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研究生:黃鈺媛
研究生(外文):Yu-Yuan Huang
論文名稱:我國可歸因於吸菸之醫療費用趨勢研究
論文名稱(外文):The trend of smoking attributable medical expenditures in Taiwan
指導教授:李玉春李玉春引用關係
指導教授(外文):Yue-Chun Lee
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:衛生福利研究所
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:140
中文關鍵詞:醫療費用吸菸可歸因於吸菸之費用趨勢
外文關鍵詞:medical expendituresmokingsmoking attritutable expenditurestrend
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吸菸行為對全球所造成的經濟損失危害甚大,特別是在醫療費用部份。因此國內外相關研究都有探討可歸因於吸菸之醫療費用,但是多半以一年的調查為基礎,未反映出年度間的差異。此外,國內相關研究在估計與菸相關疾病時較為保守,且未考量門診釋出處方於特約藥局之醫療費用,可能造成可歸因於吸菸之醫療費用低估。故本研究以2005至2007年國衛院一百萬人檔歸人檔中門住診、特約藥局費用,並將所有可能與菸相關之疾病全部納入計算,以更完整評估我國可歸因於吸菸之醫療費用趨勢,其研究結果可做為菸品健康捐調整的參考依據。
本研究採縱貫性研究設計,依據2005至2007年國健局之成人吸菸資料庫計算吸菸盛行率並參考溫啟邦(2004)我國與菸相關疾病之相對危險性研究數值,計算出可歸因於菸之比例(SAF)。並利用健保資料庫計算與菸相關疾病之醫療費用,將與菸相關疾病之醫療費用與可歸因於菸之比例相乘後,計算出2005至2007年35歲以上可歸因於吸菸之醫療費用,並分析各年度可歸因於吸菸之醫療費用其趨勢、疾病貢獻度。並以吸菸率是否改變,與不同醫療費用成長率之假設,去推估未來第11年至第15年的醫療費用。其研究結果如下︰
1.我國可歸因於吸菸之醫療費用2005年為256.52億元、2006年為275.67億元、2007年272.99億元。若依性別分層來看,男性佔率最大為92%-94%。若以年齡分層來看,則以65歲以上佔率最大為38-40%。而可歸因於吸菸醫療費用之改變率最主要是受到吸菸率之影響最大。
2005至2007年可歸因於吸菸之醫療費用其疾病排名序位皆為︰第一名為呼吸系統疾病(約佔22-24%)、第二名為心血管系統疾病(約佔18%)、第三名為消化系統疾病(約佔16-18%)、第四名為腎臟系統疾病(約佔15-16%)、第五名為惡性腫瘤(約佔13-16%)、第六名為意外傷害(約佔5-7%)、第七名為糖尿病(約佔3-4%)。
2.可歸因於吸菸之未來醫療費用部份︰
a、假設該年吸菸人口未來會持續吸菸,則2005-2007之固定樣本未來11-15年可歸因於吸菸之醫療費用應介在687.09億元-985.96億元之間。
b、假設未來吸菸率之變動趨勢與2004至2007年成人吸菸資料庫一致,則未來11-15年(2016-2022年)依經建會推估人口計算可歸因於吸菸之醫療費用應介在667.38億元-813.08億元。
綜合上述結果,本研究發現︰2009年06月菸害防制法修整調漲菸捐後,其用於健保部份之菸捐(266億)與本研究之可歸因金額相近。故2009年菸害防制法之調整的確有其必要性,建議未來應定期評估可歸因於吸菸之醫療費用,做為調整菸捐之依據。以及在可歸因於吸菸之醫療費用改變率影響最大因素為吸菸率,故建議菸捐運用在菸害防制之比例應提高,以降低吸菸率及可歸因於吸菸之醫療費用。
Smoking behaviors do great harm to the global enconomy a lot, especially in medical expenditures. Many studies show interests in the smoking attritutable medical expenditures (SAME), but most surveys were based on one year and all the previous domestic studies calculated the smoking attritutable diseases (SAD) in a conservative way, and didn’t take into account the pharmacy data, which will undertestimated SAME. Therefore, this research uses the National health insurance database including inpatient, outpatient and pharmacy databases to estimate SAME. Our research also takes all SAD into account based on the evidence shown by previous empirical studies. The research results can be useful for the adjustment of tobacco tax according to the Tobacco Control Act.
The research applied longitudinal design, using the smoking prevalence data estimated from Adult Smoking Survey conducted by Bureau of Health Promotion of the Department of Health from 2005 to 2007, and applying relative risk of SAD from empirical study in Taiwan to calculate the smoking attributable fraction (SAF). Besides it used NHI database and SAF to calculate the SAME of people aged over thirty-five during 2005-2007. Further, we also analysed the trend of future projection, and the contribution of various smoking related diseases to SAME.
Our major findings are follows:
1.The SAME were 25.652, 27.567, and 27.299 billion NT dollars respectively from 2005-2007; mostly contributed by men (92-94%) or by people over 65 years and over (about 38-40%). The prevalence rate of smoking is the most important factor affecting the annual changes in the SAME. Regarding impacts of various SAD to SAME, respiratory system disease ranked first (accounted for about 22-24% of SAME); followed by cardiovascular system disease (accounted for 18%); digestive system (accounted for 16-18%); kidney system disease (15-16%); Cancer (about 13-16%); accident (about 5-7%); and diabetes. (about 3-4%).
2.Projection of future SAME
a、If smoking behavior for the fixed cohort of the 2005-2007 population keep unchanged, SAME in 2016-2022 will be about 68.709-98.596 billion NT dollars, after being discounted to current values.
b、If we estimated smoking rates based on the trends in Adult Smoking Survey from 2005 to 2007 and the projected population by Council for Economic Planning and Development; SAME will be 66.738 to 81.308 billion NT dollars from 2016 to 2022 after being discounted to current values.
In conclusion, the magnitude of SAME estimated from our research are similar to the amount allocated to National Health Insurance (26.6 billion NT dollars) from the levy of the tobacco tax following the amendment of the Smoking Control Act in 2009.
Therefore, the health authorities may evaluate the SAME regularly to be used as a basis to adjust tobacco tax. Moreover, we found smoking rate is the most important contribution factor to the annual change in SAME, so we recommend that more tobacco tax should be used in Tobacco Control.
誌謝 I
中文摘要 II
ABSTRACT IV
目錄 VI
第一章 緣起 1
第一節 研究背景與動機 1
第二節 研究目的與問題 3
第三節 研究重要性 4
第四節 重要名詞定義 5
第二章 文獻探討 6
第一節 可歸因於吸菸之疾病探討 6
第二節 與菸相關疾病之風險研究 9
第三節 醫療費用計算-罹病成本 17
第四節 可歸因於吸菸之醫療費用研究 20
第五節 文獻小結 24
第三章 研究方法 25
第一節 研究設計 25
第二節 分析概念架構 32
第三節 研究對象 33
第四節 資料來源 34
第五節 變項及測量 36
第六節 資料篩選與處理過程 37
第七節 統計分析 40
第四章 研究結果 41
第一節 描述性統計分析 41
第二節 未來費用推估 65
第三節 敏感度分析 69
第五章 討論 73
第一節 研究方法之討論 73
第二節 研究結果之討論 74
第二節 研究限制 82
第六章 結論與建議 83
第一節 結論 83
第二節 建議 84
參考文獻 86
附錄 89
一、中文部份
中央健康保險局. (2008). 民國96 年全民健康保險費率精算報告. from全國菸害防制制策略會議總結報告書. (2005). 國家衛生研究院.
行政院經濟建設委員會. (2006). 中華民國臺灣97年至140年人口推計報告. 台北.
吳季倫, & 楊銘欽. (1998). 肝癌患者罹病成本與其相關因子之探討:以某醫學中心患者為例. 中華公共衛生雜誌 17(2), 148-157.
施嫈瑜. (2006). 菸害與肺癌. 聲洋防癌之聲, 112, 12-16.
張景然, & 王珮蘭. (2004). 吸菸行為的形成、持續、戒斷與復發歷程. 中華心理衛生學刊, 17(4).
菸害防制法. (2007). from http://law.moj.gov.tw/
馮南雄. (2005). 菸害與肺癌的關係. 聲洋防癌之聲, 110, 22-26.
黃雅慧. (2004). 國民健康局門診戒菸計劃之成本效益分析. 國立陽明大學, 台北.
蔡宜樺, 楊銘欽, & 季瑋珠. (1998). 乳癌確診後之初期罹病成本與相關因子之探討--以臺大醫院病患為例. 中華公共衛生雜誌 17(3 ), 242-252.
衛生署統計室. (2005-2007). 全民健康保險醫療統計年報. from http://www.doh.gov.tw/CHT2006/DM/DM2.aspx?now_fod_list_no=9513&class_no=440&level_no=1
鄭丁元 , 溫啟邦 , 蔡孟娟 , & 蔡善璞. (2003). 國人吸菸行為現況:2001年國民健康調查之分析. 臺灣公共衛生雜誌 22(6 ), 453-464.
羅于韻 , 劉瑞瑤, 陳振文, & 黃信彰. (2005). 戒菸面面觀. 基層醫學 20(10), 272-278.

二、英文部份
Akiba, S., & Hirayama, T. (1990). Cigarette smoking and cancer mortality risk in Japanese men and women--results from reanalysis of the six-prefecture cohort study data. Environmental Health Perspectives, 87, 19-26.
Baliunas, D., Patra, J., Rehm, J., Popova, S., & Taylor, B. (2007). Smoking-attributable morbidity: acute care hospital diagnoses and days of treatment in Canada, 2002. BMC Public Health, 7, 247.
Centers for Disease, C., & Prevention. (2003). Cigarette smoking-attributable morbidity---United States, 2000. MMWR - Morbidity & Mortality Weekly Report, 52(35), 842-844.
Cheng, T. Y., Wen, C. P., Tsai, S. P., Chung, W. S. I., & Hsu, C. C. (2005). Reducing health disparity in Taiwan: quantifying the role of smoking. Tobacco Control, 14 Suppl 1, i23-27.
Chung, C.-W., Wang, J.-D., Yu, C.-F., & Yang, M.-C. (2007). Lifetime medical expenditure and life expectancy lost attributable to smoking through major smoking related diseases in Taiwan. Tobacco Control, 16(6), 394-399.
Doll, R., Peto, R., Wheatley, K., Gray, R., & Sutherland, I. (1994). Mortality in relation to smoking: 40 years' observations on male British doctors.[see comment]. BMJ, 309(6959), 901-911.
Drummond, M. F., Sculpher, M. J., Torrance, G. W., O’brien, B. J., Stoddart, G. L., & Drummond, M. F. (2005). Methods for the Economic Evaluation of Health Care Programmes Oxford Univ Pr
Hu, F. B., Manson, J. E., Stampfer, M. J., Colditz, G., Liu, S., Solomon, C. G., et al. (2001). Diet, lifestyle, and the risk of type 2 diabetes mellitus in women.[see comment]. New England Journal of Medicine, 345(11), 790-797.
Jacobs, D. R., Jr., Adachi, H., Mulder, I., Kromhout, D., Menotti, A., Nissinen, A., et al. (1999). Cigarette smoking and mortality risk: twenty-five-year follow-up of the Seven Countries Study. Archives of Internal Medicine, 159(7), 733-740.
Kawakami N., Takatsuka N., & Shimizu H. (1997). Effects of smoking on the incidence of non-insulin-dependent diabetes mellitus: replication and extension in
a Japanese cohort of male employees. American Journal of Epidemiology, 145, 103-109.
Lam, T. H., Ho, S. Y., Hedley, A. J., Mak, K. H., & Peto, R. (2001). Mortality and smoking in Hong Kong: case-control study of all adult deaths in 1998. BMJ, 323(7309), 361.
Leartsakulpanitch, J., Nganthavee, W., & Salole, E. (2007). The economic burden of smoking-related disease in Thailand: a prevalence-based analysis. Journal of the Medical Association of Thailand, 90(9), 1925-1929.
Liaw, K. M., & Chen, C. J. (1998). Mortality attributable to cigarette smoking in Taiwan: a 12-year follow-up study. Tobacco Control, 7(2), 141-148.
Liu, B. Q., Peto, R., Chen, Z. M., Boreham, J., Wu, Y. P., Li, J. Y., et al. (1998). Emerging tobacco hazards in China: 1. Retrospective proportional mortality study of one million deaths.[see comment]. BMJ, 317(7170), 1411-1422.
Manning, W. G., Fryback, D. G., & Weinstein, M. C. (1996a). Reflecting uncertainty in cost-effectiveness analysis.
Manning, W. G., Fryback, D. G., & Weinstein, M. C. (1996b). Reflecting uncertainty in cost-effectiveness analysis. Cost-effectiveness health and medicine, 247-275.
Manson, J. E., Ajani, U. A., Liu, S., Nathan, D. M., & Hennekens, C. H. (2000). A prospective study of cigarette smoking and the incidence of diabetes mellitus among US male physicians. American Journal of Medicine, 109(7), 538-542.
Max, W. (2001). The financial impact of smoking on health-related costs: a review of the literature. American Journal of Health Promotion, 15(5), 321-331.
McGhee, S. M., Ho, L. M., Lapsley, H. M., Chau, J., Cheung, W. L., Ho, S. Y., et al. (2006). Cost of tobacco-related diseases, including passive smoking, in Hong Kong. Tobacco Control, 15(2), 125-130.
Rice, D. P., Hodgson, T. A., Sinsheimer, P., Browner, W., & Kopstein, A. N. (1986). The economic costs of the health effects of smoking, 1984. Milbank Quarterly, 64(4), 489-547.
Shultz, J. M., Novotny, T. E., & Rice, D. P. (1991). Quantifying the disease impact of cigarette smoking with SAMMEC II software. Public Health Reports, 106(3), 326-333.
Sung, H. Y., Wang, L., Jin, S., Hu, T. W., & Jiang, Y. (2006). Economic burden of smoking in China, 2000. Tobacco Control, 15 Suppl 1, i5-11.
U.S.Centers for Disease Control and Prevention. (2004 ). The health consequences of smoking: a report of the Surgeon General. from http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2004/chapters.htm,
U.S.Centers for Disease Control and Prevention. (2006). The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. from http://www.surgeongeneral.gov/library/secondhandsmoke/report/fullreport.pdf
Wannamethee, S. G., Shaper, A. G., Perry, I. J., & British Regional Heart, S. (2001). Smoking as a modifiable risk factor for type 2 diabetes in middle-aged men. Diabetes Care, 24(9), 1590-1595.
Warner, K. E., Hodgson, T. A., & Carroll, C. E. (1999). Medical costs of smoking in the United States: estimates, their validity, and their implications. Tobacco Control, 8(3), 290-300.
Wen, C.-P., Tsai, S. P., Chen, C.-J., & Cheng, T.-Y. (2004). The mortality risks of smokers in Taiwan: Part I: cause-specific mortality. Preventive Medicine, 39(3), 528-535.
WHO. (2008). mPOWER. WHO REPORT on the global TOBACCO epidemic.
Will, J. C., Galuska, D. A., Ford, E. S., Mokdad, A., & Calle, E. E. (2001). Cigarette smoking and diabetes mellitus: evidence of a positive association from a large prospective cohort study.[see comment]. International Journal of Epidemiology, 30(3), 540-546.
Woodward, M., Lam, T. H., Barzi, F., Patel, A., Gu, D., Rodgers, A., et al. (2005). Smoking, quitting, and the risk of cardiovascular disease among women and men in the Asia-Pacific region.[see comment]. International Journal of Epidemiology, 34(5), 1036-1045.
Yang, M. C., Fann, C. Y., Wen, C. P., & Cheng, T. Y. (2005). Smoking attributable medical expenditures, years of potential life lost, and the cost of premature death in Taiwan. Tobacco Control, 14 Suppl 1, i62-70.
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