臺灣博碩士論文加值系統

研究背景:
衰弱與空氣污染對人體健康具有重大影響，均為重要的健康照護與公共衛生議題。衰弱具可逆性和可改變的特性，較失能更適合作為預防介入之標的，近二十年來已經成為臨床和公共衛生健康促進介入目標。空氣污染是導致過早死亡或失能的重要可逆環境因素之一。直徑≤2.5 微米（micrometer,㎛）的細顆粒物質（PM2.5），因其小顆粒特性更易於吸入到肺泡層級。雖然大量的流行病學研究為暴露在空氣污染之下與不良健康後果的關聯提供了廣泛的證據。例如心血管疾病、癌症，阿茲海默病，甚至是死亡。但對於衰弱與懸浮微粒仍然不確定。
因此，本研究欲探討社區老人暴露在直徑≤2.5μm（PM2.5）的懸浮微粒中與衰弱的相關性。
研究目的:
本研究旨在探討社區老人暴露在直徑≤2.5μm（PM2.5）的懸浮微粒中，是否與衰弱相關。
研究設計:
對象為居住在新北市65歲以上之民眾參加健康檢查，收集了 20,606份分析樣本並與台灣空氣質量監測數據庫（TAQMD）做聯結。依變項是衰弱狀態，分為強健、衰弱前期、衰弱，自變項包含人口學特性、健康行為、疾病史、都市化指數、疾病嚴重度、PM2.5等，針對研究樣本之基本人口學資料與其他相關因子項目進行敘述性統計分析，再以邏輯式回歸分析，探討可能之危險因子。
研究結果:
所有參與者衰弱佔了1,080位（5.2%），特徵為年齡較大，女性，疾病嚴重度高，生活在鄉村地區為主。高暴露的PM2.5(≥16.3μg/m3)情況下，相較於健壯者，成為衰弱前期的勝算比是1.4倍(OR:1.4，95% CI:1.3-1.5)，成為衰弱的勝算比是1.6倍(OR:1.6，95% CI:1.3-2.0)。
在高暴露的PM2.5情況下，相較於健壯者，男性成為衰弱前期的勝算比是2.2倍(OR:2.2，95% CI:1.9-2.6，p <0.001)，成為衰弱的勝算比是2.3倍(OR:2.3，95% CI:1.5-3.3，p <0.001)，相較於健壯者，≥85歲成為衰弱前期的勝算比是1.5倍(OR:1.5，95% CI:1.0-2.3，p =0.040)，成為衰弱的勝算比是2.8倍(OR:2.8，95% CI:1.5-5.1，p <0.001);相較於健壯者，無吸菸習慣成為衰弱前期的勝算比是1.4倍(OR:1.4，95% CI:1.2-1.5，p <0.001) ，成為衰弱的勝算比是1.7倍(OR:1.7，95% CI:1.3-2.2，p <0.001)，相較於健壯者，疾病嚴重度高者 (CCI≥2)成為衰弱前期的勝算比是2.0倍(OR:2.0，95% CI:1.1-3.5，p =0.021)，成為衰弱的勝算比是5.6倍(OR:5.6，95% CI:2.2-14.1，p <0.001)。
結論:
在社區老人中暴露在高濃度的PM2.5與衰弱之間存在顯著相關性，而在衰弱群組中高濃度的PM2.5對衰弱性的影響更大。且高暴露的PM2.5與衰弱表徵中握力低及低活動量這2個活動型變項之間存在顯著相關性，這表明暴露於高濃度的PM2.5與衰弱的核心亞型呈顯著相關。

Background
Frailty and air pollution impact senior health and are important issues in clinic and public health. Given inherint nature of reversibility and modifiability, frailty per se has been an optimal target for disability prevention and intervention. In past two decades, frailty has raised escalating intersts in clinical and public health researches.
Air pollution is one of the reversible environmental factors leading to premature death or disability. Particulate Matter 2.5 (PM 2.5) indicates fine air particulate with a sizeless than 2.5 micrometers per cubic meter. PM 2.5 might be inhaled into pulmonary alveolar due to their small particle characteristics. Although piles of epidemiological evidences support associations between exposure to air pollution and adverse health consequence, such as cardiovascular disease, cancer, Alzheimer's disease, and even motality, association between fraity and PM2.5 reamins uncertain..
The study aims to explore the associations between frailty and PM 2.5 exposure among community-living older adults.
Objective
The research is to explore the association between frailty and PM 2.5.
Methods
Data of the study exercpted from New Taipei City Elderly Health Examination database, which comprised of 20,606 New Taipei City older adults aged ≥65 years were linked with air pollute data from the Taiwan Air Quality-Monitoring Database (TAQMD). The dependent variable was phenotypic frailty.Independent variables include demographic characteristic, health behaviors, medical history, urbanization index, and PM2.5.
Result
There were 1080 (5.2%) frail participants characterized by older age, predominantly female, multiple comorbidities, and living in rural areas. Compare to those exposreu to lower PM2.5 level, odds ratios in those exposre to higher PM2.5 level had was 1.4(OR：1.4, 95% CI：1.3-1.5) for becoming pre-frail and 1.6 (OR：1.6, 95% CI：1.3-2.0) for becoming frail.
Compared to those exposured to lower level of PM2.5, men exposured to high level PM2.5 had odds ratio of 2.2 for being pre-frail (OR: 2.2, 95% CI: 1.9-2.6, p <0.001) and odds ratio of 2.3 to beingfrail (OR: 2.3, 95% CI: 1.5-3.3, p <0.001); older adults aged ≥85 years had odds ratio of 1.5 for being prefrail (OR: 1.5, 95% CI: 1.0-2.3 ,p = 0.040) , and odds ratio of 2.8 for being frail (OR: 2.8, 95% CI: 1.5-5.1, p <0.001); those without tobacco consumption had odds ratio of 1.4 to being prefrail (OR: 1.4, 95% CI: 1.2-1.5, p <0.001),and odds ratio of 1.7 for being frail (OR: 1.7, 95% CI :1.3-2.2, p <0.001). Those multimorbid persons (CCI ≥ 2) had odds rato of 2.0 for being prefrail (OR: 2.0, 95% CI: 1.1-3.5, p =0.021), and odds ratio of 5.6 for being frail (OR: 5.6, 95 % CI: 2.2-14.1, p <0.001).
Conclusion
The study showed exposure to high level PM2.5 significantly associated with frailty in community-living older adults. Of five frailty phenotypes, weakness and low activity were significantly associated with exposure to high level PM2.5.

誌謝 I
中文摘要 II
英文摘要 IV
目錄 VI
圖目錄 VIII
表目錄 VIII

第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究重要性 3
第三節 研究目的 3
第二章 文獻探討 4
第一節 衰弱的定義 4
第二節 衰弱的流行病學 6
第三節 衰弱的重要性 7
第四節 懸浮微粒定義 7
第五節 懸浮微粒污染主要來源 8
第六節 懸浮微粒污染管制標準 8
第七節 細懸浮微粒(PM2.5)對人體的傷害 8
第八節 衰弱與懸浮微粒的相關性 10
第三章 研究方法 12
第一節 研究設計和架構 12
第二節 研究對象與資料來源 13
第三節 研究工具 13
第四節 研究變項操作型定義 15
第五節 統計分析 21
第四章 研究結果 22
第一節 研究樣本各變項之特徵描述 22
第二節 研究樣本各變項之相關性 26
第三節 衰弱與各表現型和PM2.5之間的相關性 51
第五章 討論 56
第六章 結論 60
參考文獻 62
附錄 68
附錄一 新北市衛生局函同意使用新北市長者健康檢查資料庫 68
圖目錄
圖 1:研究架構圖 12
表目錄
表 1 依變項操作型定義 16
表2 自變項操作型定義 17
表3特徵資料分析 23
表4按性別劃分的人口與健康相關特徵 28
表5按年齡區分的人口與健康相關特徵 32
表6按吸菸習慣區分的人口與健康相關特徵 35
表7按疾病嚴重度區分的人口與健康相關特徵 39
表8按都市化指數劃分的人口與健康相關特徵 42
表9按PM2.5濃度區分的人口與健康相關特徵 45
表10衰弱指標與各變項之間的相關性 49
表11衰弱與PM2.5之間的相關性 51
表12衰弱各表現型與PM2.5之間的相關性 52
表13其他變項與PM2.5之間的相關性 54

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