臺灣博碩士論文加值系統

背景與目的
根據2015年臺灣衛生福利部之統計，攝護腺癌為男性惡性腫瘤發生率的第五名，死亡率為第七名，目前攝護腺癌的病因尚未完全了解，且有關其危險因子的資訊是缺少且不足的，過去研究探討攝護腺癌相關危險因子有很多，其中僅年齡及家族史為明確之危險因子，近年來有國外研究指出環境外源性因素與攝護腺癌發生具有相關性，其中環境因素包含有空氣污染物的曝露，環境中的空氣污染物已經使全球許多疾病發生且造成社會很大的負擔，國際癌症研究機構近年來將空氣污染物列為人類致癌物質之一，故空氣污染物與攝護腺發生之相關議題值得重視，然而，國內尚未有任何關於空氣污染物與攝護腺癌之相關研究發表，為此，本研究利用我國全民健康保險資料庫，來探討長期曝露於空氣污染物中與攝護腺癌發生率之間的相關性。

研究方法
本研究利用族群為基礎的病例對照研究設計來探討長期曝露於空氣污染物與攝護腺癌發生率之相關性。資料來源主要為臺灣1997年至2010年全民健保資料庫，並從中找出2009年男性攝護腺癌新發生個案共5,115人，以及利用「年齡」及「診斷年」為匹配條件選出2009年男性非攝護腺癌個案共20,460人，再與余化龍等學者推估之空氣污染物資料結合再與行政院環境保護署空氣品質監測網之空氣污染物資料結合，來估計研究對象1998年或投保日期至發病日診斷日前或至發病日診斷日前三年之空氣污染物（CO、NOX 、O3、PM10 、PM2.5 及SO2平均曝露濃度，並且依以多變量邏輯斯迴歸模型分析空氣污染物與攝護腺癌發生率之間的相關性。

研究結果
調整年齡、慢性阻塞性肺病、共病症指數、投保金額、都市化程度及空氣污染物後，當空氣污染物一氧化碳CO及氮氧化物NOX之平均曝露濃度增加，會增加罹患攝護腺癌的風險，而增加之風險分別為11%（95% CI=1.05-1.17）及20%（95% CI=1.13-1.28），此外，敏感度分析發現，在同一地區就醫常見上呼吸道疾病者其空氣污染物與攝護腺癌發生之相關性較強，當空氣污染物CO、NOX及O3之平均曝露濃度增加，皆會增加罹患攝護腺癌的風險，而增加之風險分別為13%（95% CI=1.04-1.23）、22%（95% CI=1.11-1.34）及3%（95% CI=0.94-1.12），依研究對象特性之交互作用而言，曝露於北部地區者，其受空氣污染物NOX的影響較大，而曝露於都市化程度為鄉村地區及南部地區者，其對空氣污染物O3較為敏感。

結論與建議
本研究之結果發現長期曝露於高濃度的空氣污染物CO及NOX ，會增加罹患攝護腺癌的風險，因此本研究結果可提供相關環保相關單位參考，以加強監控與限制空氣污染物的來源與排放，另提供衛生相關單位，為了控制攝護腺癌的發生，應加強宣導民眾對於空氣污染物與健康之影響的認知，並降低其空氣污染的曝露，且應針對敏感族群提供攝護腺癌的篩檢及針對攝護腺癌高危險族群進行追蹤，以降低其他可能使攝護腺癌發生之危險因子的曝露。

Objectives
According to statistics from the Ministry of Health and Welfare, prostate cancer is the fifth highest in incidence rate and seventh in mortality rate for male malignant tumor in Taiwan. Currently the causes of prostate cancer are not clearly and there is a paucity of information on risk factors for prostate cancer. More pPrevious studies have been investigated the risk factors for prostate cancer and age and family history of prostate cancer have been shown consistenly to increase risk of prostate cancer.that clear signal has emerged such as age and family history of prostate cancer. In addition, one of the foreign study indicated that environmental and exogenous factors such as air pollution do correlate with increased risks of prostate cancer such as air pollution. Air pollution of environmental is thought to cause a substantial global burden of disease and the International Agency for Research on Cancer defined that air pollution is one of the carcinogen for human. Therefore, the issues about effects of air pollution on prostate cancer can not be ignored. However, the studies about on air pollution and incidence of prostate cancer in Taiwan have never been releasedinvestigated. Therefore, our study is to examine the relationship between long-term exposure to air pollution and the incidence of prostate cancer in Taiwan using the National Health Insurance Research Database.

Methods
We conducted a population-based case-control study to investigate associations between long-term exposure to air pollution and the incidence of prostate cancer. Based on data extracted from the National Health Insurance Research Database from 1997 to 2010, we identified 5,115 incident prostate cacer cases and matching age and diagnosis of year to select 20,460 of none prostate cancer controls in 2009. Concentrations of air pollution（CO、NOX 、O3 、PM10 、PM2.5 and SO2 ）were modeled based on air quality data. Mean concentrations estimates of exposure were estimated based on the clinic location where the participant most frequently sought treatment for acute upper respiratory infections (ICD-9-CM code 460)calculated for subjects’s area from 1998 or date of insure to diagnosedindex date and to three years before index date. We used multivariate logistic regression models to analysis effects of air pollution on incidence of prostate cancer.

Results
After adjusting for age, COPD, charlson comorbidity index, insured amount, urbanization level and air pollution, the odds ratio of prostate caner incidence increased by 11%（95% CI=1.05-1.17）and 20%（95% CI=1.13-1.28）per interquartile increase in average CO and NOX exposure. In addition, Associations were stronger for subjects who cured common respiratory diseases in the same area, the odds ratio of prostate caner incidence increased by 13%（95% CI=1.04-1.23）, 22%（95% CI=1.11-1.34）and 3%（95% CI=0.94-1.12）per interquartile increase in average CO, NOX and O3 exposure. Considering interaction with subjects characteristics, we fonund stronger effects of NOX among subjects who exposure resident in north area, and subjects who exposure resident in rural area and sourth area are sensitive to O3 effects.

Conclusions
We observed that long-term exposure to air pollution was associated with prostate cancer risk, especially for CO and NOX. It Our results provides evidence for environmental protection administration to monitor and control emissions of air pollution. In addition, our resultsIn order to control the incidence of prostate cancer, it also provides the Ministry of Health and Welfare to awareness advocacy to enhance the people's knowledge about health effects of air pollution and provide the screening of prostate cancer and follow-up people who have higher risk of prostate cancer to reduce that expose to another risk factors of prostate cancer.

中文摘要 I
Abstract II
表目錄 IV
圖目錄 V
第一章 緒論 1
第一節 研究背景與動機 1
第二節 問題陳述 5
第三節 研究目的及研究問題與假設 7
第四節 研究之重要性 8
第二章 文獻探討 9
第一節 攝護腺癌之流行病學及其危險因子 9
第二節 空氣污染物之特性與污染源 33
第三節 空氣污染物與癌症之相關 38
第四節 空氣污染物與攝護腺癌之相關 55
第五節 空氣污染物與攝護腺癌之可能生物機制 60
第六節 文獻總結 63
第三章 研究方法 64
第一節 研究架構 64
第二節 研究設計 66
第三節 研究對象 67
第四節 研究資料來源及變項的操作型定義 69
第五節 研究資料處理過程 84
第六節 統計分析 96
第四章 研究結果 99
第一節 研究對象特性及各縣市攝護腺癌發生率分佈 99
第二節 六種空氣污染物之相關性 102
第三節 空氣污染物曝露與攝護腺癌發生之相關性 106
第四節 依研究對象特性分層分析空氣污染物曝露與攝護腺癌發生之相關性 116
第五章 討論與建議 134
第一節 研究結果總結和討論 134
第二節 研究之優點、限制及建議 143
第三節 研究結果之應用 146
參考資料 147
(一) 中文部分 147
(二) 英文部分 149
附錄 167

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