台灣痔瘡患者看病特性的描述與分析

研究背景:痔瘡為一種常見的疾病,但是關於它的盛行數據,人口分布,以及就醫情況很少討論到.

研究目的:了解台灣近十年來痔瘡的盛行率,就醫習慣以及接受手術治療比例,並分析影響手術治療的相關因子.

研究方法:我們使用台灣健保資料庫,取自2000,2005,2010年百萬歸人檔,分析這三
年就醫資料,選取ICD9的痔瘡診斷碼,以及相關檢查及治療碼,分析痔瘡在不同性
別,年齡層的分布情形,以及各種痔瘡手術在不同性別,年齡層,各級醫院及不同共病指數的分布情形,影響手術治療的相關因子則以邏輯斯回歸分析.

研究結果:根據我們的研究發現,台灣有症狀的痔瘡患者粗盛行從1.37%增為2.01% 而校正盛行則是從0.58%增為1.01%,男女比例相近,好發年齡為61至80歲,接受手術治療的比例從39.6%降為27.4%.大多數患者在診所接受手術治療(37.23%),至於接受痔瘡全切除手術患者則以區域醫院最高(9.59%),查爾森共病指數越高者,接受手術比例越低.

研究結論:台灣痔瘡的盛行逐年增加,接受手術治療比例則是逐年降低,以在診所接受手術治療的比例最高,共病指數較高患者接受手術比例較低.
關鍵字:痔瘡,盛行 ,醫院,治療

Characteristics of hemorrhoids patients in Taiwan-A
descriptive analysis based on the National Health Insurance database
Abstract
Background: Hemorrhoids is a common disease, but itsprevalence, patient population and health seekingbehaviorwere notreported in Taiwan.
The purpose of the study is to evaluate the prevalence of hemorrhoids and to explore the factors of undergoingsurgical treatment such as gender, age, and Charlson comorbidity index.
Methods: We used a nationally representative dataset (Taiwan’s National Health Insurance Research Database) containing 1,000,000patients, who were randomlysampled from the years 2000,2005, and 2010, respectively.Information of diagnosis, examination, and treatment were further retrieved.The factors in relation to undergoing surgery for hemorrhoids patients were analyzed by logistic regression model.
Result:
1. From 2000 to 2010,the crude prevalence of patients with symptomatic hemorrhoids

increased from 1.37 to 2.01%, and the adjusted prevalence increased from 0.58 to 1.01%.

The prevalence among males and females was similar. The prevalent age group for

Hemorrhoids was 61–80 years (crude, 3.4%;adjusted, 1.77%).

2.From 2000 to 2010,the proportion of patients undergoing surgical treatment decreased

from 39.6 to 27.4%.Among all types of medical facilities where the surgery was carried

out, clinics had the highest proportion (37.23%,p<0.05).Patients without comorbidities

also had higher proportion as compared with those with comorbidities. (29.57%, p < 0.05).

The odds ratio (OR) for surgery was highest in those aged 41–60 years (1.431, p < 0.05, 95%CI: 1.202-1.703),presenting at clinics (2.787, p<0.05, 95% CI:2.569- 3.025) and

without comorbidities (1.875, p<0.05, 95% CI:1.687-2.045).

3.From 2000 to 2010, the proportion of patients undergoing total hemorrhoidectomy

decreased from 13.06 to 7.75%. The peak age for total hemorrhoidectomy was 21–40

years (9.85%, p <0.05). The proportion was highest in regional hospitals (9.59%, p <

0.05) and in patients without comorbidities (8.98%, p <0.05). The OR of performing a

Surgery was highest in those aged 21–40 years (3.425, p <0.05, 95% CI: 2.190–5.356),

regional hospitals (1.283, p <0.05, 95% CI:1.020–1.613), and those without comorbidities

(1.334, p <0.05, 95% CI: 1.088–1.635).

Conclusions: From 2000 to 2010, the prevalence of hemorrhoids increased in Taiwan, whereas the proportion of patients undergoing surgical treatments decreased.
Patients with a higher comorbidity score had a lower surgical treatment rate. The highest proportion of medical facilities undergoing surgical treatment for hemorrhoids was clinics.

Key word: Hemorrhoid, prevalence, treatment, hospital

目錄
誌謝………………………………………………………………………….I
中文摘要…………………………………………………………………….II
英文摘要………………………………………………………………..…..III
目錄…………………………………………………………………...…......V
表目錄……………………………………………………………………....VI
圖目錄……………………………………………………………………..VII
第一章 Introduction……………………………………………………… 1
第二章Materials and methods……………………………………………..1
2.1.Data source………………………………..………………………… 1
2.2.Safety and quality control of data………..……………………..…….2
2.3.Data selection………………………………………………………...2
2.4.Statistical analysis…………………………………………………….4
第三章Result…………………………………………….…………………..4
第四章 Discussion…………………………………………………………...7
第五章 Conclusion…………………………………………………………10
第六章 Referrence………………………………………………………….18

表目錄
表 1Characteristics of population from Taiwan's NHI database………..…………..…11
表 2Crude Prevalence of hemorrhoids……………………………………….....……..12
表 3Adjusted Prevalence of hemorrhoids…………………………………...…..……..13
表 4Proportion of surgical treatment………………………………………......………14
表 5Proportion of total hemorrhoidectomy(74410c)……………………….………….15
表 6Logistic regression analysis for surgical patients from 2000 to 2010………..…...16

圖目錄
圖 1Prevalence of hemorrhoids…………………………………………………….17

Referrence

1.Peter A.Hass ,Gabriel P.Hass. et al.The prevalence of hemorrhoids.Dis colon rectum
1983,July:435-439.

2.Ronald Bleday M.D et al .Symptomatic hemorrhoids:Current incidence and
complications of operative therapy. Dis colon rectum 1992;35:447-481.

3.John.F.Johason,Amnon Sonnenberg. The prevalence of hemorhroids and
Constipation. Gastroenterology.1990;98:380-386.

4.Stefan Riss.Friedrich Anton Weiser et al.The prevalenc of hemorhroid in adult.
Int.J. colonrectal Dis 2012;27:215-220.

5.Pei-Chang Lee,Yu-wen Hu et al.The risk of cancer in patients with benign anal
lesions:A nation-wide population-based study.The Am J. Medicine. 2013.December,
No.12,Vol 126:1143e9-e18.