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研究生:張偉綸
研究生(外文):CHANG, WEI-LUN
論文名稱:探討高雄旗津與台灣的地區剝奪指標、醫療資源指標對代謝症候群的相關性研究
論文名稱(外文):A Study of the Association of Area Depreciation Index, Area Medical Resource Index and Metabolic Syndrome Between CiJin District, Kaohsiung and Taiwan
指導教授:謝慧敏謝慧敏引用關係
指導教授(外文):HSIEH, HUI-MIN
口試委員:廖容瑜蔡忠榮
口試委員(外文):LIAO, JUNG-YUTSAI, JONG-RUNG
口試日期:2023-06-13
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:公共衛生學系碩士班
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:2023
畢業學年度:111
語文別:中文
論文頁數:72
中文關鍵詞:代謝症候群旗津地區剝奪地區醫療資源
外文關鍵詞:metabolic syndromeCijinarea deprivationarea medical resources
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研究背景
代謝症候群在世界各地的盛行率皆很高,且易引起慢性腎臟疾病(CKD)、第二型糖尿病(T2DM)、冠狀動脈疾病(CAD)、冠狀動脈心臟病(CHD)等慢性疾病,社會經濟狀況一直都是慢性病的危險因子之一,然而過去探討大多以個人層級為主,少有以地區層級的社會經濟狀況探討代謝症候群的研究,地區剝奪指標即為衡量一地社會經濟狀況的重要指標。目前國內外也較少有醫療資源對於健康狀況的相關探討,研究數量仍受到限制,且旗津區因長年對外交通不便,工作機會少,因此造成旗津區老年人口比例偏高的狀況。
研究目的
本研究之目的有三,一是探討地區剝奪程度對代謝症候群健康狀況的影響,一是探討醫療資源指數對代謝症候群健康狀況的影響,最後是探討旗津世代20歲以上成人代謝症候群之現況。
研究方法
本研究是橫斷型研究,資料來源自高雄市旗津區成人居民生活型態與健康研究、台灣人體生物資料庫(TW-biobank),以及政府公開資料。最終的樣本數量為81552筆,使用主成分分析計算地區剝奪以及醫療資源指標,使用卡方檢定、t檢定進定基本人口學分佈差異,最後使用多項式邏輯斯迴歸分析(Multiple Logistic Regression Analysis)探討地區剝奪、醫療資源以及居住地區與代謝症候群之間的相關。資料分析使用SAS 9.4統計軟體。
研究結果
在控制了基本人口學變項後,結果發現地區剝奪分數越高則代謝症候群罹患風險就越高(aOR: 1.10, 95% CI: 1.07-1.13),且高剝奪地區罹患代謝症候群的風險較低剝奪地區高13%(aOR: 1.13, 95% CI: 1.01-1.25)。醫療資源分數越高則代謝症候群罹患的風險就越低(aOR: 0.99, 95% CI: 0.97-0.998) ,且高醫療資源地區罹患代謝症候群的風險較低醫療資源地區少8%(aOR: 0.92, 95% CI: 0.86-0.99)。而居住在旗津地區罹患代謝症候群的風險較非旗津地區多45%(aOR: 1.45, 95% CI: 1.28-1.64)。
研究結論
本研究發現地區剝奪程度、醫療資源指標以及居住地對代謝症候群具有獨立的影響性。本研究建議政策制定者在未來在財務、福利計劃或基礎設施建設時可以參考各地區的地區剝奪程度作為必要資訊。且因為本研究旗津地區剝奪程度和代謝症候群盛行率較高,本研究建議可以加強旗津地區民眾慢性病方面的健康衛教。

Background
Metabolic syndrome is highly prevalent worldwide and is associated with chronic diseases such as chronic kidney disease (CKD), type 2 diabetes mellitus (T2DM), coronary artery disease (CAD), and coronary heart disease (CHD). Socioeconomic status has long been recognized as one of the risk factors for chronic diseases. However, previous studies have primarily focused on the individual level, with limited research investigating the relationship between metabolic syndrome and socioeconomic status at the regional level. Area deprivation index is an important indicator used to measure the socioeconomic status of an area. Currently, there is limited research on the relationship between area medical resources and health status, both domestically and internationally, and the number of studies is still limited. Additionally, due to its geographical isolation and limited job opportunities, Cijin District has a higher proportion of elderly population compared to Kaohsiung city.
Objectives
This study has three objectives. First, to explore the impact of area deprivation level on the health status of individuals with metabolic syndrome. Second, to examine the influence of medical resource index on the health status of individuals with metabolic syndrome. Lastly, to investigate the current status of metabolic syndrome among adults aged 20 and above in Cijin.
Methods
This study is cross-sectional designed and used data from the study of Cijin District Adult Residents' Lifestyle and Health Study, Taiwan Biobank, and publicly available government data. The final sample size consisted of 81,552 records. Principal component analysis was used to calculate the area deprivation and medical resource indices. Chi-square test and t-test were employed to analyze the differences in basic demographic characteristics. Multiple logistic regression analysis was performed to examine the associations between area deprivation, medical resources, residential area and metabolic syndrome. Data analysis was conducted using SAS 9.4 statistical software.
Results
After controlling for basic demographic variables, the results showed that higher deprivation index were associated with an increased risk of developing metabolic syndrome (aOR: 1.10, 95% CI: 1.07-1.13). Furthermore, individuals residing in areas that categorized as “high deprivation areas” had a 13% higher risk of metabolic syndrome compared to those in “low deprivation areas” (aOR: 1.13, 95% CI: 1.01-1.25). Higher medical resource index were associated with a decreased risk of metabolic syndrome (aOR: 0.99, 95% CI: 0.97-0.998). Moreover, individuals residing in areas that categorized as “high medical resource areas” had an 8% lower risk of metabolic syndrome compared to those in “low medical resource areas” (aOR: 0.92, 95% CI: 0.86-0.99). Lastly, individuals residing in Cijin District had a 45% higher risk of metabolic syndrome compared to those in non-Cijin District (aOR: 1.45, 95% CI: 1.28-1.64).
Conclusion
This study found that area deprivation index, medical resource index, and residential area independently influenced the risk of metabolic syndrome. The study suggests that policymakers should consider area deprivation level as essential information when making financial, welfare, and infrastructure planning decisions. Additionally, due to the higher deprivation level and prevalence of metabolic syndrome in Cijin District, this study recommends strengthening health education on chronic diseases for the residents in Cijin District.

目錄
致謝 i
摘要 ii
Abstract iv
目錄 vi
附錄 ix
圖目錄 x
表目錄 xi
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 代謝症候群之危險因子 4
第二節 地區剝奪的概念與測量 6
第三節 地區剝奪與代謝症候群及其組成因子之相關之實證研究 8
第四節 醫療資源與代謝症候群及其組成因子之相關之實證研究 10
第三章 材料與方法 12
第一節 研究架構及研究假說 12
第二節 研究資料 13
第三節 研究對象篩選流程 16
第四節 變項定義及測量 17
第五節 統計分析方法 19
第四章 研究結果 21
第一節 台灣鄉鎮市區地區剝奪、醫療資源及其相關指標分佈 21
第二節 地區剝奪、醫療資源指標分佈 23
第三節 基本人口學分佈 26
第四節 代謝症候群及其組成因子分佈 31
第五節 代謝症候群的影響因子:單變量分析 34
第六節 代謝症候群的影響因子:多變量分析 35
第五章 討論 42

附錄
附錄 一、 國內外代謝症候群罹病風險之相關研究 50
附錄 二、 代謝症候群盛行率 52
附錄 三、 社經狀況與代謝症候群相關之研究 53
附錄 四、 國內外地區剝奪與健康狀況相關之研究 54
附錄 五、 國內外地區醫療資源與健康狀況相關之研究 56
附錄 六、 國內外代謝症候群及其危險因子之相關之實證研究 57
附錄 七、 國內外地區剝奪、醫療資源與代謝症候群及其組成因子之相關之實證研究 58
附錄 八、 高雄市旗津區成人居民生活型態與健康研究-人體試驗委員會通過證書 59
附錄 十、 口試委員意見 60

圖目錄
圖 1 研究框架圖 12
圖 2 樣本篩選流程圖 16
圖 3 地區剝奪指標分佈 24
圖 4 醫療資源指標分佈 25

表目錄
表 1 地區剝奪指標比較表 7
表 2 政府部門資料來源與使用目的 15
表 3 台灣鄉鎮市區地區剝奪、醫療資源及其相關指標 22
表 4 居住地區與基本人口學分佈 29
表 5 居住地區與代謝症候群及其組成因子分佈 33
表 6 居住地區、地區剝奪以及醫療資源與代謝症候群的相關性 40


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