會針對糖尿病合併高血脂之標準治療建議。內科學誌，16(4)；169-174
張紹勳、張紹評、林秀娟(2000)。多變量統計分析。台北：松崗。
張順全、賴美淑(2005)。台灣地理區域社經差異與糖尿病患罹病、死亡的關聯性探討。醫護科技學刊，7(2)；140-148。
陳淑娟(1999)。營養師國考大補帖/公共衛生營養學。台北：合記。
梁文薔(2006)。三十年來飲食與營養的回顧與前瞻。健康世界，241；87-93。
潘文涵、高美丁、曾明淑、李蘭、洪永泰、李隆安、蕭信雲、葉文婷、黃伯超(1999)。調查設計、執行方式、及內容。國民營養現況：1993-1996 國民營養健康狀況變遷調查結果（修訂版）。行政院衛生署，1-8。
錢美伃(2003)。台灣地區老人飲食攝取與心血管疾病危險因子之探討。未出版之碩士論文，國防醫學院公共衛生學研究所，台北縣。