臺灣博碩士論文加值系統

目的：癌症病患是感染流行性感冒的高危險族群，而且，自1982年以來癌症一直高居台灣死亡原因的第一位。研究顯示，雖然癌症病患接種流行性感冒疫苗後產生的抗體是相似於一般族群，但是，台灣地區並未特別加強癌症病患接種流行性感冒疫苗的政策，也未有癌症病患感染流行性感冒的相關流行病學研究，因此，本研究目的為探討癌症病患因感染流行性感冒及相關肺炎住院所造成的疾病負擔與醫療成本花費，以提供未來接種流行性感冒疫苗政策之參考。
方法：本研究是收集1997至2003年全民健康保險研究資料庫的住院資料。所有因主診斷碼為流行性感冒及相關肺炎住院的病人均被納入研究對象，次診斷碼則是選取癌症病患。由這些資料分析癌症病患因流行性感冒及相關肺炎住院的住院平均天數、醫療資源耗用和醫療費用，並且，利用衛生署衛生統計和台灣癌症登記資料庫的資料估算每年癌症病患的存活人口數，以估計每年癌症病患因流行性感冒及相關肺炎住院的住院發生率。
結果：1997年至2003年共有1,410位癌症病患因流行性感冒及相關肺炎住院，所有癌症病患因感染流行性感冒及相關肺炎住院的住院發生率是非癌症病患的1.58倍。與一般族群比較，所有癌症病患因感染流行性感冒及相關肺炎住院後的住院平均天數較長(12天 vs. 5天，P<0.0001)，住院期間較需要接受插管治療(2.27% vs. 0.10%，P<0.0001)。癌症病患因流行性感冒及相關肺炎住院之平均住院一天健保支付的醫療費用約為台幣5,587元，每次住院健保支付的總醫療費用約為台幣71,411元，每年健保需支付癌症病患因感染流行性感冒及相關肺炎住院的醫療費用總共為台幣14,384,216元。
結論：癌症病患感染流行性感冒及相關肺炎住院是台灣地區重要的公共衛生問題，未來應加強癌症病患施打流行性感冒疫苗之政策，以減少其感染流行性感冒及相關肺炎後所造成的住院治療數、死亡數和經濟負擔。

Aims：Cancer patients are high risk group of infecting influenza, and cancer is the first cause of death in Taiwan since 1982. Most articles mentioned the humoral response to influenza immunization in cancer patients was similar to general population, but the recommended influenza vaccination schedule doesn’t reinforce cancer patients in Taiwan. In the same time, epidemiology studies of influenza related infections in cancer patients are rare. Therefore, the purpose of this study is to analyze the disease burden and medical costs of influenza and related pneumonia in cancer patients for the recommended influenza vaccination schedule in the future.
Methods：From the NHI Research Database of 1997-2003, we created a sample included discharges with principle diagnosis code for influenza and related pneumonia and next four diagnosis codes for cancer. We analyzed the influenza and related pneumonia hospitalizations in terms of average length of stay, resource utilization and expense in cancer patients. Furthermore, using information of Health and National Health Insurance Annual Statistics and Taiwan Cancer Registration System to estimate the cancer patients and described the rates of influenza and related pneumonia hospitalizations in cancer patients.
Results：Between 1997 and 2003, there were 1,410 cancer patients who hospitalized with influenza and related pneumonia. The estimated rate for influenza and related pneumonia hospitalization in the cancer patients was higher than non-cancer patients, and the cancer-non-cancer hospitalization RR for hospitalization due to influenza and related pneumonia infections was 1.58. Comparing to general population, cancer patients with diagnosed influenza and related pneumonia of the average length of stay was longer (12 days vs. 5 days，P<0.0001), and needed more further mechanical or artificial ventilation during hospitalization (2.27% vs. 0.10%，P<0.0001). Moreover, mean medical cost was NT 5,587/day, mean medical cost of each hospital stay was NT 71,411, and total costs were NT 14,384,216/year.
Conclusions：Cancer patients who hospitalized with influenza and related pneumonia were a serious public health problem in Taiwan. To reinforce the recommended influenza vaccination schedule for cancer patients and reduce hospitalizations, deaths and economic burden in this highly susceptible population.

摘要-------------------------------------------------------------------------------------I
Abstract--------------------------------------------------------------------------------II
誌謝-------------------------------------------------------------------------------------IV
表目錄---------------------------------------------------------------------------------VII
圖目錄----------------------------------------------------------------------------------IX
第一章 緒論
第一節 研究背景------------------------------------------------------------------------------1
第二節 研究目的------------------------------------------------------------------------------3
第二章 文獻探討
第一節 流行性感冒---------------------------------------------------------------------------4
第二節 流行性感冒病毒---------------------------------------------------------------------5
第三節 傳播方式------------------------------------------------------------------------------6
第四節 臨床表徵------------------------------------------------------------------------------7
第五節 流行性感冒的流行病學------------------------------------------------------------8
第六節 流行性感冒疫苗-------------------------------------------------------------------17
第三章 材料與方法
第一節 資料來源----------------------------------------------------------------------------20
第二節 研究對象----------------------------------------------------------------------------21
第三節 變項定義----------------------------------------------------------------------------23
第四節 統計方法----------------------------------------------------------------------------24
第四章 研究結果
第一節 基本人口學資料-------------------------------------------------------------------25
第二節 因流行性感冒及相關肺炎住院之住院發生率-------------------------------26
第三節 因流行性感冒及相關肺炎住院之住院平均天數、醫療費用與醫療資源的耗用-----------------------29
第五章 討論--------------------------------------------------------------------------37
第六章 研究限制--------------------------------------------------------------------42
第七章 結論與建議-----------------------------------------------------------------43
參考文獻
英文部份---------------------------------------------------------------------------------------44
中文部分---------------------------------------------------------------------------------------47
表----------------------------------------------------------------------------------------48
圖----------------------------------------------------------------------------------------74
附錄-------------------------------------------------------------------------------------79
自述-------------------------------------------------------------------------------------85

表 目 錄
表一、感冒和流行性感冒症狀之區別-----------------------------------------------------------48
表二、各國因流行性感冒或疑似流行性感冒所造成之疾病影響結果---------------------49
表三、施打流行性感冒疫苗的效果---------------------------------------------------------------50
表四、1997-2003年因流感及相關肺炎住院病患之基本人口學資料----------------------51
表五、1997-2003年所有癌症與非癌症病患在不同性別、年齡層因流感及相關肺炎住院之住院發生率---52
表六、1997-2003年男性所有癌症與非癌症病患在不同年齡層因流感及相關肺炎住院之住院發生率-----53
表七、1997-2003年女性所有癌症與非癌症病患在不同年齡層因流感及相關肺炎住院之住院發生率-----54
表八、所有癌症與非癌症病患因流感及相關肺炎住院之住院發生率--------------------55
表九、男性所有癌症與非癌症病患因流感及相關肺炎住院之住院發生率---------------56
表十、女性所有癌症與非癌症病患因流感及相關肺炎住院之住院發生率---------------57
表十一、0-19歲所有癌症與非癌症病患因流感及相關肺炎住院之住院發生率---------58
表十二、20-64歲所有癌症與非癌症病患因流感及相關肺炎住院之住院發生率-------59
表十三、65歲以上所有癌症與非癌症病患因流感及相關肺炎住院之住院發生率-----60
表十四、1997-2003年所有癌症與非癌症病患在不同性別、年齡層因流感及相關肺炎住院之住院發生率比較----61
表十五、1997-2003年所有癌症病患因流感及相關肺炎住院之住院平均天數、插管治療比例及醫療費用之比較----62
表十六、1997-2003年所有癌症與非癌症病患因流感及相關肺炎住院之住院平均天數的比較----63
表十七、1997-2003年所有癌症與非癌症病患因流感及相關肺炎住院之醫療費用(元/天)的比較-----64
表十八、1997-2003年所有癌症與非癌症病患因流感及相關肺炎住院之總醫療費用(元/次)的比較-----65
表十九、1997-2003年所有癌症與非癌症病患因流感及相關肺炎住院之醫療資源耗用的比較-----66
表二十、1997-2003年單純癌症病患、慢性疾病患者、癌症合併慢性疾病患者和一般族群因流感及相關肺炎住院之住院平均天數的比較-------------67
表二十一、1997-2003年單純癌症病患、慢性疾病患者、癌症合併慢性疾病患者和一般族群因流感及相關肺炎住院之醫療費用(元/天)的比較--------69
表二十二、1997-2003年單純癌症病患、慢性疾病患者、癌症合併慢性疾病患者和一般族群因流感及相關肺炎住院之總醫療費用(元/次)的比較----------71
表二十三、1997-2003年單純癌症病患、慢性疾病患者、癌症合併慢性疾病患者和一般族群因流感及相關肺炎住院之醫療資源耗用的比較----------73

圖 目 錄
圖一、1997-2003年男女性所有癌症與非癌症病患因流感及相關肺炎住院之住院發生率--------74
圖二、1997-2003年在各年齡層所有癌症與非癌症病患因流感及相關肺炎住院之住院發生率------74
圖三、1997-2003年男性所有癌症與非癌症族群因流感及相關肺炎住院之住院發生率------75
圖四、1997-2003年女性所有癌症與非癌症族群因流感及相關肺炎住院之住院發生率------75
圖五、所有癌症與非癌症病患因流感及相關肺炎住院之住院發生率--------------------76
圖六、男性所有癌症與非癌症病患因流感及相關肺炎住院之住院發生率--------------76
圖七、女性所有癌症與非癌症病患因流感及相關肺炎住院之住院發生率--------------77
圖八、0-19歲所有癌症與非癌症病患因流感及相關肺炎住院之住院發生率------------77
圖九、20-64歲所有癌症與非癌症病患因流感及相關肺炎住院之住院發生率----------78
圖十、65歲以上所有癌症與非癌症病患因流感及相關肺炎住院之住院發生率--------78

英文部分

Anderson H, Petrie K, Berrisford C, Charlett A, Thatcher N and Zambon M. Seroconversion after influenza vaccination in patients with lung cancer. Br J Cancer 1999;80:219-20.
Ampofo K, Gest eland PH, Bender J, Mills M, Daly J, Samore M, Byington C, Pavia AT, Srivastava R. Epidemiology, complications, and cost of hospitalization in children with laboratory-confirmed influenza infection. Pediatrics 2006;118:2409-17.
American Cancer Society. Learn About Cancer (General Information) www.cancer.org/docroot/lrn/lrn_0.asp (accessed 16 November 2006)
Barker WH. Excess pneumonia and influenza associated hospitalization during influenza epidemics in the United States, 1970-78. Am J Public Health 1986;76:761-5.
Barker WH, Mullooly JP. Impact of epidemic type A influenza in a defined adult population. Am J Epidemiol 1980;112:798-813.
Brydak LB and Machala M. Humoral Immune Response to Influenza Vaccination in Patients from High Risk Groups. Drugs 2000;60:35-53.
Brydak LB, Guzy J, Starzyk J, Machala M, Gozdz SS. Humoral immune response after vaccination against influenza in patients with breast cancer. Support Care Cancer 2000;9:65-8.
Brown AE, Steinhertz PG, Miller DR, Miller DR, Armstrong D, Kellick MG, Gross PA, Davis AE. Immunization against influenza in children with cancer : results of a three-dose trial. J Infect Dis 1982;145:126.
Cox NJ, Subbarao K. Influenza. Lancet 1999;354:1277-82.
Chisholm JC, Devine T, Charlett A, Pinkerton CR, Zambon M. Response to influenza immunization during treatment for cancer. Arch Dis Child 2001;84:496-500.
Cooksley CD, Avritscher EB, Bekele BN, Rolston KV, Geraci JM, Elting LS. Epidemiology and outcomes of serious influenza-related infections in the cancer. Cancer 2005;104:618-28.
Centers for Disease Control and Prevention. Influenza(Flu). www.cdc.gov/flu/ (accessed 16 November 2006)
Chemaly RF, Ghosh S, Bodey GP, Rohatgi N, Safdar A, Keating MJ, Champlin RE, Aguilera EA, Tarrand JT, and Raad II. Respiratory viral infections in adults with hematologic malignanies and human stem cell transplantation recipients. Medicine 2006;85:278-87.
Diana Vilar-Compte, Patricia Cornejo, Alejandra Valle-Salinas, Rodrigo Roldan-Marin, Iguala, Yolanda Cervantes, Irma Lopez. Influenza vaccination in patients with breast cancer : a case-series analysis. Med Sci Monit 2006;12: CR332-6.
Earle CC. Influenza vaccination in elderly patients with advanced colorectal cancer. J Clin Oncol 2003;21:1161-6.
Fedson DS. Preparing for pandemic vaccination: an international policy agenda for vaccine development. J Public Health Policy 2005;26:4-29.
Griffin MR, Coffey CS, Neuail KM, Mitchel EF, Wright PF, Edwards KM. Winter viruses. Influenza- and respiratory syncytial virus-related morbidity in chronic lung disease. Arch Intern Med 2002;162:1229-36.
Hampson AW. Epidemiology data on influenza in Asian countries. Vaccine 1999;17:S19-23.
Hak E, Wei F, Nordin J, Mullooly J, Poblete S, and Nichol KL. Development and validation of a clinical prediction rule for hospitalization due to pneumonia or influenza or death during influenza epidemics among community-dwelling elderly persons. J Infect Dis 2004;189;450-8.
Hsieh YC, Chen H, Yen JJ, Liu DP, Chang LY, Lu CY, Shao PL, Lee CY, Huang LM. Influenza in Taiwan: seasonality and vaccine strain match. J Microbiol Immunol Infect 2005;38:238-43.
Huber VC, McCullers JA. Live attenuated influenza vaccine is safe and immunogenic in immunocompromised ferrets. J Infec Dis 2006;193:677-84.
Izurieta HS, Thompson WW, Kramarz P, et al. Influenza and the rates of hospitalization for respiratory disease among infants and young children. N Engl J Med 2000;342:232-9.
Jefferson T, Rivetti D, Rivetti A, Rudin M, Di Pietrantonj C, Demicheli V. Efficacy and effectiveness of influenza vaccines in elderly people: a systematic review. Lancet 2005;366:1165-74.
Kempe A, Hall CB, MacDonald NE, Foye HR, Woodin KA, Cohen HJ, Lewis ED, Gullace M, Gala CL, Dulberg CS, and Katsanis E. Influenza in children with cancer. J Pediatr 1989;115:33-9.
Kamps BS, Hoffmann C, and Preiser W. Influenza Report 2006.
Lo W, Whimbey E, Elting L, Couch R, Cabanillas F, Bodey G. Antibody response to a two-dose influenza vaccine regimen in adult lymphoma patients on chemotherapy. Eur J Clin Microbiol Infect Dis 1993;12:778-82.
Mullooly JP, Barker WH. Impact of type A influenza on children :a retrospective study. Am J Public Health 1982;72:1008-16.
Melcher L. Recommendations for influenza and pneumococcal vaccinations in people receiving chemotherapy. Clin Oncol 2005;17:12-5.
Mullooly JP, Bridges CB, Thompson WW, Chen J, Weintraub E, Jackson LA, Black S, Shay DK. Influenza- and RSV- associated hospitalizations among adults. Vaccine 2007;25:846-55.
Neuzil KM, Reed GW, Mitchel EF, Griffin MR. Influenza-associated morbidity and mortality in young and middle-aged women. JAMA 1999;281:901-7.
Neuzil KM, Mellen BG, Wright PF, Mitchel EF, Griffin MR. The effect of influenza on hospitalizations, outpatient visits, and courses of antibiotics in children. N Engl J Med 2000a;342:255-31.
Neuzil KM, Wright PF, Mitcbel EF, Griffin MR. The burden of influenza illness in children with asthma and other chronic medical conditions. J Pediatr 2000b;137:856-64.
Nicholson KG, Wood JM, Zambon M. Influenza. Lancet 2003;362:1733-45.
Ortbals DW, Liebhaber H, Presant CA, Amburug AL, Lee JY, Missouri SL. Influenza immunization of adult patients with malignant disease. Ann Intern Med 1977;87:552-7.
Porter CC, Poehling KA, Hamilton R, Frangoul H, and Cooper WO. Influenza immunization practices among pediatric oncologists. J Pediatr Hematol Oncol 2003;25;134-8.
Steinherz PG, Brown AE, Gross PA, Braun D, Ghavimi F, Wollner N, Rosen G, Armstrong D, Miller DR. Immunization of children with neoplastic diseases. Cancer 1980;45:750-6.
Simonsen L, Clarke MJ, Schonberger LB, Arden NH, Cox NJ, Fukuda K. Pandemic versus epidemic influenza mortality: a pattern of changing age distribution. J Infect Dis 1998;178:53-60.
Simonsen L, Fukeda K, Schonberger LB, and Cox NJ. The impact of influenza epidemics on hospitalizations J Infect Dis 2000;181:831-7.
Stephenson I and Zambon M. The epidemiology of influenza. Occup Med 2002;52:241-7.
Sanchez MC, Contreras JR, Vivanco JL, Carrion FF, Fernandez MB, Ramos JT, Otero JR, Folgueira D. Respiratory virus infections in children with cancer or HIV infection. J Pediatr Hematol Oncol 2006;28:154-9.
Thompson WW, Shay DK, Weintraub E, Brammer L, Bridges CB, Cox NJ, Fukuda K. Influenza-associated hospitalizations in the United States. JAMA 2004;292:1333-40.
Wang CS, Wang ST, Chou P. Efficacy and cost-effectiveness of influenza vaccination of the elderly in a densely populated and unvaccinated community. Vaccine 2002;20:2494-9.
Wang ST, Lee LT, Chen LS, Chen TH. Economic evaluation of vaccination against influenza in the elderly: an exercise from a population-based influenza vaccination program in Taiwan. Vaccine 2005;23:1973-80.
World Health Organization. Acute Respiratory Infections: Influenza.www.who.int/vaccine_research/diseases/ari/en/index.html#disease%20burden#disease%20burden (accessed 16 November 2006)
Yuen KY, Wong SS. Human infection by avian influenza A H5N1. Hong Kong Med J 2005;11:189-99.

中文部份

李嘉偉，台灣地區機構外老人流感疫苗效果之評估，台北：國立陽明大學公共衛生究所碩士論文，2001
行政院衛生署編，民國88年衛生統計(一)公務統計年報，台北：行政院衛生署，1999 (www.doh.gov.tw/statistic/index.htm)
行政院衛生署編，民國92年衛生統計(一)公務統計年報，台北：行政院衛生署，2003 (www.doh.gov.tw/statistic/index.htm)
行政院衛生署編，民國94年衛生統計(一)公務統計年報，台北：行政院衛生署， 2005 (www.doh.gov.tw/statistic/index.htm)
衛生署疾病管制局，流感防治網，2006 (flu.cdc.gov.tw/ accessed 24 November 2006)