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研究生:侯文萱
研究生(外文):Wen-Hsuan Hou
論文名稱:台灣機轉別跌倒死亡率趨勢分析
論文名稱(外文):Trends in Falls Mortality by Mechanism in Taiwan
指導教授:呂宗學呂宗學引用關係
指導教授(外文):Tsung-hsueh Lu
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
畢業學年度:96
語文別:中文
論文頁數:71
中文關鍵詞:跌倒死因統計死亡率台灣機轉
外文關鍵詞:Death statisticsFallMortalityMechanismTaiwan
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研究背景:
國際疾病分類將跌倒發生的環境事件與情況依註碼分為由建築物跌落、樓梯跌倒、平地滑跤、被家具絆倒等跌倒機轉,但是過去世界各國文獻與台灣官方統計資料的全人口跌倒死亡率趨勢研究中,都只將跌倒視為一個整體,卻沒有對於跌倒防制訊息十分重要的跌倒機轉別的死亡率分析。
研究目的:
本研究以經評估者以國際疾病分類第十版的電腦化原死因選擇系統校正後的資料為黃金標準,分析不同機轉別跌倒死亡率的趨勢分析。
研究材料與方法:
利用1971年至2005年台灣地區衛生署生命統計的死因統計資料庫中,選取原死因中註碼為跌倒者(國際疾病分類第九版註碼E880-E888,國際疾病分類第十版註碼W00-W19),進行死因統計品質之比較,並分析不同性別、年齡別、城鄉別和機轉別跌倒死亡率的分佈情形,最後利用卜瓦松迴歸模型,檢定此期間機轉別跌倒死亡率之相對危險性趨勢變動的差異。
研究結果:
台灣地區1971-2005年的性別、年齡別、城鄉別跌倒死亡率大致上皆呈現先上昇後下降的趨勢型態,且官方統計和評估者校正後資料的差別不大。在機轉別跌倒死亡率方面,高處墜落是漸漸下降的趨勢,平地跌倒和未明示跌倒的死亡率趨勢都是呈現先上昇後下降的趨勢但官方統計和評估者校正後資料在平地跌倒和未明示跌倒死亡率趨勢的差異極大。進一步以卜瓦松迴歸模型分析評估者校正後資料分析各性別、年齡別、城鄉別和機轉別跌倒死亡率趨勢的變動皆不大(相對危險性皆小於二)。
結論:
台灣地區的性別、年齡別、城鄉別與機轉別跌倒死亡率趨勢型態,並不如歐美國家在最近幾年有漸漸開始上昇的趨勢型態,而是呈現先上昇後下降的年代趨勢變化。
Background:
Many codes of the International Classification of Diseases System describe mechanisms of fall environmental events and circumferences such as fall from buildings, fall from stairs, fall involving furniture, and level fall. However, not only Taiwan official reports but also foreign population-based studies analyzed fall mortality as a whole and never aimed at fall mortality by mechanism which provides important information in fall prevention.
Purpose:
To analyze the trend of fall mortality by mechanism in Taiwan according to the outcomes of reevaluating causes of death in the Tenth Revision of International Classification of Disease (ICD-10).
Material and methods:
Using the death statistics of vital statistics data bank from 1971 to 2005 in the Department of Health, Taiwan, we recruit all fall (ICD-9 codes E880-888, ICD-10 codes W00-19) as the underlying cause of death to compare the quality of the death statistics and analyze the trends of fall mortality by different sex, age, urbanization and mechanism. We also examined the relative risks by Poisson regression model of fall mortality during this period.
Results:
The trends of fall mortality by sex, age, urbanization and mechanism generally revealed the patterns of first increased then decreased in both official statistics and reviewer adjusted data. The trend patterns of fall from height mortality decreased while level fall and unspecified fall mortality both first increased then decreased. Marked variation of trend patterns also existed between the official statistics and reviewer-adjusted data in the level fall and unspecified fall mortality. Besides, there were no abrupt changes (relative risks between 0~2) of fall mortality trend patterns between different sex, age, urbanization, and mechanism in reviewer adjusted data.
Conclusions:
The trends of fall mortality by sex, age, urbanization, and mechanism showed first increased then decreased changing patterns in Taiwan, different from the recent increasing trends in Western countries.
考試合格證明................................................................................................................................I
中文摘要...................................................................................................................................... II
ABSTRACT ................................................................................................................................ III
誌 謝....................................................................................................................................... IV
目 錄........................................................................................................................................ V
圖目錄.................................................................................................................................... VIII
表目錄....................................................................................................................................... IX
第一章 前言 1
1.1 研究背景 1
1.1.1 死亡率趨勢分析的重要 1
1.1.2 台灣主要死因別死亡率趨勢之型態 1
1.1.3 跌倒死亡率趨勢在事故傷害死亡率的重要 1
1.1.4 不同國家的跌倒死亡率的趨勢型態是否有差異 2
1.1.5 過去研究的限制 2
1.1.6 以機轉別分析跌倒死亡率的可能限制 2
1.1.7 本研究的目的 3
1.2 研究問題 3
第二章 文獻回顧 4
2.1 死因統計可能的錯誤來源 4
2.1.1 原死因選擇規則 5
2.1.2 國際疾病分類改版對死因統計的影響 6
2.1.3 跌倒死因的錯誤註碼問題 6
2.1.4 小結 7
2.2 不同國家的跌倒死亡率趨勢研究 8
2.2.1 芬蘭 8
2.2.2 美國 10
2.2.3 澳洲 11
2.2.4 大陸 11
2.2.5 台灣 11
2.2.6 小結 12
2.3 以跌倒發生的機轉為分類變項的跌倒受傷或死亡之文獻 12
2.3.1 全人口統計資料 12
2.3.2 法醫判定資料 13
2.3.3 醫院就診資料 13
2.3.4 小結 13
第三章 研究方法 15
3.1 資料來源 15
3.2 死因統計 15
3.3 跌倒定義 16
3.4 資料分析 17
3.4.1 依變項的操作 17
3.4.2 解釋變項的操作 17
3.4.2.1 跌倒機轉分類 17
3.4.2.2 年齡分組 17
3.4.2.3 城鄉分組 18
3.4.3 統計分析方法 18
3.4.5 卜瓦松迴歸 18
第四章 結果 20
4.1 比較官方註碼員和評估者校正後原死因不一致之情形 20
4.2 官方統計和評估者校正後資料在跌倒死亡差異原因之探討 21
4.3 比較官方統計和評估者校正後資料之跌倒死亡數和跌倒死亡率趨勢 23
4.3.1 比較官方統計和評估者校正後資料之機轉別跌倒死亡率趨勢 23
4.3.2 標準化跌倒死亡率趨勢 23
4.3.3 性別跌倒死亡率趨勢 23
4.3.4 年齡別跌倒死亡率趨勢 24
4.3.5 城鄉別跌倒死亡率趨勢 24
4.3.6 機轉別跌倒死亡率趨勢 25
4.4 卜瓦松迴歸分析評估者校正後之跌倒死亡率趨勢 25
4.4.1 全部跌倒死亡率趨勢 25
4.4.2 高處墜落死亡率趨勢 26
4.4.3 平地跌倒死亡率趨勢 26
4.4.4 未明示跌倒死亡率趨勢 26
第五章 討論 28
5.1 比較官方統計資料與評估者校正後資料在跌倒死亡趨勢上的差異 28
5.1.1造成死亡率趨勢型態改變的原因 28
5.1.2 死因統計可能的錯誤來源 28
5.1.3 跌倒註碼在國際疾病分類第九版和第十版的異同 29
5.1.4 國際疾病分類改版對原死因選擇和註碼的影響 29
5.2 研究問題的回答與過去研究結果的比較 30
5.2.1 全部跌倒死亡率 30
5.2.2 性別跌倒死亡率 30
5.2.3 跌倒死亡情形在兩性間的異同 31
5.2.4 年齡別跌倒死亡率 31
5.2.5 跌倒死亡情形在年齡上的異同 32
5.2.6 城鄉別跌倒死亡率 32
5.2.7 跌倒死亡情形在城鄉間的異同 32
5.2.8 小結 32
5.3 機轉別跌倒死亡率 33
5.3.1 探討造成機轉別跌倒死亡率差異的原因 33
5.3.2 未明示機轉的跌倒死亡和其對死因統計的影響 35
5.3.3 未明示跌倒死亡比例對高處墜落和平地跌倒死亡比例的影響 35
5.3.4 未明示跌倒外因機轉對跌倒防制計畫的影響 36
5.4 本研究的限制 36
第六章 結論 37
參考文獻 38















圖目錄
圖 一:主要死因標準化死亡率趨勢圖,1985-2005,台灣 42
圖 二:各類事故傷害機轉之死亡率趨勢,1982-2006,台灣 43
圖 三:各類事故傷害機轉之年齡標準化死亡率趨勢圖,1985-2004,美國 44
圖 四:美國、澳洲、芬蘭三國老人之年齡標準化跌倒死亡率趨勢,1990-1997 45
圖 五:衛生署民國96年修訂之死亡證明書 46
圖 六:死亡證明書填表說明 47
圖 七:三種不同跌倒機轉的死亡率趨勢,依官方統計和校正後資料,1971-2005,台灣 48
圖 八:官方統計與校正後資料的跌倒死亡率趨勢,1971-2005,台灣 49
圖 九:官方統計與校正後資料的跌倒死亡率趨勢,依性別,1971-2005,台灣 50
圖 十:官方統計與校正後資料的跌倒死亡率趨勢,依年齡別,1971-2005,台灣 51
圖 十一:官方統計與校正後資料的跌倒死亡率趨勢,依城鄉別,1971-2005,台灣 52
圖 十二:官方統計與校正後資料的跌倒死亡率趨勢,依跌倒機轉別,1971-2005,台灣 53




























表目錄
表 一:各國不同死亡率形式趨勢之分析年代、年齡及性別之比較 54
表 二:美國、澳洲、芬蘭三國老人之年齡標準化跌倒死亡率趨勢,1990-1997 55
表 三:跌倒外因註碼在國際疾病分類第九版與第十版之對應比與其在跌倒機轉分類上之異同 56
表 四:官方統計死亡數和評估者校正後死亡數兩者間一致過度註碼和不足註碼的情形 57
表 五:以評估者校正為金字標準分析官方註碼和評估者之機轉別跌倒死亡數及其品質指標 58
表 六:跌倒死亡的不足註碼和過度註碼不一致的情形分類 59
表 七:官方統計和評估者校正後之機轉別跌倒死亡數和其百分比 60
表 八:官方統計和評估者校正後在跌倒機轉中不一致的跌倒原死因診斷死亡數和其百分比 61
表 九:官方統計與校正後資料的跌倒死亡數和死亡率,1971-2005,台灣 62
表 十:官方統計與校正後資料的跌倒死亡數和死亡率,依性別,1971-2005,台灣 63
表 十一:官方統計與校正後資料的跌倒死亡數和死亡率,依年齡別,1971-2005,台灣 64
表 十二:官方統計與校正後資料的跌倒死亡數和死亡率,依城鄉別,1971-2005,台灣 65
表 十三:官方統計與校正後資料的跌倒死亡數和死亡率,依跌倒機轉別,1971-2005,台灣 66
表 十四:不同年代跌倒死亡率比及95%信賴區間,依性別、年齡別、城鄉別,1987-2002,台灣 67
表 十五:不同年代高處墜落死亡率比及95%信賴區間,依性別、年齡別、城鄉別,1987-2002,台灣 68
表 十六:不同年代平地跌倒死亡率比及95%信賴區間,依性別、年齡別、城鄉別,1987-2002,台灣 69
表 十七:不同年代之未明示跌倒死亡率比及95%信賴區間,依性別、年齡別、城鄉別,1987-2002,台灣 70
表 十八:不同年代之高處墜落跌倒死亡數及其百分比,依跌倒地點別,1987-2002,台灣 71
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