顯著增加乳癌醫療支出並未減少死亡率和發病率

Significantly Increased Medical Expenditure on Breast Cancer Failing to Bring Down Its Mortality and Incidence Rate

何明霖(Ming-Lin Ho)

指導教授 ： 周明智

中山醫學大學/醫學院/醫學研究所/博士(2014年)

https://doi.org/10.6834/CSMU.2014.00210

摘要

第一篇
背景：增加乳癌的醫療費用是否直接影響到發病率和死亡率，還沒有得到充分解決。本研究的目的是研究在台灣乳腺癌的發病率和死亡率與醫療費用之間潛在關連的探討。
材料與方法：本研究乳癌病例是從台灣全民健康保險研究資料庫（健保資料庫NHIRD, 從1999年1月至2006年12月）確定了相應的國際疾病分類，以及國際疾病傷害及死因分類標準第九版（ICD-9）代碼174 (174.0至174.9)，和175 (175.0至175.9)。年齡別發病率從內政部統計處獲得的人口數據進行了估算。醫療費用，包括門診和住院服務，也從資料庫檢索。
結果：乳癌病例從1999年發病率每10萬人20.06，2006年上升至每10萬人30.34; 台灣健保在乳癌病例總開支由1999年新台幣14億4933萬3521元，增加至2006年新台幣43億5040萬0592元。台灣在2006年的女性的乳癌年齡別標準化死亡率為並沒有改變，然而年齡別標準化發病率卻穩定地上升（2002-2003年除外）。在排名前20個共存的ICD-9編碼的費用，有4個是直接與乳腺癌有關，而另外的16個在其他疾病或症狀，這不一定是由乳癌直接引起的。
結論：乳癌顯著增加台灣健保醫療支出，但是未能降低它的死亡率和發病率。藉由這一個研究希望能夠建議國家醫療保健政策制定者對於台灣乳癌的控制和資源分配，提出較好的應對策略。
第二篇
本研究企圖從生命歷程的角度探討在台灣乳癌死亡率，預計以APC 模型(Age-Period-Cohort Model Analysis, 年齡-年代-世代效應)分析，在集體資料中萃取出不同出生年輪的世代（Cohort），以年齡(Age)、年代(Period)和世代(Cohort)作為解釋的變數，出生世代是不會改變，但年齡階段卻是變動的，以此探討不同出生世代女性是否存在差異，而此差異是否隨著世代越年輕而加大，與年齡，時期和世代效應。
女性乳癌死亡率數據是從台灣死亡登記處為1971-2010收集。每年的百分比變化，年齡標準化死亡率（ASMR）和APC模型進行了計算。女性乳癌死亡率的增加從20-44歲年齡組上升54.79％，增加到45-64歲年齡組149.78％ （1971-1975年間和2006-2010年間）。
在45-64歲年齡組別的女性乳癌死亡率穩步上升1971~1975年和2006~2010年期間。 1951年出生世代 （實際出生世代; 1947~1955年）顯示， 50-54歲和45-49歲年齡組是女性乳癌死亡率的高峰期。
我們發現，1951年出生世代有乳腺癌最大的死亡風險。這可能是由於在台灣大量使用DDT，這是以防止死於瘧疾的藥劑。然而，未來的研究需要DDT數據來評估乳腺癌和DDT的使用之間的關聯。

關鍵字

發生率 ； 醫療費用 ； 年齡-年代-世代效應 ； 乳癌 ； 台灣

並列摘要

[First]
Background: The direct impact of medical expenses on breast cancer incidence and mortality rate has not been sufficiently addressed. The purpose of this study is to investigate the potential correlation between the incidence and mortality rate of breast cancer and the medical expenses in Taiwan.
Materials and Methods: Breast cancer cases were identified from the National Health Insurance Research Database (NHIRD) with corresponding to International Classification of Diseases, and the Ninth Revision (ICD-9) code 174, 1740-1749, 175, 1750 and 1759 from January 1999 to December 2006. Age-specific incidences were estimated by population data obtained from the Department of Statistics, Ministry of the Interior. Medical expenses, including outpatient and inpatient services, were also retrieved from the NHIRD.
Results: The incidence increased from 20.06 per 100,000 in 1999 to 30.34 per 100,000 in 2006; the total expenses increased from 1,449,333,521 in 1999 to 4,350,400,592 Taiwan dollars in 2006. The age-standardized mortality rate for female breast cancer remained essentially unchanged, while the age-standardized incidence increased steadily (except 2002-2003). Among the top 20 coexisting ICD-9 codes for expenses, four are directly on cancers, while 16 are on other diseases or symptoms, which are not necessarily caused by breast cancer.
Conclusions: Significantly increased medical expenditure on breast cancer failed to bring down its mortality and incidence rate. The finding has implications for healthcare policy planners in proposing strategies for breast cancer control and allocating the resources.
[Second]
Background: The current paper describes the age, period and cohort effects on breast cancer mortality in Taiwan.
Materials and Methods: Female breast cancer mortality data were collected from the Taiwan death registries for 1971–2010. The annual percentage changes, age- standardized mortality rates (ASMR) and age–period–cohort model were calculated.
Results: The mortality rates increased with advancing age groups when fixing the period. The percentage change in the breast cancer mortality rate increased from 54.79% at aged 20–44 years, to 149.78% in those aged 45–64 years (between 1971–75 and 2006–10). The mortality rates in the 45–64 age group increased steadily from 1971 to 1975 and 2006–10.
Conclusions: The 1951 birth cohorts (actual birth cohort; 1947–55) showed peak mortalities in both the 50–54 and 45–49 age groups. We found that the 1951 birth cohorts had the greatest mortality risk from breast cancer. This might be attributed to the DDT that was used in large amounts to prevent deaths from malaria in Taiwan. However, future researches require DDT data to evaluate the association between breast cancer and DDT use

並列關鍵字

Incidence ； Mortality ； Medical expense ； Age–period–cohort analysis ； Breast cancer:Taiwan

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