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研究生:方玉安
研究生(外文):Yu-Ann Fang,
論文名稱:台灣男性肝癌篩檢、肝癌發生及存活之社會不平等
論文名稱(外文):Social inequality in liver cancer screening and liver cancer morbidity and survival from liver cancer among men in Taiwan
指導教授:陳建仁陳建仁引用關係陳素秋陳素秋引用關係
指導教授(外文):Chien-Jen Chen,Su-Chiu Chen,
學位類別:碩士
校院名稱:國立台北護理學院
系所名稱:醫護管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2009
畢業學年度:98
語文別:中文
論文頁數:90
中文關鍵詞:社會不平等肝癌篩檢肝癌發生肝癌存活
外文關鍵詞:Social inequalityliver cancer screeningliver cancer morbiditysurvival from liver cancer
相關次數:
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背景:依文獻顯示癌症篩檢、癌症發生及癌症存活與社會不平等有關係,台灣
肝癌的死亡率及發生率一直居高不下,而對於肝癌這項常見癌症的這方
面研究卻不多見。所以本研究以追蹤性之次級資料探討社會不平等與肝
癌篩檢、肝癌發生及存活的因果關係。

方法:本研究利用2003年家庭收支調查的15,514位男性資料,結合衛生署健
保資料庫及死亡檔,從2001-2005年追蹤這群樣本,以Cox proportional
hazards regression分析探討之。

結果:經複迴歸調整變項後,較高教育程度者及高危險族群比較會做預防性(中
/重度肝病及所有肝癌)篩檢。較高教育程度者也會有比較少罹患肝癌的風
險。有做預防性篩檢有較低得肝癌後死於所有肝癌的風險。

討論與建議:預防性篩檢可以大幅降低死於所有肝癌的風險,所以可以作為政府機關宣導肝癌篩檢的參考。低教育程度的人較少會去做預防性篩檢且有較高的肝癌發生率及有潛在較不好的得肝癌後死於所有肝癌的風險,這些結果可以提供政府關心這些弱勢團體,以及增加這些人的篩檢率。

限制:全民健保檔中未有完整的癌症期別等嚴重度指標。家庭可支配收入是行
政院主計處家庭收支調查的資料,有可能被調查的人本身並不富有,但
是他的子女(跟他戶籍不同)卻很富有。
Objectives: Literatures have shown that the relationship between social inequality and cancer screening/cancer morbidity/survival from cancer. Although liver cancer is a common type of cancer and its mortality rate and incidence rate in Taiwan have been high all the while, there have not been many social inequality studies on it. Therefore, this study was conducted to explore potential causal effects of social inequality and liver cancer screening/morbidity/survival from liver cancer based on longitudinal secondary data.

Methods: Investigators of this study used 15,514 male sample data from the Family Income and Expenditure Survey in 2003, and linked to the National Health Insurance Database and the National Death Certification (NDC) system of Department of Health in the follow-up period 2001-2005. Data were analyzed mainly by the Cox proportional hazards regression.

Results: After adjusting variables by multiple regression, men with higher education, and liver cancer high-risk group had a higher tendency to go for preventive (moderate/severe liver disease or all liver cancer) screening; in addition, men with higher education also had a lower risk of getting liver cancer. Men with preventive liver cancer screening had higher survival from all liver cancer after occurrence of liver cancer.

Conclusions: Preventive screening can substantially reduce the risk of death from all liver cancer; therefore, these results can provide suggestions for the government to enhance the promotion of liver cancer screening. This study also discovered that men with lower education had a lower tendency to go for preventive screening but they had a higher risk of getting liver cancer and a potential risk of deaths from all liver cancer after occurrence of liver cancer. The government may refer to these results and provide more services for this underprivileged group and plan and adopt measures to increase the rate of preventive screening of this group of people.
Limitation: The National Health Insurance Research Database does not contain complete cancer stage information to indicate the seriousness, and disposable family income is based on the family income and expenditure survey conducted by the Directorate-General of Budget, Accounting and Statistics, Executive Yuan. For example, the surveyed person might not be rich, but their son or daughter could be rich while holding different household registration.
目錄

誌謝 i
目錄 ii
國立台北護理學院健康事業管理研究所碩士論文中文摘要 v
Abstract vi
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 4
第三節 研究重要性 4
第二章 文獻探討 5
第一節 肝癌的流行病學 5
第二節 社會不平等與癌症篩檢 10
第三節 社會不平等與癌症發生 14
第四節 社會不平等與癌症存活 18
第五節 對本研究的啟示 19
第三章 研究方法 20
第一節 概念性架構 20
第二節 操作性定義 26
第三節 研究問題 30
第四節 研究期間及對象與資料來源及處理 31
第五節 資料分析方法與本章小結 34
第四章 研究結果 37
第一節 描述性統計 37
第二節 預防性篩檢影響因素之分析及假說檢定結果 45
第三節 肝癌發生影響因素之分析及假說檢定結果 49
第四節 肝癌後存活影響因素之分析及假說檢定結果 52
第五章 討論與建議 56
第一節 重要結果討論 56
第二節 本研究優缺點及研究限制 60
第三節 建議 62
參考文獻 63
附錄一 2001-2005年肝病防治篩檢地區及人數(附表一) 76
附錄二 預防性篩檢之高危險群分層分析表(附表二~三) 77
附錄三 肝癌發生之高危險群及預防性篩檢分層分析表(附表四~七) 81
附錄四 得肝癌後死因分佈表(附表八) 89
附錄五 得肝癌後死於肝癌KM圖(附圖一~二) 90
表目錄

表一 國內外肝癌篩檢相關研究 9
表二 社會不平等與篩檢相關研究 13
表三 社會不平等與癌症發生相關研究 17
表四 改編共存疾病指標與ICD9-CM之對照表 25
表五 變項操作性定義說明表 27
表六、每年及此五年至少篩檢一次的人數及其百分比分佈 40
表七 各教育程度下之社經地位指標分佈 41
表八 各教育程度下之個人特質分佈 42
表九 各教育程度下之醫療利用分佈 42
表十 各教育程度下之個人健康狀況分佈 43
表十一 全部族群之2002年後預防性篩檢之COX迴歸分析表 (N=15,514) 47
表十二 全部族群之肝癌發生之COX迴歸分析表 (N=15,514) 50
表十三 得肝癌後肝癌死因COX迴歸分析表 (N=115) 54
表十四 得肝癌後肝病死因COX迴歸分析表 (N=115) 55
附表一 2001-2005年肝病防治篩檢地區及人數分佈表 76
附表二 高危險族群(N=2,364)2002年後預防性篩檢之COX迴歸分析表 77
附表三 非高危險族群(N=13,150)2002年後預防性篩檢之COX迴歸分析表 79
附表四 有篩檢高危險群族群(N=2,093)肝癌發生之COX迴歸分析表 81
附表五 有篩檢非高危險群族群(N=2,380)肝癌發生之COX迴歸分析表 83
附表六 無篩檢高危險群族群(N=889)肝癌發生之COX迴歸分析表 85
附表七 無篩檢非高危險群族群(N=10,152)肝癌發生之COX迴歸分析表 87
附表八 得肝癌後死因分佈表(N=115) 89


圖目錄

圖一 社經地位、個人特質、醫療利用及個人健康狀況與預防性篩檢之概念架構 22
圖二 社經地位、個人特質、醫療利用及個人健康狀況與肝癌發生情形之概念架 23
圖三 社經地位、個人特質、醫療利用及個人健康狀況與肝癌後存活情形之概念 24
圖四 研究對象篩選流程 33
圖五 有處理lead time預防性篩檢別得肝癌後死於所有肝癌之Kaplan-Meier圖 53
圖六 有處理lead time教育程度別得肝癌後死於所有肝癌之Kaplan-Meier圖 53
附圖一 有調整lead time收入分兩層得肝癌後肝癌死因情形 90
附圖二 有調整lead time收入分三層得肝癌後肝癌死因情形 90
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