胃食道逆流疾病發生率與季節性變化和氣候因素之探討-以全民為基礎的研究

Seasonal variations in the incidence of gastro-esophageal reflux disease (GERD) and the association with climate: A national population-base study

陳冠仰(Kuan-Yang Chen)

指導教授 ： 林恆慶 ； 陳志彥 ； 陳建麟

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2009年)

摘要

研究背景：研究台灣地區胃食道逆流疾病的發生率與季節變化的關聯性，並進一步分析不同年齡、不同性別及五種氣候因子(氣溫、相對溼度、大氣壓力、降雨量、日照時間)，對胃食道逆流疾病發生率的影響。

研究方法：從2001年1月至2006年12月間衛生署全民健康保險局健保費用申請資料庫中，挑選出76,636名因胃食道逆流症來門診接受治療的病人納入本研究。除了計算72個月的胃食道逆流疾病月發生率(每10,000人口)，並將這些資料依性別及年齡(19-44歲、45-64歲及>64歲)區分成子群。因季節是時間序列，所以運用自我迴歸整合移動平均模型(ARIMA)來評估季節月份及氣候因素，對胃食道逆流疾病發生率的影響。

研究結果：經分析資料發現胃食道逆流疾病的發生率，在十月至十二月為發生率的高峰，其後在一月逐漸減少，至二月為最低發生率，到三月才又明顯的增加發生率。這樣的趨勢在不同性別、不同年齡族群或合併兩者都有相似性的季節變化。經過自我迴歸整合移動平均模型調整後，發現在全體族群(p<0.01)，女性病患(p<0.05)及年齡45-64歲(p<0.01) 、年齡>64歲(p<0.01)的族群都和季節性有明顯的相關性，自我迴歸整合移動平均模型也發現相對溼度和男性及大於64歲族群(p<0.01)的每個月胃食道逆流疾病發生率呈負相關，而降雨量只和大於64歲的年齡族群(p<0.05) 呈正相關。

結論：這是全世界第一個以全民為基礎，探討胃食道逆流症發生率和氣候變化及氣候因子關聯性的研究。研究發現胃食道逆流症的發生率和台灣氣候的變化有關，相對濕度與男性、大於64歲的族群的胃食道逆流症發生率呈負相關，而降雨量只和大於64歲的族群呈正相關。

關鍵字

胃食道逆流疾病；季節變化；氣候

並列摘要

Purpose: To examine the seasonal variation in the incidence of gastroesophageal reflux disease (GERD) for different gender and age groups and its association with climatic parameters (ambient temperature, relative humidity,atmospheric pressure, rainfall, hours of sunshine).

Methods: A total of 76,636 ambulatory care visits for the treatment of GERD between 2001 and 2006 were included. Monthly GERD incidence rates per 10,000 people were calculated over 72 months and categorized by gender and age groupings (of 19-44, 45-64, and >= 64 years). Seasonality is a general component of time series patterns.
The Auto-Regressive Integrated Moving Average (ARIMA) regression method was used to evaluate the effects of climatic and monthly factors on GERD incidence rates after adjusting for the time-trend effect.

Results: Seasonal trends showed an incidence peak in October-December, followed by a sharp decrease in January and a trough in February; a fairly similar seasonal pattern of GERD incidence was apparent for gender, age and combined groups. The ARIMA test for seasonality found a significant association for the total group (p<0.01), and female (p<0.05) patients, and for the 45-64 (p<0.01) and >64 (p<0.01) age groups. The ARIMA models also showed that relative humidity was negatively related to monthly GERD incidence rates for males (p<0.01) and the >64 (p<0.05) age group.

Conclusion: Data showed seasonal variations in GERD incidence. Relative humidity was associated with monthly GERD incidence rates for males and the >64 age group.

並列關鍵字

gastroesophageal reflux disease ； climate ； seasonality

參考文獻

Adachi, K., Fujishiro, H., & Katsube, T. (2001). Predominant nocturnal acid reflux in patients with Los Angeles grade C and D reflux esophagitis. J. Gastroenterol Hepatol , 16 (11), 1191–6.

Aratari, A., Papi, C., Galletti, B., Angelucci, E., Viscido, A., & D’Ovidio, V. (2006). Seasonal variations in onset of symptoms in Crohn’s disease. Digestive and Liver Disease, 38, 319–323

Boeckxstaens, GE. ( 2007 ). Review article: the pathophysiology of gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 26(2),149-60.

Bor, S., Mandiracioglu, A., Kitapcioglu, G., Caymaz-Bor, C., & Gilbert, RJ. (2005). Gastroesophageal reflux disease in a low-income region in Turkey, Am J Gastroenterol., 100(4):759-65.

Chen, C.H., Xirasagar, S. & Lin, H.C. (2006). Seasonality in Adult Asthma Admissions, Air Pollutant Levels, and Climate: A Population-based Study. Journal of asthma, 43 (4), 287 – 292