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研究生:黃絢縵
研究生(外文):Sen MonNg
論文名稱:臺灣原住民族與全國的平均餘命與健康餘命差距及解構
論文名稱(外文):Decomposition of the gap in life expectancy and healthy expectancy between indigenous people and general population in Taiwan
指導教授:王亮懿
指導教授(外文):Liang-Yi Wang
學位類別:碩士
校院名稱:國立成功大學
系所名稱:公共衛生研究所
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:2017
畢業學年度:105
語文別:中文
論文頁數:117
中文關鍵詞:台灣原住民族平均餘命健康餘命餘命差距解構
外文關鍵詞:Indigenous peoplelife expectancyhealth expectancydecomposition
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前言:臺灣原住民族與全國之間的健康一直存在差異,無論是平均餘命、死亡率、疾病盛行率等,原住民族的表現皆較為不佳,甚至有明顯的差距(葛應欽、劉碧華與謝淑芬,1994)。平均餘命雖為反映死亡率變化之指標,但隨著高齡者死亡率降低及慢性病盛行率增加,平均餘命無法細緻的呈現重要疾病之負擔。因此,藉由計算健康餘命,將可以呈現原住民族的壽命長度與品質。又透過解構原住民族與全國的健康餘命差距,探討造成兩族群健康餘命差距的原因別,將可了解健康不平等的問題根源,並提供政府實證資料來決定衛生醫療政策的優先順序。

材料與方法:本研究使用內政部公佈之2013年、2006年全國兩性簡易生命表及全體原住民族簡易生命表為基礎,利用2013年國民健康訪問調查以歐盟出版之失能盛行率歸因工具(Attribution tool)估算全國與原住民族原因別的健康風險,搭配健保就醫檔所計算出的全人口與原住民族的疾病盛行率,推估各族群的原因別失能率,接著使用Nusselder發展之解構工具(Decomposition tool),加入衛生福利部的死因統計檔之個原因別死因分率,以Sullivan的計算健康餘命方式為基礎,估算台灣原住民族與全國之健康餘命趨勢,並解構兩族群間健康餘命差距之原因。

結果與討論:2006年原住民族與全國男性零歲平均餘命差距為10.62歲,健康餘命差距為11.02歲;女性部分,零歲平均餘命差距為8.81歲,健康餘命差距為7.39歲。解構2006年男性之間零歲餘命差距,肝硬化、肺炎、中風、心臟病及事故傷害為主要造成兩族群間平均餘命及健康餘命差距的重要疾病,其分別佔平均餘命差距的58.29%及健康餘命差距的38.1%;在2006年女性部分,造成其平均餘命差距的主要原因為中風、肝硬化、心臟病、肺炎、糖尿病,其佔平均餘命差距的45.9%。肝硬化、肺炎、中風、心臟病、事故傷害則為主要造成健康餘命差距的原因,其佔健康餘命差距29.66%。
2013年原住民族與全國男性零歲平均餘命為10.17歲,健康餘命差距為10.88歲;2013年原住民族與全國女性零歲平均餘命差距為7.46歲,健康餘命差距為6.63歲。相較於2006年的結果,2013年原住民族與全國之間的平均餘命及健康餘命差距出現較為縮小的現象,其中原住民族女性的餘命表現較原住民族男性佳,與全國之間的差距則是男性大於女性的。造成2013年與2006年男性之間的平均餘命及健康餘命差距原因相似,其中肺炎及心臟病的佔比明顯上升,肝硬化及事故傷害出現明顯下降趨勢。女性的部分,中風、肝硬化的佔比都出現下降的現象,而肺炎及癌症則造成的餘命差距佔比出現提升的狀況。
此外,在比較不同年代原住民族的餘命現象發現,2013年的原住民男性較2006年原住民男性平均餘命增加了2.25歲,健康餘命增加1.24歲,女性的部分,2013年較2006年平均餘命增加3.33歲,健康餘命增加1.42歲,無論性別,原住民族的平均餘命增加年數大於健康餘命,且原住民族女性增加年數大於男性。解構2006年與2013年原住民族零歲餘命差距原因別部分,事故傷害、肝硬化、癌症及慢性阻塞性肺疾病為主要影響2006年與2013年原住民族男性健康餘命差距的重要疾病。女性部分,中風、肝硬化、事故傷害等為影響2006年與2013年原住民族女性健康餘命的重要疾病。

結論:無論年份或性別,相較於全國族群,原住民族平均餘命及健康餘命皆表現不佳,其中較常見造成兩族之間餘命差距的疾病為肝硬化、肺炎、心臟病、中風等,皆屬於慢性疾病居多。再者,2013年原住民族相較於2006年原住民族,無論是平均餘命或健康餘命皆出現上升的現象,主要以事故傷害、肝硬化等死因的出現明顯改善現象所造成的。最後,若要根除兩族群之間的健康不平等差距,除了觀察公共衛生因素,兩族之間的社經差異及政策等因素所造成的影響也不能被忽略。
INTRODUCTION
Over the years, there have been noticeable gap in terms of the average life expectancy, the mortality rate and the prevalence rate of the disease between the indigenous Taiwanese and the general population of Taiwan. Although the average life expectancy serves as an indicator for the change in mortality rate, it could not appropriately picture the subtle effect bought by major diseases.Therefore, by estimating health expectancy, we can better understand the lifespan and the quality of life of the indigenous people.Furthermore, by deconstructing the life expectancy and health expectancy gap between the indigenous Taiwanese and the general population of Taiwan as well as exploring the diseases that lead to the health expectancy gap between the two communities, one can determine the root causes of health inequality, ultimately providing valuable information to the government in decision making of health care policies.
The aim of this study is to examine the health inequality between the indigenous people and general population in Taiwan, and to quantify the contribution of the major causes of death and disease to the gap of life expectancy and healthy expectancy between the indigenous people and the general population of Taiwan in 2006 and 2013. In addition, we also look for the main causes to the change in the life expectancy and health expectancy of the indigenous Taiwanese in 2006 and 2013.

MATERIALS AND METHODS
The life tables of the indigenous and the general population from Ministry of the Interior in 2006 and 2013 are included in this study. An attribution tool published by the European Union is used in this study to estimate the health risks of the various causes from each ethnic group by utilizing data from 2013 National Health interview survey(NHIS) of Taiwan.We also use the disease prevalence from Taiwan’s National Health Insurance(NHI) to estimate disability prevalence by each ethnic group.And a decomposition tool developed by Nusselder to estimate the life expectancy and health expectancy by each ethnic group and decompose the difference between the life expectancy and the health expectancy by cause between each group.

RESULTS AND DISCUSSION
The result demonstrated that the health of the indigenous people is more vulnerable in 2006 or 2013.The gap in life expectancy and health expectancy at birth in males are 10.62 and 11.02 years respectively in 2006. The main reasons are Cirrhosis of the liver, Pneumonia, Accidents and Injury, Heart disease and stroke.On the other hand, the gaps in females are smaller than in males, which are 8.81 and 7.39 years respectively. The difference observed in life expectancy is thought to be caused by diseases such as stroke, Cirrhosis of the liver, Heart disease, Pneumonia and diabetes while Cirrhosis of the liver, Pneumonia, stroke, Heart disease, Accidents and Injury account for the gap observed in health expectancy at birth in females in 2006.
Moreover, the gap in life expectancy and health expectancy at birth in males are 10.17 and 10.88 years respectively in 2013.Both 2006 and 2013 share similar reasons for the gap observed in life expectancy and health expectancy. Of note, Pneumonia and Heart disease seen a marked increase in contributions while contributions from Cirrhosis of the liver and Accidents and Injury dwindled.In women, there is a downward trend to the contributions of stroke and cirrhosis of the liver while Pneumonia and Cancer appear to have heightened contributions to the gap observed in life expectancy and health expectancy.
In addition, when comparing the change in life expectancy and health expectancy of the male indigenous Taiwanese population in 2013 with 2006, life expectancy has increased by 2.25 years while health expectancy increased by 1.24 years.Accidents and Injury, Cirrhosis of the liver and Cancer and COPD are the diseases that impact the change in health expectancy of male population the most in both 2006 and 2013.There is a positive influence from Accidents and Injury and Cirrhosis of the liver to the gap in health expectancy in 2013. However, this gain is then reduced by the impact from Pneumonia and Heart disease, which shorten the gap in health expectancy, result in only a slight improvement in the gap in health expectancy in 2013 compared with 2006. The change in the life expectancy and the health expectancy at birth in females are 3.33 and 1.42 years respectively. Stroke, Cirrhosis of the liver, Diabetes, Accidents and Injury are the main contributions to the improvement to the change in life expectancy and health expectancy at birth in females. However, this is not the case with Pneumonia, which reduces both the life expectancy and health expectancy at birth in female.

CONCLUSION
When compared with the general population, indigenous Taiwanese do not fare well in both life expectancy and health expectancy, regardless of sex or year. Of note, Cirrhosis of the liver, Pneumonia, Heart disease and Stroke are the most common chronic diseases that cause the gap seen in both population.In addition, when compared 2013 with 2006, indigenous Taiwanese saw an improvement both in life expectancy and health expectancy, largely due to a reduced mortality rate seen in Accidents and Injury and Cirrhosis of the liver.Lastly, to ultimately eradicate the health inequality seen in both population, we not only need to take public health factors into consideration but also to consider the difference in effects of socioeconomic and policy between the populations.
目錄

第壹章 前言 1
第貳章 文獻探討 3
第一節 原住民族的定義與處境 3
第二節 原住民族的健康弱勢 5
第三節 族群間的健康餘命分析 7
第四節 台灣原住民族現況 11
第參章 研究方法 21
第一節 資料來源與研究對象 21
第二節 變項定義 23
第三節 分析策略 26
第肆章 研究結果 35
第一節 2013年國民健康訪問調查樣本特徵 35
第二節 年齡層死亡機率及失能率 36
第三節 死因分率與失能原因別比例 37
第四節 平均餘命與健康餘命 38
第五節 平均餘命、健康餘命差距之原因解構 40
第伍章 討論 87
參考文獻 94
附件 98
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