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研究生:徐韻茹
研究生(外文):HSU, YUN-JU
論文名稱:公園綠地密度與第二型糖尿病盛行率及其門診醫療資源使用之相關性
論文名稱(外文):The Correlation between Urban Green Space Density and the Prevalence of Diabetes and its Outpatient Medical Resources
指導教授:周雨青周雨青引用關係
指導教授(外文):CHOU, YU-CHING
口試委員:周雨青邱于容江博煌
口試委員(外文):CHOU, YU-CHINGCHIU, YU-LUNGCHIANG, PO-HUANG
口試日期:2019-05-03
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:2019
畢業學年度:107
語文別:中文
論文頁數:70
中文關鍵詞:糖尿病盛行率公園綠地健保資料庫地理資訊系統醫療資源使用
外文關鍵詞:Prevalence of diabetesurban green spaceNHI databaseGISMedical resource utilization
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糖尿病常年位居國人十大死因之ㄧ,每年近萬人因糖尿病死亡,不但造成病患經濟負擔,亦佔用大量醫療資源。公園綠地通常作為運動的場所,與健康和降低全因死亡率和許多慢性病的風險相關,故本研究採二階段研究設計來進行,第一階段將以生態學研究設計來探討群體層次之間的關聯性;第二階段將以橫斷式研究設計,結合健保資料庫與GIS來探討個人層次台灣公園綠地密度與年滿20歲以上者糖尿病狀態之相關及其醫療資源使用之修飾作用。結果發現群體層次各鄉鎮公園綠地密度與糖尿病盛行率呈現負相關(r= -0.1553, p= 0.004),公園綠地密度之糖尿病盛行率以密度低(8.86%)顯著高於密度高(7.34%);罹病風險亦為密度低顯著高於密度高,為其1.23倍(95%CI:1.210~1.250),本研究並發現公園綠地密度高低及性別、都市化程度、每萬人醫師數和鄉鎮區醫療院所數與醫療資源使用具有交互作用。公園綠地不但可以提升國人健康和預防糖尿病和其他慢性病發生的風險和降低共病症發生的機會,若能提供更好的公園綠地規劃,必能增加民眾使用公園綠地,從而減少健保支出及糖尿病或其他慢性病患的負擔。
Diabetes has always been on the 10 leading causes of death in Taiwan, the morbidity increases every year, and approximately 10,000 people die of diabetes every year. Not only does Diabetes cause financial burden on the patients, it also utilizes the majority of medical resources. Urban green space is often used as a venue for physical activity, which is associated with health and reducing all-cause mortality and risk of many chronic diseases. Therefore, this research adopted a two phase design; in the first phase, we explored the relevance on a general level with ecological research design; longitudinal design was used in the second phase, combined with NHI database and GIS, to analyze and explore the correlation between urban green space density and diabetic patients over 20 years old and its medical resource utilization. The results showed that the density of urban green space in each township at general level was negatively correlated with the prevalence of diabetes (r= -0.1553, p= 0.004), the prevalence of diabetes in low density urban green space is significantly higher (8.86%) than that of high density (7.34%). The risk of diabetes in low density urban green space is 1.23 folds (95% CI: 1.210~1.250) higher than that of high density. The study has also found that the density of urban green space and gender, urbanization, the number of physicians per 10,000 people and the number of hospitals in townships have an interaction with the utilization of medical resources. Urban green space can improve the health of people and prevent the risk of diabetes and other chronic diseases, it can also reduce the chances of comorbidity. By providing better urban green space planning, the utility of park green space will be increased, and therefore reducing NHI expenditure and the burden of diabetic or other chronic disease patients.
目錄
中文摘要 V
Abstract VI
第一章 緒論 1
第一節 背景及重要性 1
第二節 研究動機 3
第三節 研究目的 4
第四節 名詞解釋 5
第二章 文獻探討 6
第一節 糖尿病危險因子及影響糖尿病患者醫療利用的因子 6
第二節 糖尿病患者的醫療利用情形與醫療費用支出 7
第三節 公園綠地的定義 8
第四節 公園綠地的健康效益 9
第五節 運動對糖尿病之影響 13
第三章 方法 15
第一節 研究設計 15
第二節 研究架構與研究假設 16
第三節 研究對象 17
第四節 資料收集與研究工具 18
第五節 研究變項與操作型定義 19
第六節 統計分析 20
第四章 結果 21
第一節 群體層次各鄉鎮公園綠地密度與糖尿病盛行率 21
第二節 個人層次公園綠地密度與糖尿病風險 23
第三節 個人層次公園綠地密度影響醫療資源使用的獨立與交互作用 26
第五章 討論 33
第一節 群體層次各鄉鎮公園綠地密度與糖尿病盛行率 33
第二節 個人層次公園綠地密度與糖尿病風險 34
第三節 個人層次公園綠地密度影響醫療資源使用的交互作用 35
第四節 研究限制 38
第六章 結論與建議 39
第一節 結論 39
第二節 建議 39
第三節 未來展望 40
參考文獻 41
英文文獻 41
中文文獻 47


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