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研究生:吳佩寧
研究生(外文):Pei-Ning Wu
論文名稱:臺灣地區初次藥物相關案件犯罪者之死亡率及相關因素分析:1987-2003年
論文名稱(外文):Mortality and associated factors in the first-time drug offenders in Taiwan, 1987-2003
指導教授:周穎政周穎政引用關係陳娟瑜陳娟瑜引用關係
指導教授(外文):Yiing-Jenq ChouChuan-Yu Chen
學位類別:碩士
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:中文
論文頁數:133
中文關鍵詞:藥物犯罪者標準化死亡比存活分析死因別死亡率
外文關鍵詞:drug offendersstandardized mortality ratio (SMR)survival analysiscause-specific mortality
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研究目的:探討近二十年臺灣地區初次因藥物相關案件而進入矯正/治機構者之(一)人口學特徵及藥物相關犯罪型態等分佈之差異;(二)相較於一般族群,區分性別、年齡之主要死因別標準化死亡比與年度死亡率變動結果;及(三)比較接受不同矯正/治規定之世代,自機構釋放後的長期存活情形,並做相關危險因子之探討。

研究方法:本研究採用資料串連之研究方式,經由法務部統計室連結民國76-94年之法務系統資料及衛生署死亡登記檔,依照臺灣地區主要藥物相關法律規定之變化時間點,區分為三個不同世代,共納入94,388名成年個案。經以臺灣地區人口性別、年齡結構別死亡率為標準率逐年調整後,計算不同世代自初次釋放後至94年底之標準化死亡比 (standardized mortality ratio; SMR),並以Kaplan-Meier method觀察年齡層、性別及藥物等級等變項之三年累積存活機率 (Cumulative survival probability)的差異,及以Cox proportional hazard model估計相關變項造成之死亡風險對比值 (Hazard ratio; HR)。

結果:成年藥物相關案件受刑人中,女性、年齡在30歲以下及二級藥物犯罪者所佔比例有逐年增加的趨勢。相較於一般族群,18-29歲之受刑人實際死亡人數在男性為6~8倍,女性則為9~40倍;各年度間之死亡情形又以女性變動程度較大。在死因別方面,以非自然死因之標準化死亡比部分為最高,並以未滿30歲之年輕族群最為明顯。出所三年後的存活狀態,男性、年齡層較高及使用一級藥物者,其死亡速率皆較快;在調整其他因素後發現,男性與一級藥物相關犯罪者的死亡風險分別為0.94~1.53、1.17~2.3倍。相較於18-29歲者,45歲以上之死亡風險最高 (aHR=2.09~2.97),然性別與藥物分級僅於世代二及三達到統計上顯著意義。世代三因法律規定變動而有矯正/治機構之區分,分析後發現相較於僅接受觀察勒戒之個案,合併觀察勒戒與戒治者,其死亡風險增加近30% (95% CI: 1.08-1.55, p=0.006)。

結論:臺灣地區藥物相關案件犯罪者之人口學特徵及藥物犯罪等級逐漸在改變。相較於一般族群,其不僅具有較高死亡風險,且程度上具有明顯之年度及性別差異;其中又以18-29歲之年輕族群的相對死亡情形最高。在不同藥物相關法律規定區分的研究世代中,出所後三年死亡風險的相關因子包括年齡、性別及藥物等級等;第三世代中,接受戒治者之死亡速率較快。為減少藥物相關犯罪者之健康問題與降低其死亡率,未來的研究與防治計畫須將個體特質(如年齡與性別等)與總體環境(如藥物相關政策制定及加強醫療可近性等)納入參考。
Objectives: This study sougt to (i) understand the trend of mortality and (ii) examine sociodemographics and judiciary factors associated with survival status among the first-time drug offenders in Taiwan.

Methods: A total of 94,388 first-time adult drug-offenders were selected from the 1987-2003 judiciary records, through data linkage their information concering survival status and primary cause of death were obtained from the 1987-2005 deaths register system. Three sequential cohorts were identified on the basis of the dates for enactment and implementation of major drug laws and regulations. The standardized mortality ratio (SMR) was derived by the comparison of observed deaths to the expected values based on sex-, 5-year age-, and calendar year-specific mortality in Taiwan population. The 3-year cumulative survival probability after release among durg-offeners was estimated Kaplan-Meier method, and the association, hazard ratio (HR), was calculated by Cox proportional hazard model.

Results: Overall, the proportion of female, younger-age, and schedule II drug-involved offenders gradually increased overtime. In the drug offenders aged 18-29 years, the estimated all cause SMRs were 6~8 for males and 9~40 for females. Cause-specpifc SMRs were highest in unnatural causes, including accident, suicide, and homicide. Moreover, the SMR of schedule I drugs gradually increased over three sequential cohorts. Older age and male gender were found associated with increased death rate within three years after release in cohort II & III offenders. Furthermore, for cohort Ⅲ, those who served sentence in the detoxication and rehabilitaiton institution were more likely to die earlier than their peers having detoxication sentence only (aHR=1.29, 95% CI: 1.08-1.55, p=0.006).

Conclusions: The demographic and judiciary profiles of first-time adult drug offenders in Taiwan have been noticeably changing during the past decades. The drug offense-related excess in mortality was especially higher in the female and younger-age. The survival status within 3 years after release from correctional faciltities was affected by both sociodemographic and judiciary characteristics. Future research is needed to understand macroenvironmental factors accounting for differential mortality in drug-offenders (e.g., drug law/regulation, health insurance policy, and medical service accessibility), in order to reduce health problems and address the healthcare need for this marginalized population.
目錄
第一章 緒論 1
第一節 研究背景 1
第二節 研究動機 5
第三節 研究目的 6
第二章 文獻探討 7
第一節 非法藥物使用之流行病學 7
第二節 監獄受刑人的死亡相關研究 13
第三節 相關法律及政策 20
第三章 研究材料與方法 26
第一節 研究設計 26
第二節 資料來源及處理 30
第三節 研究對象 35
第四節 變項之操作型定義及測量步驟 41
第五節 資料分析方法 46
第四章 研究結果 53
第一節 樣本描述性統計 53
第二節 死亡率分析 58
第三節 存活分析 64
第五章 討論 68
第一節 描述性統計 68
第二節 標準化死亡比 70
第三節 存活情形 76
第四節 研究限制 79
第六章 結論與建議 81
第一節 結論 81
第二節 建議 82
參考文獻 83
附 91


表目錄
表2.1 臺灣地區非法藥物使用之相關盛行率研究結果 92
表2.2 非法藥物使用者之主要死因、全死因及特殊死因別標準化死亡比之相關研究結果 93
表2.3 臺灣地區藥物相關政策與法制發展一覽表,1955-2005年 95
表3.1 藥物相關犯罪偵查案件串連死亡登記檔之檔案清理流程 98
表3.2 觀察勒戒、戒治及監獄執行檔之檔案清理流程 99
表3.3 民國76-94年,初次藥物相關犯罪偵查案件、觀察勒戒、戒治及監獄執行人次之分佈,按年度區分 100
表3.4 民國76-94年,初次藥物相關案件犯罪者基本描述性統計 (N=237,646) 101
表3.5 研究主要分析變項內容及格式 102
表4.1 民國76-92年,初次藥物相關案件犯罪者世代別描述性統計,按年齡分層 104
表4.2 民國76-92年,初次藥物相關案件犯罪者世代別描述性統計,按偵查地區分層 105
表4.3 民國76-92年,初次藥物相關案件犯罪者世代別描述性統計,按犯罪案由分層 106
表4.4 至民國94年,初次藥物相關案件犯罪者世代別描述性統計,按死亡年齡分層 107
表4.5 民國76-92年,臺灣地區初次藥物相關案件犯罪者之描述性統計,按世代區分 108
表4.6 至民國94年底,初次藥物相關案件犯罪者世代別死亡數分布,按性別分層 109
表4.7 至民國94年底,臺灣地區初次藥物相關案件犯罪者年度死亡率及標準化死亡比,按性別分層 110
表4.8 民國76-92年,臺灣地區初次藥物相關案件犯罪者年齡層別標準化死亡比,按性別分層 111
表4.9 民國76-92年,臺灣地區男性初次藥物相關案件犯罪者,藥物級別特殊死因別標準化死亡比,按世代區分 (N=80,888) 112
表4.10 民國76-92年,臺灣地區女性初次藥物相關案件犯罪者,藥物級別特殊死因別標準化死亡比,按世代區分 (N=13,500) 113
表4.11 民國76-92年,臺灣地區18-29歲死亡之初次藥物相關案件犯罪者特殊死因別標準化死亡比,按性別分層 114
表4.12 民國76-92年,臺灣地區30-44歲死亡之初次藥物相關案件犯罪者特殊死因別標準化死亡比,按性別分層 115
表4.13 民國76-92年,臺灣地區45歲以上死亡之初次藥物相關案件犯罪者特殊死因別標準化死亡比,按性別分層 116
表4.14 民國76-92年,臺灣地區初次一級藥物相關案件犯罪者特殊死因別標準化死亡比,按性別分層 117
表4.15 民國76-92年,臺灣地區初次二級藥物相關案件犯罪者特殊死因別標準化死亡比,按性別分層 118
表4.16 民國76-92年,臺灣地區初次藥物相關案件犯罪者之存活分析,按世代區分 119


圖目錄
圖3.1 研究資料串檔流程,按處理單位區分 120
圖3.2 藥物相關犯罪偵查案件及後續矯正/治機構執行記錄之串連方式,按刑事案件相關司法流程判定 121
圖3.3 民國76-94年,初次藥物相關犯罪偵查案件、觀察勒戒、戒治及監獄執行人次之分布 122
圖3.4 臺灣地區藥物相關政策及法律變動時間點,1929-2008年 123
圖3.5 民國76-92年,臺灣世代別藥物相關政策及法律之比較,按主要變動時間點區分 124
圖3.6 研究樣本篩選及分組流程圖 125
圖4.1 民國79至94年,臺灣地區初次藥物相關案件犯罪者年度死亡數及標準化死亡比,按性別分層 126
圖4.2 藥物相關案件犯罪者三年存活分析圖 (Kaplan-Meier curve),按性別分層,1987-2003年 127
圖4.3 藥物相關案件犯罪者三年存活分析圖 (Kaplan-Meier curve),按年齡層分層,1987-2003年 128
圖4.4 藥物相關案件犯罪者三年存活分析圖 (Kaplan-Meier curve),按藥物等級分層,1987-2003年 129
圖4.5 藥物相關案件犯罪者三年存活分析圖 (Kaplan-Meier curve),按偵查地區分層,1987-2003年 130
圖4.6 藥物相關案件犯罪者三年存活分析圖 (Kaplan-Meier curve),按矯正/治機構分層,1998-2003年 131
圖4.7 藥物相關案件犯罪者一年存活分析圖 (Kaplan-Meier curve),按矯正/治機構分層,1998-2003年 132
圖4.8 藥物相關案件犯罪者一年死亡風險圖 (Hazard rate curve),按矯正/治機構分層,1998-2003年 133
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