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研究生:黃琦婷
研究生(外文):Chi-Ting Huang
論文名稱:台灣地區主要中風類型疾病率與醫療利用分析
論文名稱(外文):Incidence, 30-day fatality and medical utilization of the major stroke subtypes in Taiwan
指導教授:李奕慧李奕慧引用關係
指導教授(外文):Yi-Hwei Li
學位類別:碩士
校院名稱:慈濟大學
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:97
語文別:中文
論文頁數:61
中文關鍵詞:中風發生率致死率醫療利用醫療費用
外文關鍵詞:strokeincidencefatalitymedical utilizationcost
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目前台灣已是高齡化社會,中風發生率會隨著年齡的增長而增加,尤其是65 歲以上老年人口。在2007 年腦血管疾病為十大死因第三名,中風已成為死亡及失能的主要疾病之一,且需要花費龐大的醫療費用,造成家庭、社會的負擔。而我國對於中風發生率相關研究不多,張淑鳳以及Hu 等人所做的研究年代甚遠,而近年來廖建彰等人利用全民健保資料庫分析台灣地區中風發生率,因為納入所有中風診斷碼以致高估發生率。
本研究目的為分析台灣地區30-100 歲人口,各中風類型的發生率及分佈情形,並探討中風住院的醫療利用。本研究利用國家衛生研究院的承保抽樣歸人檔資料,建構一動態世代,計114,145無中風病史者,其中男性57,417 人、女性56,728 人,追蹤研究樣本2000 年至2006 年的初次中風紀錄,共計觀察687,953 人年。
本研究結果顯示共2310 位新中風個案。男性粗發生率為每100,000 人年412 人(95%CI:391-434)、女性260 人(95%CI:244-277)。不同中風類型發生率,IS 為每100,000 人年208 人、ICH 為73 人、SAH 為11 人、US 為45 人。老年(≧65 歲)男性發生率為每100,000 人年1493 人、女性1164 人。男性IS 為每100,000 人年982 人,ICH 為264 人;女性IS 為790 人,ICH 為182人;男性老年罹患IS 的風險是壯年的8.6 倍、ICH 的風險是壯年的4.0倍;女性老年罹患IS 的風險是壯年的14.8 倍、ICH 的風險是壯年的7.0 倍。不同中風類型平均發病年齡,男性IS-67 歲、ICH-62 歲、SAH-56 歲,女性IS-71 歲、ICH-65歲、SAH-62 歲。30 天致死率:IS-5%、ICH-20%、SAH-39%;住院天數:IS-9 天、ICH-14 天、SAH-17 天;醫療費用:IS-27,879 元、ICH-65,972 元、SAH-179,956 元,皆以出血性中風最高。不同中風類型在住院天數、醫療費用、每日醫療費是有顯著差異的(P<.001)。
台灣地區中風發生率高,以65 歲以上老年人為主,應特別注意老年中風的預防及治療。IS、ICH 中風發生率與其他國家比較都相當高,但是我國受到歐美國家的影響,目前較著重在IS 的預防與治療,台灣地區的出血性中風風險較高,且發病年齡較輕,失能程度、致死率、住院天數、醫療費用都較高,若壯年患者失能,其後續照護費用與社會成本更不可忽視。因此本國對中風的預防及治療除了IS 外,也應重視出血性中風,尤其是65 歲以下族群出血性中風的預防與後續照護。
As an aging society, the incidence of stroke in Taiwan is increasing rapidly, the increasing rate is particularly sharp among the population over 65 years old. In 2007, the cerebrovascular disease is the leading third cause of death in Taiwan. The consequences of stroke, high fatality rate, severe disability, and long term medical and home care expenses have caused greatest burden in the family and society. There is only few literature on the incidence of stroke in Taiwan, and most of them, such as the studies of Chang (1992) and Hu et al (1992) are outdated. Recently, Liao et al (2006) used the National Health Insurance Research Database to investigate the incidence of stroke in Taiwan. However, due to inadequate coding of stroke diagnosis, their work considerably overestimated the incidence.
The purpose of the present study was to investigate the first-ever stroke incidence by stroke subtypes among 30 to 100 year-old Taiwanese, the 30-day fatality and medical utilization of the disease. A dynamic cohort of 114,145 stroke-free people was established by using the Longitudinal Health Insurance Database 2000 provided by the Bureau of National Health Insurance. The cohort was followed up from 2000 to 2006 to identify new stroke cases, and the total observed person-years were 687,953.
There were 2,310 stroke cases identified in the study period. The age-standardized incidence rates of stroke per 100,000 person-years were 447(95%CI:423-470) in male, and 291(95%CI:272-310) in female. The incidence was 230 per 100,000 person-years for ischemic stroke (IS), 78 for intra-cerebral hemorrhage (ICH), 11 for subarachnoid hemorrhage (SAH), and 49 for unclassified stroke (US). For the elderly (over 65 years), the incidence was 888 (95%CI:830-943) per 100,000 person-years for IS, 225(95%CI:195-252) for ICH, 22(95%CI:14-32) for SAH, and 199(95%CI:170-223) for US.
The age-adjusted incidence rates in this study are higher than those of most western countries. ICH is more common among Taiwanese than among Occidental people. The incidence of IS for the elderly is higher than that reported in 1992, and those reported from Beijing, Shanghai, and Changsha because of a fast-aging society. In addition, the incidence of ICH is relatively high and close to that in Beijing indicating an urgency to launch appropriate public health campaigns to prevent the occurrence of IS and ICH.
第一章 緒論................................................................................................................................................1
第一節、前言與研究動機...................................................................................................................1
第二節、研究目的...............................................................................................................................2
第二章 文獻探討........................................................................................................................................3
第一節、中風的介紹...........................................................................................................................3
第二節、中風流行病學研究...............................................................................................................6
第三節、中風醫療利用.....................................................................................................................14
第三章 材料與方法..................................................................................................................................17
第一節、資料來源.............................................................................................................................17
第二節、研究樣本與中風篩選規則.................................................................................................17
第三節、分析方法.............................................................................................................................22
第四章 研究結果......................................................................................................................................26
第一節、中風發生率.........................................................................................................................26
第二節、中風病患預後與醫療利用.................................................................................................34
第五章 結論與討論..................................................................................................................................40
第一節、與其他研究比較.................................................................................................................40
第二節、結論與建議.........................................................................................................................48
第三節、研究限制.............................................................................................................................49
參考文獻...................................................................................................................................................51
參考文獻
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