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研究生:胡曉雲
研究生(外文):Hsiao-Yun Hu
論文名稱:肥胖、疾病與醫療費用
論文名稱(外文):Obesity, Diseases and MEdical Care Expenditure
指導教授:周穎政周穎政引用關係黃心苑黃心苑引用關係
指導教授(外文):Yiing-Jeng ChouNicole Huang
學位類別:博士
校院名稱:國立陽明大學
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
論文出版年:2009
畢業學年度:97
語文別:英文
論文頁數:120
中文關鍵詞:肥胖身體質量指數疾病傷害下背痛醫療費用臺灣
外文關鍵詞:obesitybody mass indexdiseasesinjurylow back painmedical care expenditureTaiwan
相關次數:
  • 被引用被引用:11
  • 點閱點閱:550
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:2
背景:肥胖在西方國家已被認為是一種大流行。近年來隨著肥胖的盛行率在亞洲快速增加的趨勢,使大家意識到肥胖的問題在亞洲地區也同樣嚴重。然而有關亞洲肥胖、疾病與醫療費用之間的關係仍有待釐清。因此,本研究目的為探討臺灣成人肥胖、疾病與醫療費用之關係。
方法:研究樣本為2001年國民健康訪問調查中有簽署同意連結健保資料庫之18歲以上受訪者,共計12,520人。依據亞太地區身體質量指數作為定義肥胖。利用羅吉斯迴歸分析肥胖與各種疾病之關係,利用柯克斯比例風險迴歸分析肥胖與傷害及下背痛之關係,同時也利用二部模型分析肥胖與肥胖相關醫療費用之關係。
結果:肥胖與高血壓、痛風、糖尿病、內分泌代謝異常、心臟病、心血管疾病、骨關節炎、精神分裂症、皮膚及軟組織感染、白內障、傷害及下背痛有高度相關。二級肥胖成人發生傷害及下背痛的機率分別是正常體重者的1.18倍 (95% CI: 1.05-1.34)及1.28倍 (95% CI: 1.08-1.52);且二級肥胖成人發生傷害及下背痛相關醫療費用也分別比正常體重者高出32.7%及67.5%。此外,二級肥胖的男性相對於正常男性高出44.6%的醫療費用。而二級肥胖的女性分別比正常女性高出93.3%的醫療費用。在控制相關因素後,每個年齡層皆呈現身體質量指數越高醫療費用越高,且年齡層越高越明顯。在不同的社經地位也顯示隨著身體質量指數增加醫療費用皆逐漸增加,此現象在低社經地位的女性特別明顯,但卻沒有出現於低收入的男性
結論:肥胖與高血壓、痛風、糖尿病、內分泌代謝異常、心臟病、心血管疾病這些新陳代謝疾病有高度相關。高的身體質量指數不僅增加發生傷害及下背痛的機率及同時也會增加其相關的醫療費用。身體質量指數與醫療費用有顯著正相關,且隨著性別、年齡及社經地位有明顯之變化。本研究結果不僅提供衛生政策執行者在制訂肥胖預防措施重要的參考,同時也建議未來擬定肥胖相關醫療費用策略時應進一步考慮相關人口學因素。
Background: Obesity is widely recognized as an epidemic in the Western world. In recent years, the alarming rate of increase in the prevalence of obesity in Asian counties makes people realize that the problem of obesity is no longer limited to western societies and becomes equally serious in Asian regions. However, the relationship between obesity, diseased and medical care expenditure is less well established. The aim of this study is to evaluate the relationship between obesity, the occurrence of diseases, and the medical care expenditure among Taiwanese adults.
Methods: Our study sample consisted of 12,520 adults aged 18 years or older from the 2001 National Health Interview Survey, who had consented to the linking of their survey responses with their National Health Insurance claims records. Obesity was defined by Body Mass Index (BMI) based on the WHO-Asia Pacific categories. Multiple logistic regression was used to identify associated between obesity and types of diseases. Cox’s proportional hazards regression was used to identify factors associated with injury and low back pain (LBP). In addition, we used a two-part model to analyze the association between obesity and medical care expenditure.
Results: The odds ratio of sustained hypertension, gout and other crystal arthropathies, diabetes mellitus, metabolic disorders, heart diseases, cardiovascular disease and osteoarthritis, osteoarthritis, schizophrenia, skin and subcutaneous tissue infections, cataract, injury and low back pain rose to statistical significance (p<0.001) among persons with a higher BMI. Relative to normal weight adults, the HR of injury and LBP were, respectively, 1.18 (95% CI: 1.05-1.34) and 1.28 (95% CI: 1.08-1.52) for obese class II adults. For obese class II, the adjusted injury-related expenditure and LBP-related expenditure were, respectively, 32.7% and 67.4% greater than those of normal weight adults. Adjusted expenditure for obese class II men was 44.6% greater than normal weight men. For obese class II women, the adjusted expenditure was 93.3% greater than normal weight women. After adjusting for other factors, higher medical care expenditure was associated with a higher BMI for each age group. The relative magnitude of the association became more apparent as age increased. Annual medical care expenditure increased as the BMI increased among low socioeconomic status women. On the other hand, the relationship between BMI and medical care expenditure in men varied by household income.
Conclusions: There was a positive relationship between BMI and hypertension, gout and other crystal arthropathies, diabetes mellitus, metabolic disorders, heart diseases, cardiovascular disease and osteoarthritis. Aside from chronic diseases, excess body mass would also increased the risk of schizophrenia, skin and subcutaneous tissue infections, cataract and strain/sprain in a general Asian adult population. There was a strong positive relationship between high BMI and increased risk of injury and LBP as well as higher injury-related expenditure and LBP-related expenditure. Moreover, higher BMI increased medical care expenditure and this varied according to sex, age and socioeconomic status. The findings provide the important implications for health policy makers for implementing obesity prevention programs in Taiwan. Furthermore, our findings suggest that projections of future health care costs attributable to obesity will need to take into consideration the demographic make-up of the obese population.
CHAPTER ONE: INTRODUCTION 1
Ⅰ. Background 1
Ⅱ. Scope of the Problem 3
Ⅲ. Specific Aim 5
CHAPTER TWO: LITERATURE REVIEW 6
Ⅰ. Overview of Obesity and Diseases 6
Ⅱ. Review of Obesity and Injury 9
Ⅲ. Review of Obesity and Low Back Pain 12
Ⅳ. Review of Obesity and Medical Care Expenditure 14
Ⅴ. Summary of Gaps in Literature 17
CHAPTER THREE: METHODS 19
Ⅰ. Data Source 19
Ⅱ. Study Design and Sample 21
Ⅲ. Construction of Variable 22
Ⅳ. Statistical Analysis 29
CHAPTER FOUR: RESULTS 32
Ⅰ. Obesity and Diseases 32
Ⅱ. Obesity and Injury 37
Ⅲ. Obesity and Low Back Pain 44
Ⅳ. Obesity and Medical Care Expenditure 49
CHAPTER FIVE: DISCUSSION 60
Ⅰ. Obesity and Diseases 60
Ⅱ. Obesity and Injury 61
Ⅲ. Obesity and Low Back Pain 64
Ⅳ. Obesity and Medical Care Expenditure 66
Ⅴ. Study Limitation 69
CHAPTER SIX: CONCLUSION 74
REFERENCES 76
APPEXDIX A: Sensitivity Analysis Results by Using Taiwan BMI Cut-offs Criteria 91
APPEXDIX B: ICD-9-CM Codes for the Single-level Diagnosis CCS Categories 108
APPEXDIX C: Published Papers 120
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