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研究生:陳薏安
研究生(外文):CHEN, YI-AN
論文名稱:依據癌症類別與期別之發生率、死亡率及醫療經驗統計分析
論文名稱(外文):Analysis of Experienced Incidence, Mortality and Empirical Statistics of Medical Care by Cancer Site and Stage
指導教授:莊聲和莊聲和引用關係喬治華喬治華引用關係
指導教授(外文):JUANG, SHING-HERCHIAO, CHIH-HUA
口試委員:林民浩湯美玲
口試委員(外文):LIN, MIN-HAUTANG, MEI-LING
口試日期:2021-06-28
學位類別:碩士
校院名稱:東吳大學
系所名稱:財務工程與精算數學系
學門:數學及統計學門
學類:其他數學及統計學類
論文種類:學術論文
論文出版年:2021
畢業學年度:109
語文別:中文
論文頁數:62
中文關鍵詞:癌症類別癌症期別初次發生率癌症登記檔全民健康保險
外文關鍵詞:cancer sitecancer stageincidence rateTaiwan cancer registryNational Health Insurance
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現今市面上癌症相關保險商品,多以2015年金融監督管理委員會(後簡稱為金管會)發表的「癌症保險之癌症定義」訂定給付方式。然而,癌症醫療費用會根據原發部位、期別、罹病年齡產生差異。本研究利用「衛生福利部衛生福利資料科學中心」提供之資料,進行統計得到癌症登記年報之16種分期癌症首次發生率,並觀察罹癌後住院醫療使用狀況。
研究結果發現,男性全分期癌症標準化首發率無明顯年度趨勢(2011年、2017年分別為219.98、218.24),女性則呈現逐年遞增(2011年、2017年分別為172.25、190.49)。屬於癌症篩檢補助範圍內之癌症或被納入於衛生福利部教育防治政策之癌症,在2011年至2017年之間,期別首發率多存有年度趨勢:(1)肺癌第一期首發率兩性皆逐年遞增,男性第二至四期逐年遞減,女性無明顯年度趨勢。(2)肝癌、子宮頸癌第一至四期首發率大致呈現逐年遞減。(3)乳癌、攝護腺癌第一至四期首發率大致呈現逐年遞增。以肺癌患者後續住院統計可得:(1) 第一罹病年度住院醫療成本花費最多。(2)第一期患者因住院發生率、住院日數平均值兩者影響,住院醫療成本隨罹病年齡遞增。(3)第三、四期患者在住院發生率、住院次數平均值、住院日數平均值三者交互作用下,各罹病年齡之住院醫療成本無明顯差異。以第一罹病年度不分性別住院醫療使用天數為例,第三期與第四期患者依序為45至51天、49至59天,第三罹病年度約15至22天、20至31天。
本研究結果能使精算人員了解各分期癌症病患之風險範圍,根據癌症類別差異設計保單,解決現今癌症險保障不足現象,亦能幫助精算人員提列準備金時,有更好的風險控管能力。

At present, most cancer-related insurance payouts are based on definitions of cancers provided by the Financial Supervisory Commission, R.O.C. (Taiwan), from 2015. However, the medical expenses incurred by each patient with cancer vary according to cancer site, stage, and the patient’s age. In this study, we evaluated stage-specific incidence rates, inpatient admittance rates, and average durations of inpatient admittance in relation to 16 types of cancers on the basis of cancer stage information contained in the cancer registry annual reports. These were accessed using the database from the Health and Welfare Data Science Center.
Our results suggest that the overall age-standardized incidence rates (ASRs; per 100,000 persons) in males had not significantly increased from 2011 to 2017, whereas ASRs in females had significantly increased from 172.25 in 2011 to 190.49 in 2017. Most of the cancer sites exhibited trends of increasing or decreasing incidence rates amidst the promotion of cancer prevention policies or public health campaigns. The incidence of stage 1 lung cancer increased. The liver and cervix uteri displayed significantly decreased incidences for Stage 1-4, whereas the female breast and the male prostate registered increased incidences.
In addition, the inpatient admittance results indicated the following: (a) the highest average inpatient expenses incurred by patients with lung cancer in the first year after diagnosis; (b) because of their higher inpatient admittance rates and longer average inpatient admittance days, older patients with stage 1 lung cancer had higher average inpatient expenses then the younger ones did; and (c) the average inpatient expenses per patient with stage 3-4 lung cancer did not significantly vary among age groups.

第壹章、 緒論......................................................1
第貳章、 文獻探討 ..................................................3
第參章、 研究方法 ..................................................5
第一節 資料來源 ................................................. 5
第二節 癌症登記長表介紹 ......................................... 5
第三節 名詞定義 ................................................. 6
第四節 資料處理 ................................................. 8
第五節 研究方法 ................................................ 11
第肆章、 結果與討論 ............................................... 14
第一節 敘述性統計 .............................................. 14
第二節 首次罹癌率 .............................................. 16
4.2.1 分期癌症概況 .......................................... 16
4.2.2 年齡趨勢 .............................................. 18
4.2.3 年度分布 .............................................. 22
第三節 後續住院醫療統計—以肺癌患者為例 ........................ 31
第四節 討論 .................................................... 37
第伍章、 結論與建議 ............................................... 38
參考文獻...............................................................41
附錄一:分期癌症年度趨勢 ............................................. 42


[1] Roshandel et al., “Cancer in Iran 2008 to 2025: Recent incidence trends and short‐term predictions of the future burden,” International Journal of Cancer, 2021.
[2] Hannah K. Weir PhD, Trevor D. Thompson BS, Ashwini Soman MBBS, MPH, Bjørn Møller PhD, Steven Leadbetter MS, “The past, present, and future of cancer incidence in the United States: 1975 through 2020,” Cancer, pp. 1827-1837, 2015;121(11).
[3] Melina Arnold et.al,, “Progress in cancer survival, mortality, and incidence in seven high-income countries 1995-2004(ICBP SURVMARK-2) a population-based study,” Lancet Oncology, pp. 1493-1505, 2019;20(11).
[4] Ava Kwong, BS, MBBS, FRCS, Oscar W. K. Mang, CStat, MS, Connie H. N. Wong, MS, W.W. Chau, MS,The Hong Kong Breast Cancer Research Group, and Stephen C. K. Law, FRCR, “Breast Cancer in Hong Kong, Southern China: The First Population-Based Analysis of Epidemiological Characteristics, Stage-Specific, Cancer-Specific, and Disease-Free Survival in Breast Cancer Patients: 1997–2001,” Annals of Surgical Oncology, pp. 3072-3078, 2011;18(11).
[5] Moe Sandar, Lim Gek Hsiang, Chow Khuan Yew, Lee Bee Guat, “Use of Population-Based Cancer Registry Data to Determine the Effect of Timely Treatment on the Survival of Colorectal Cancer Patients,” Journal of Registry Management, pp. 130-138, 2015;42(4).
[6] Chun-Ju Chiang, Wei-Cheng Lo, Ya-Wen Yang, San-Lin You, Chien-Jen Chen, Mei-Shu Lai, “Incidence and survival of adult cancer patients in Taiwan, 2002-2012,” Journal of the Formosan Medical Association, pp. 1076-1088, 2016;115(12).
[7] Jack C. Yue, Hsin-Chung Wang, Yin-Yee Leong, Wei-Ping Su, “Using Taiwan National Health Insurance Database to model cancer incidence and mortality rates,” Insurance: Mathematics and Economics, pp. 316-324, 2018;78.

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