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研究生:陳怡光
研究生(外文):Yi-Kuang Chen
論文名稱:臺灣尿路結石患者急診利用與季節變化的關聯性:以全民為基礎的研究
論文名稱(外文):The emergency department utilization of urinary calculi and the association with seasonality in Taiwan :A population-based study
指導教授:林恆慶林恆慶引用關係
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:醫務管理學研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:英文
論文頁數:60
中文關鍵詞:尿路結石季節變化氣候
外文關鍵詞:urinary calculiseasonalityclimate
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目的:利用五年之中尿路結石患者急診就醫資料進行分析,探討臺灣地區尿路結石患者發作與季節變化的關聯性,更進一步確認五種氣象因子中,影響尿路結石發作之主要因子。
方法:從全民健康保險研究資料庫中,挑選出從西元1999年到2003年五年期間,尿路結石患者每個月急診就診率(每十萬人口)的資料。將這些資料依性別及年竛(三群:18-44歲,45-64歲,≧65歲)區分成子群。再以自我廻歸整合移動平均模型(ARIMA)進行分析,以評估尿路結石每月發生率與天氣變化的關聯性及其趨勢走向。
結果:不論性別或年齡之差異,尿路結石患者急診利用的情況,呈現季節性的變化,夏季乃是明顯的高峰期。雖然周遭氣溫、大氣壓力、及日照時數與尿路結石發生率均有統計學上的意義,但在經過自我廻歸整合移動平均模型調整之後,只有周遭氣溫才是主要之影響因子。
結論:這是第一個以全國人民為基礎,進行尿路結石發生率與氣象學因子關聯性之研究,藉此,希望世界上其他地區,不同種族也可以進行頪似資料之蒐集,以探討尿路結石之全球趨勢。
關鍵字:尿路結石;季節變化;氣候
Purpose: Using five-year emergency department visits of urinary calculi data in Taiwan, this study sets out to investigate the hypothesis of a seasonal association with urinary calculi. To clarify the component factors we investigate the relationship with five climatic factors.
Method: National emergency department data from the Taiwan National Health Insurance Research Database (1999 to 2003) provided monthly urinary calculi emergency department visit rates (per 100,000 population). We created subgroups of the urinary calculi cases for gender, and age (3 groups: 18~44, 45~64, and ≥ 65 years). The ARIMA (Auto-Regressive Integrated Moving Average) regression method was performed to evaluate the effects of climatic factors and monthly urinary calculi attack rates after adjusting for the time-trend effect.
Results: Seasonality with a summer peak was evident in emergency department utilization of urinary calculi regardless of gender or age. Although significant associations were found between ambient temperature, atmospheric pressure, hours of sunshine and the urinary calculi incidence rates for total population, ambient temperature was the major factor which was positively associated with urinary calculi incidence after adjustment for trend and seasonality.
Conclusion:This is the first nationwide population-based study to investigate the dependence of urinary calculi rates on meteorological conditions. We recommend data be collected from other regions and among other ethnic groups to determine the general pattern worldwide.

Key words: urinary calculi; seasonality; climate
Catalog
page
Thanks I
Chinese abstract II
Abstract IV
Catalog V
Table list VII
Figure list VIII

Chapter 1 Introduction 1
1.1 Background and Motives 1
1.2 Research Purposes 3
1.3 Importance of Research 4
Chapter 2 Literatures review 5
2.1 General Observation of Urinary Calculi 5
2.2 The Relationship between Seasonality and Urinary calculi 6
2.3 Other Weather-related Literatures 9
Chapter 3 Methods and Materials 10
3.1 Study Design and Framework 10
3.2 Study Variables and the Operative Definition 11
3.2.1 Dependent Variables and the Operative Definition 11
3.2.2 Independent Variables and the Operative Definition 12
3.2.3 Control Variables and the Operative Definition 13
3.3 Hypothesis of the Study 14
3.4 Study Database 15
3.4.1 Urinary calculi data 15
3.4.2 Population Data 16
Chapter 4 Results 18
4.1 Incidence Rates 18
4.2 Seasonality 22
Chapter 5 Discussion and Conclusion 40
5.1 Discussion 40
5.1.1 Ambient temperature 41
5.1.2 Atmospheric Pressure 43
5.1.3 Hours of Sunshine 44
5.1.4 Relative Humidity 45
5.1.5 Rainfall 46
5.1.6 ARIMA 47
5.2 Conclusion 48
5.3 Suggestion 49
5.4 Limitation 50
5.5 Acknowledgements 51
References 52

Table list

Table 3-1:Dependent variable and the operative definition…………..………………….11
Table 3-2:Independent variables and the operative definition…………………...……...12
Table 3-3:control variables and the operative definition…………….…………………..13
Table 4-1: Monthly mean values of urinary calculi admissions to emergency
departments and meteorological factors……………..………………………....19
Table 4-2: Demographic characteristics and type of principal diagnosis among
urinary calculi admissions to emergency departments……………..….……....20
Table 4-3: Crude correlations between climate factors and monthly urinary caliculi admissions rates in Taiwan, 1999~2003…………………………….….……......26
Table 4-4: ARIMA regression analysis showing seasonal and meteorological effects
on monthly urinary calculi admissions to emergency department rates
according to gender in Taiwan………………………………………..………….38
Table 4-5: ARIMA regression analysis showing meteorological effects on monthly
urinary calculi admissions to emergency department rates according to
age group in Taiwan………………………………………………………….......39

Figure list
Figure 3-1: Study framework………………………………………………………………10
Figure 4-1: Monthly urinary calculi admission rates (per 100,000) by gender from
1998 to 2003 in Taiwan………………………………………….……………..23
Figure 4-2: Monthly urinary calculi admission rates (per 100,000) by age from
1998 to 2003 in Taiwan……………………………………...………………....24
Figure 4-3: Monthly urinary calculi admission rates (per 100,000) and the association with atmospheric pressure by gender from 1998 to 2003 in
Taiwan…………………………………………………………………………..27
Figure 4-4: Monthly urinary calculi admission rates (per 100,000) and the association with ambient temperature by gender from 1998 to 2003 in
Taiwan………………………………………………………….…………........28
Figure 4-5: Monthly urinary calculi admission rates (per 100,000) and the
association with relative humidity by gender from 1998 to 2003 in
Taiwan………………………………………………………………….……….29
Figure 4-6: Monthly urinary calculi admission rates (per 100,000) and the
association with hours of sunshine by gender from 1998 to 2003 in
Taiwan…………………………………………………………………..……….30
Figure 4-7: Monthly urinary calculi admission rates (per 100,000) and the
association with rainfall by gender from 1998 to 2003 in Taiwan…………...31
Figure 4-8: Monthly urinary calculi admission rates (per 100,000) and the
association with atmospheric pressure by age from 1998 to 2003 in
Taiwan…………………………………………………………………………...32
Figure 4-9: Monthly urinary calculi admission rates (per 100,000) and the
association with ambient temperature by age from 1998 to 2003 in
Taiwan……………………………………………………………………….......33
Figure 4-10: Monthly urinary calculi admission rates (per 100,000) and the
association with relative humidity by age from 1998 to 2003 in Taiwan.…..34
Figure 4-11: Monthly urinary calculi admission rates (per 100,000) and the
association with hours of sunshine by age from 1998 to 2003 in Taiwan…...35
Figure 4-12: Monthly urinary calculi admission rates (per 100,000) and the
association with rainfall by age from 1998 to 2003 in Taiwan…………........36
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李瀛輝、黃榮慶、陳明村、張心湜: 性別與年齡在上尿路結石流行病學所扮演之角色。中華泌尿醫誌。1992; 3:824-830
李瀛輝、張心湜、陳明村、黃榮慶: 臺灣南部地區尿路結石流行病學之研究。中華泌尿醫誌。1994;5:1-7
何淑貞、郭漢崇: 尿路結石之成因與流行病學。慈濟醫學。2002; 14:337-346
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