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研究生:胡喻婷
研究生(外文):Yu-Ting Hu
論文名稱:失眠的個人與環境因子之多層次空間分析
論文名稱(外文):Individual and Environmental Factors of Insomnia: Individual and Environmental Factors of Insomnia: A Spatial and Multilevel Analysis
指導教授:陳端容陳端容引用關係
口試委員:鄧志松喬芷
口試日期:2014-06-20
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:健康政策與管理研究所
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:2014
畢業學年度:102
語文別:中文
論文頁數:95
中文關鍵詞:失眠環境因子運動環境空間分析多階層分析
外文關鍵詞:insomniaindividual factorenvironment factorspatial analysismutilevel regression model
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研究背景與目的:失眠會對人體在生理、心理和生活品質上造成很大的影響,從盛行率的相關研究中發現國人的失眠發生率節節上升;治療失眠除了藥物外,運動也被認為對失眠發生率的下降和相關症狀的改善有所助益。在失眠相關危險因子的研究中,失眠的發生除了與個人特質有所相關外,睡眠品質也因深受外界環境所影響。故本研究主要的目的為了解失眠的發生是否受居住環境影響,以及如何與這些環境因子進行互動;並在控制個人因素後對外在環境是否會影響個人發生失眠的機率進行推論。
研究方法:本研究使用2005年和2010年健保資料庫之歸人檔,推估其居住地後選取診斷為失眠者進行研究。以空間群聚分析探索失眠的發生是否在台灣存在空間分布上的差異,接著對失眠與其環境因子的互動進行區域層級的分析了解,了解居住地的社會環境和運動環境是否與對該地區失眠發生比率有所影響;而為推論個人失眠與否是受到環境因子影響,則使用多階層迴歸分析,先控制個人因素後進行區域層級自變項是否對個人失眠的發生機率產生脈絡調節的效果做了解。
研究結果:在區位空間分析中,以空間群聚分析的方式證實了失眠的發生在台灣的分布有空間群聚的現象,其中在成年人身上最為顯著;從空間迴歸中則發現居住在發展邊緣化之鄉鎮(高扶養比和遷出人口比率)的地區失眠比率較高,並且與鄰居鄉鎮的失眠比率有高度的相關;至於運動環境數量多能降低地區失眠人口比率,則只在高社會經濟發展的地區在得到證實。在多階層羅吉斯迴歸分析結果的部分,驗證個人因素中年紀越大、女性、共病指標越高、低投保金額者個人失眠的比率就越高;在控制個人層級變項後居住在發展邊緣化的鄉鎮個人失眠的比率就越高;而個人隨年齡上升失眠率增加的速率會受到各鄉鎮的運動場所數量所調節,表示運動場所數量多的地區個人隨年齡失眠比率增加的速度會變慢。
研究結論:失眠的介入不能只是針對個人給予藥物作症狀改善,個人的健康行為和友善的居住環境都能對睡眠品質的提升有所助益。政府單位若能進行地區睡眠品質不佳的環境因子分析,視地區的需求進行政策上的環境改善,並且利用改變環境的方式培養良好的生活習慣和塑造健康的行為,國人整體的睡眠品質將大大提升。


Background and objectives: The prevalence of insomnia in Taiwan had been rising. Insomnia have negtive impacted on physical, psychologic and quality of life. Past studies had proven that sleeping quality was affected by individual and environment factors. So our purpose of this study is to understand after controlling individual factors whether insomnia were affected by the living environment, and how to interact with environmental factors.
Methods: Participants were identi&;#64257;ed from National Health Insurance enrollees in Taiwan in 2005 and 2010. Individuals with insomnia were identi&;#64257;ed using The International Classi&;#64257;cation of Diseases, Ninth Revision, Clinical Modi&;#64257;cation (ICD-9-CM) diagnostic and procedure codes of 780.52, 307.41, and 307.42. And. First we explored the spatial cluster of insomnia rates by spatial analysis, including global spatial autocorrelation and local spatial autocorrelation with Queen rule as spatial weights matrix, then used multiple regression and spatial regression to determine the effect of living environment factors (dependency, emigration and sports facilities rates)analysis on insomnia. Multilevel logistic models including random coefficient model, intercept-as-outcome and slopes-as-outcome model were employed to access the relationship between environment factors and individual’s factors(age, sex, socioeconomic status and health condition).
Result: Our results indicate that there are some significant clusters of insomnia rates in Taiwan in 2005 and 2010, and the most significant is in adults(18-65 year-old), And in spatial regeression found that living in development marginalization(high dependency and emigration rate) had high insomnia rate, the sports facilities rates only had influence on high socioeconomic towns. In addition, results from multilevel logistic models indicated that female, old, low socioeconomic status and bad health condition had a higher chance of getting insomnia; and after controlling for individual factors a person who lived in development marginalization was more likely to getting insomnia.
Conclusion: Our study found that there are significant clusters of insomnia rates in Taiwan,and after controlling individual factors insomnia were affected by the living environment.


口試委員會審定書……………………………………………………i
中文摘要…………………………………………………………… ii
英文摘要……………………………………………………………iv
第一章 緒論 1
第一節 研究背景 1
第二節 研究目的與研究貢獻 3
第二章 文獻回顧 4
第一節 失眠簡介 4
第二節 失眠與藥物使用的副作用 7
第三節 失眠的相關疾病 9
第四節 失眠與人口學特質 11
第五節 失眠與運動和生活習慣 14
第六節 失眠與居住環境 16
第七節 居住環境與運動習慣之培養 18
第三章 研究方法 20
第一節 研究架構與流程 20
第二節 研究假說 24
第三節 研究對象與操作型定義 25
第四節 資料處理與統計分析 30
第四章 分析結果 37
第一節 個人層級描述性統計 37
第二節 區域層級描述性統計 40
第三節 空間群聚分析 43
第四節 因素分析與區域層級描述性統計 51
第五節 區域層級複迴歸模型 54
第六節 空間迴歸分析 57
第七節 地理加權迴歸 62
第八節 個人層級推論性統計 67
第九節 多層次分析 69
第十節 敏感度分析 74
第五章 討論 78
第一節 區位空間分析 78
第二節 多階層羅吉斯迴歸分析 81
第三節 研究限制 84
第六章 結論與建議 86
第一節 研究結論 86
第二節 研究建議 87
參考文獻 88
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