臺灣博碩士論文加值系統

背景：全球人口老化速度加快，但健康平均餘命沒有隨之上升，尤其失智症盛行率逐年上升，2017年失智症被世界衛生組織列為優先需要關注的疾病；臺灣的道路密度較其他國家密集。失智症有眾多危險因子，目前研究失智症和環境相關的文獻，主要都以交通相關之空氣污染為主，但交通噪音卻鮮少有研究著墨於此。

目標：欲瞭解臺北地區交通造成的空氣污染和噪音是否和失智症具有相關性。

方法：空氣污染與噪音資料之取得，皆來自於環保署之定點測站之監測資料，並以地理資訊系統(Geographic Information System, GIS)，搭配土地利用迴歸模型(Land Used Regression Model, LUR)，建立大臺北地區噪音之數值地圖。同時選用健保資料庫中2000年百萬承保抽樣歸人檔，並以回溯性世代研究 (2000-2012)之方式進行研究。失智症定義為65歲以上，且有2次以上(含兩次)的失智症診斷者。使用Cox比例風險模型 (Cox proportional hazards models)，定量關係性，同時會校正基本人口學特徵等可能干擾因子。

結果：經分析後，發現道路密度與空氣污染、噪音有顯著正相關，相較於其他主要道路，縣道、鄉道之道路密度與失智症的發生風險有關(鄉道第三組：HR=1.086, 95% CI：1.047-1.127)，但交通引起之空氣污染和噪音則與失智症的發生風險沒有顯著正相關。

結論：居住在鄉道密度較高的地區相較於居住在鄉道密度較低的地區，發生失智症的風險更高，並無發現失智症與噪音暴露有正相關性，而細懸浮微粒與發生失智症的風險，雖然沒有顯著但為正相關；如果能有研究專為探討失智症之發展，可以蒐集與失智症相關的危險因子，在分析中加以校正，可以更精確判斷環境因素對失智症的影響。

Background: The global population is aging dramatically, but the average life expectancy with satisfactory quality of life has not been increased accordingly. In 2017, WHO declared that dementia was one of emerging diseases that global society should pay attention. Taiwan has been transformed into an aging society in March 2018 according to official announcement. Additionally, roadway density in Taiwan is much higher than those in other countries worldwide along with the fact that. However, most of the previous studies mainly focused on how traffic-related air pollution affects dementia but rarely address the issue of traffic noise.

Objective: To understand whether air pollution and noise produced by traffic is associated with dementia in Taiwan.

Methods: Air pollution and noise data was obtained from the monitoring information from Taiwan EPA. The geographic information system and the land-use regression models were used to establish spatial variation of noise in the Taipei Metropolitan Area. The Longitudinal Health Insurance Database (LHID) 2000 was used to assess the correlation between environmental exposure and dementia using a retrospective cohort study design (2000-2012). Dementia was defined as participants who were older than 65 years and had two or more clinical visit of dementia based on ICD-9. The Cox proportional hazards models were utilized to quantify the association adjusted for the potential confounders.

Results: The findings showed that roadway density was significantly and positively correlated with air pollution and noise. Among different type of roadways, the county and country roadway density was related to the risk of dementia (HR =1.086, 95% CI: 1.047-1.127 [Q3 versus Q1] for country roadway), but traffic-related air pollution and noise were not significantly associated with dementia.

Conclusion: Dementia risks was associated with higher exposure to roadway density, but findings did not provide the conclusive association of noise and PM2.5 with dementia risks. Further studies may collect the detailed profiles of risk factors associated with dementia to accurately assess the impact of environmental factors on risk of dementia.

致謝..................................................i
中文摘要............................................iii
英文摘要.............................................iv
目錄..................................................v
表目錄..............................................vii
圖目錄.............................................viii
第一章 前言...........................................1
1.1 研究背景與動機....................................1
第二章 文獻回顧.......................................4
2.1 失智症的疾病介紹和定義............................4
2.1.1 失智症介紹......................................4
2.1.2 失智症診斷......................................5
2.1.3 失智症的影響與社會關注程度......................6
2.2 臺灣的交通情況及大眾運輸使用率....................8
2.3交通空氣污染、噪音對人的影響.......................8
2.3.1空氣污染物.......................................9
2.3.2空污嚴重程度....................................11
2.3.3臺灣噪音管制....................................11
2.4研究目的..........................................13
第三章 材料與方法....................................17
3.1研究架構..........................................17
3.2資料來源..........................................17
3.2.1健康資料........................................17
3.2.2土地利用迴歸需要之圖層..........................20
3.2.3噪音資料........................................22
3.3暴露評估..........................................22
3.3.1空氣污染之暴露評估..............................22
3.3.2噪音值之暴露評估................................23
3.3.3道路密度之計算..................................30
3.4統計方法..........................................30
3.4.1 Cox比例風險模式................................30
3.4.2 敏感度分析.....................................31
3.4.3 分層分析.......................................32
第四章 結果..........................................33
4.1 描述性統計.......................................33
4.1.1 雙北市道路密度情形.............................33
4.1.2 雙北市細懸浮微粒狀態...........................36
4.1.3 雙北市噪音狀態.................................38
4.1.4 失智症罹病情形.................................40
4.2 土地利用迴歸推估之噪音值.........................42
4.2.1 臺北市與新北市噪音推估值.......................42
4.2.2 臺北市與新北市噪音推估值之模型驗證.............46
4.3 統計分析.........................................46
4.3.1 單變量分析.....................................46
4.3.2 多變量分析.....................................51
4.3.3 其他年份之噪音推估值與失智症的相關性...........51
4.3.4 敏感度分析.....................................56
4.3.5 分層分析.......................................59
第五章 討論..........................................62
5.1 研究結果.........................................62
5.2 相關文獻之比較...................................62
5.2.1 道路密度與發生失智症之風險.....................62
5.2.2 細懸浮微粒與發生失智症之風險...................63
5.2.3 噪音值之推估...................................64
5.2.4 噪音與發生失智症之風險.........................65
5.3 道路交通暴露與失智症的可能病理學機制.............66
5.4 本研究結果失智症風險與噪音暴露無關的原因.........68
5.5 研究限制.........................................69
5.5.1 健康資料之研究限制.............................69
5.5.2 噪音暴露資料之研究限制.........................70
第六章 結論..........................................71
第七章 參考文獻......................................72


 
表目錄
Table 1. Cars, scooters, and roadway density in the major
countries...............................................2
Table 2. Noise Regulatory standard in Taiwan...........12
Table 3-1. Epidemiological literature review about air
pollution and dementia/cognitive function..............14
Table 3-2. Epidemiological literature review about noise
and mental health......................................15
Table 3-3. Animal experiment literature review about
mechanism linking noise exposure and cognitive function
.......................................................16
Table 4. Spatial Databases and Land-use Predictor......26
Table 5. Road density of the categories of roadway in
Taipei.................................................35
Table 6. Spearman correlation coefficient between
different roadway density..............................36
Table 7. Baseline characteristics of the study population
.......................................................41
Table 8. Validation of the Land-used regression model..43
Table 9. Model explanatory power.......................43
Table 10. Univariate analysis for the associations
between demographic information and incidence of dementia
in Taipei Metropolitan Area............................48
Table 11. Multivariate analysis for the associations
between individual characteristic and the incidence of
dementia...............................................52
Table 12. Association between noise value and roadway
density................................................54
Table 13. Association between noise and risk of dementia
.......................................................55
Table 14. Sensitivity analysis for the associations
between roadways and the risks of incident dementia using
participants’ attained age as time scale..............57
Table 15-1. Stratified analysis (by sex) for associations
between roadway density and the risks of incident dementia
.......................................................60
Table 15-2. Stratified analysis (by age) for associations
between roadway density and the risks of incident dementia
.......................................................61

 
圖目錄
Figure 1. The framework of this study...................3
Figure 2. Prevalence of dementia in Taiwan, 2013........7
Figure 3. Derivation of the study population from
participants of the National Health Insurance Research
Database...............................................19
Figure 4. The Flowchart of Land-used Regression Model..29
Figure 5. Four categories roadway distribution in Taipei
city and New Taipei city...............................34
Figure 6. Characteristics of the categories of roadway in
Taipei.................................................35
Figure 7. Annual PM2.5 concentration of Taipei city and
New Taipei city, in 1994-1999......,...................37
Figure 8. Dot map of noise station in Taipei city and
New Taipei city........................................38
Figure 9. Noise value of environmental noise and traffic
noise in Taiwan, 2003-2017.............................39
Figure 10. Estimated map of noise value (2003-2017) in
Taipei.................................................44
Figure 11. Estimated mean noise value (2003-2017) in each
administrative district................................45
Figure 12. Estimated map of noise value (2003-2017) with
different roadway in Taipei............................45

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