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研究生:呂俞樺
研究生(外文):Lu, Yu-Hua
論文名稱:台灣1997-2008 年成人住院病患肥胖與高血壓醫療利用之探討
論文名稱(外文):Medical Utilization of Adult Obesity and Hypertension Inpatients in Taiwan, 1997-2008
指導教授:簡戊鑑簡戊鑑引用關係
指導教授(外文):Chien, Wu-Chien
口試委員:林金定祝年豐白璐簡戊鑑
口試委員(外文):Lin, Jin-DingChu, Nian-FengPai, LuChien, Wu-Chien
口試日期:2011-05-10
學位類別:碩士
校院名稱:國防醫學院
系所名稱:公共衛生學研究所
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:2011
畢業學年度:99
語文別:中文
論文頁數:134
中文關鍵詞:健保資料庫醫療利用住院特性肥胖
外文關鍵詞:National health insurance databaseMedical utilizationHospitalizationObesity
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「肥胖」一直是全球關注的公共衛生議題。台灣近年來國人生活型態改變,觀看電視及使用電腦等靜態作息的時間增加,國人體重過重與肥胖的盛行率有逐年增加的趨勢,世界衛生組織(WHO)提出,身體質量指數(BMI)上升也是造成慢性病的主要因素。因此本研究以1997-2008年全民健保資料庫之「住院資料」進行分析,探討肥胖住院病患醫療費用高、低的影響因子及高血壓肥胖者與非肥胖者住院醫療費用與住院天數高、低的影響因子。

本研究結果顯示,台灣1997-2008年成人肥胖住院病患之人次共計14,449人次,每人次住院的平均醫療費用為50,782元,平均住院天數為8.95天。肥胖住院病患主要是以青年及壯年(18-44歲)為主(佔60.45%),共伴疾病數增加,肥胖住院病患的比例隨之上升,且同時罹患有高血壓疾病佔30.1%,其次為糖尿病23.5%,高血脂為16.6%,周邊心血管疾病為8.6%。而在同時罹患其他慢性疾病者中,罹患高血壓及高血脂的肥胖住院病患醫療費用高的機會較高。另外,高血壓為本研究中慢性疾病比例最高的疾病,故深入探討肥胖高血壓肥胖住院病患醫療利用高、低的情形,本研究之肥胖高血壓住院病患主要的年齡層為壯、中年族群(31-64歲),多數病患就醫科別為心臟血管內科、一般內科及一般外科,其中,一般外科及骨科的醫療費用明顯較高;肥胖高血壓住院病患每案件數平均有4.31,且至少有32.7%之病患同時罹患除了高血壓以外的其他慢性疾病,如糖尿病、高血脂及周邊心血管疾病,且以糖尿病的比例最高。

影響肥胖高血壓住院病患醫療費用高、低的因子有年齡分組、就醫層級、就醫科別、共伴疾病數、周邊心血管疾病、手術處置等6個變項;影響肥胖高血壓住院病患住院天數高、低的影響因子有低收入戶、都市化程度、就醫科別、共伴疾病數、糖尿病及高血脂等6個變項。另外,在肥胖高血壓住院病患中,罹患周邊心血管疾病者的醫療費用顯著較高。

Obesity has been the subject of global concern in Public Health. In recent years, lifestyle of Taiwanese are changes, such as increase the time of watching television, using computers and other sedentary behavior, trend of prevalence in overweight and obesity are increasing year by year. While, World Health Organization (WHO) suggested that body mass index (BMI) increased is the main factor of causing chronic disease. Therefore, this research used the national health insurance research datasets, “inpatient expenditures by admissions (DD)” and “registry for contracted medical facilities (HOSB)” from 1997 to 2008 to find the factor of obesity and obesity-hypertension inpatients in medical expenditure and admission of length of days.

This study showed that Obesity inpatients in 1997-2008 are 14,449 cases, the average medical costs were 50,782 NT$, the average hospital stays were 8.95 days. Obesity inpatients are mainly 18-44 years old (60.45%), while number of diseases increased, associated with increase in the proportion of obese hospitalized patients rise, and while he had a 30.1% hypertension, followed by 23.5% for diabetes, hyperlipidemia was 16.6%. Obesity patients with other chronic diseases such as hypertension and hyperlipidemia at the same time are risk factors of high medical cost. In addition, hypertension was the highest proportion of chronic diseases in this study, so analyzed the risk factor of medical utilization of obesity inpatients with hypertension.

In the other hands, owing to hypertension was the highest proportion of chronic diseases in this study, so we developed the factor of medical utilization in obesity- hypertension inpatients. Among the obesity- hypertension inpatients, the main age group were 31-64 years, most departments was internal medicine of cardiovascular, general internal medicine and surgery department like clinical surgery, also surgery department and orthopedic department’s costs were significantly higher. Each case had an average of 4.31 diseases, and at least 32.7% of the patients also suffer from hypertension than in addition to other chronic diseases such as diabetes, hyperlipidemia and other cardiovascular disease, and the highest percentage of diabetes.

The factors associated with higher medical expenditure of obesity-hypertension patients by multivariate logistic regression were age group, hospital level, department of medical, more co-morbidity, other cardiovascular disease and surgeries, operations or treatments. Factors associated with higher length of stay of obesity-hypertension patients by multivariate logistic regression were low income, urbanization, department of medical, more co-morbidity, diabetics, and hyperlipidemia.


表目錄 III
圖目錄 IV
摘要 V
第一章 緒論 1
第一節、研究背景 1
第二節、研究動機與重要性 4
第三節、研究目的 5
第二章 文獻探討 6
第一節、肥胖的定義 6
第二節、肥胖的盛行率 9
第三節 肥胖之相關疾病 13
第四節、肥胖之醫療利用 19
第三章 研究方法及步驟 29
第一節、研究架構與研究假設 29
第二節、研究材料與方法 31
第三節、研究變項操作型定義 35
第四節、資料處理與分析 37
第四章 研究結果 39
第一節、肥胖住院病患之醫療利用的影響因子 39
第二節、肥胖高血壓住院病患醫療利用的影響因子 67
第五章 討論 88
第一節、肥胖住院病患之醫療利用的影響因子 88
第二節、肥胖高血壓住院病患醫療利用的影響因子 107
第三節、研究限制 117
第六章 結論與建議 118
參考文獻 120



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1. 何曉華 (2008)。行腹腔鏡減重患者手術式選擇之影響因素探討。明新學報, 4 ( 2), 317-353。
2. 宋文娟、洪錦墩、陳文意 (2008)。台灣老年人口醫療利用與多重慢性疾病之分析研究。臺灣老人保健學刊,4(2), 75-87。
3. 李碧霞、周雨樺、賴香如. (2009)。運用跨理論模式於體重過重、肥胖學童運動行爲之研究。醫護科技期刊, 11: (2), 71-86。
4. 張鴻仁、黃信忠、蔣翠蘋 (2002)。全民健保醫療利用集中狀況及高、低使用者特性之探討。臺灣公共衛生雜誌,21(3), 207-213。
5. 陳建良、何志聰、林自強、張兩溉 (2007)。肥胖第二型糖尿病患者之減重治療。內科學誌,18, 322-331。
6. 郭傑、唐正乾、許世元 (2005)。癌症、高血壓、肥胖與血管新生:流行病學及藥物學觀點。內科學誌,16: (6), 260-268。
7. 湯澡薰、郭乃文(1999)。臺灣醫療資源使用之公平性探討。醫護科技學刊,1(1),43-58。
8. 楊宜青、張智仁 (2007)。代謝症候群、肥胖和糖尿病。Formosan J Med., 11(4), 370-380。
9. 鄒孟婷、鄒孟文 (2009)。臺灣成人肥胖因素之分析:2001年“國民健康訪問調查”。臺灣家庭醫學雜誌,19: (1),13-23。
10. 廖南凱、游進達 (2009)。運動介入對學童肥胖影響之探討。嘉大體育健康休閒期刊, 8:(2)。
11. 趙麗雲 (2008)。臺灣兒童及青少年體重過重與肥胖問題之綜評。中華體育季刊,22: (1),35-46。
12. 劉家鴻,吳岱穎、郭冠良、陳建志、林光洋、黃惠娟 (2005 )。過重與肥胖。基層醫學,20(9)。