2006年高雄縣鳳山市登革熱之流行特徵及醫療費用分析研究

The epidemiological characteristics and medical expenditure of the dengue fever 2006 epidemic in Fongshan, Kaohsiung County.

徐琬婷(Wan-Ting Hsu)

指導教授 ： 莊弘毅

高雄醫學大學/健康科學院/公共衛生學研究所/碩士(2007年)

摘要

研究背景與目的：臺灣地區在2002年為本土最大一次登革熱流行後，直至2006年病例數明顯上升且似有2002年流行的縮影，因此本研究主要目的為瞭解2006年此波登革熱確定病例之特質及地理分佈，且進一步估算登革熱病人門急診及住院醫療費用引起的經濟損失與疾病負荷。
研究方法：以高雄縣鳳山市2006年登革熱確定病例為研究對象，利用三個時間風險指標比較與2002年流行的差異，並進一步探討病例資料與居住地之病媒蚊指數及氣象資料的關係。此外，利用通報前後兩週的門急診與住院費用，計算鳳山市2006年登革熱疑似與確定病例通報前後兩週之醫療費用。
研究結果：(1)在2002年與2006年兩波登革熱流行差異的比較方面，結果發現三個時間指標值與其在空間中的分布都有達到顯著差異，顯示此兩波流行並未十分相似；(2)以Poisson複迴歸分析評估病例數與布氏指數、人口密度及氣象因素的關係，提出相關模式：(當週登革熱發生個案數)＝-13.436＋0.024(前一週布氏指數最大值)＋0.428(前一週溫度)＋0.015(人口密度)，為較好的預測模式；(3)2006年鳳山市登革熱流行期間共計通報病例數329位，估計單獨在醫療費用上共花費了5,977,973.68元。其中確定病例平均每人個人在醫療費用上花費16469.58元，門急診及住院費用分別為平均每人個人花費5815.85元及 16315.13元。
結論：由研究的結果顯示以前一週布氏指數最大值、平均溫度與人口密度會影響疾病個案數發生，為較好的預測模式，利用此緩衝時間，也許可以妥善採取控制行動。除了在流行期間直接成本的推估提供了主要醫療服務資源支出，對於完整評估醫療補助計畫或政策重新審視則有待未來進一歩加入行政機關控制等費用之相關研究。

關鍵字

登革熱 ； 流行特徵 ； 醫療費用

並列摘要

Objective：Since 2002, the number of reported DF cases has been significant, with moderate yearly variations, except for an unusual increase in 2006. The objectives of this study are to determinate the important epidemiological characteristics of dengue fever in 2006, and to assess the economic burden of dengue-related illness.
Methods：Subjects included in dengue confirmed cases in Fongshan, Kaohsiung County. Comparisons of three temporal risk indices between the years 2002 and 2006 in the same Li, and to investigate the association among the vector index of dengue fever to climate factors and case number. In addition, the reported cases were divided into two groups (excluded and confirmed). By pooling data（including outpatient and inpatient care）, medical cost were estimated by two groups.
Result：(1)There were statistic significant in three temporal risk indices between the years 2002 and 2006 in the same Li. It may imply that two epidemic curves were different.；(2)The correlation of Breteau index, climate factors, population density with the occurrence of DF cases was assessed by Poisson multiple regression analysis. The better forecasting model is as follows:(the occurrence of DF cases)=-13.436+ 0.024(pre-week maximum Breteau index)+ 0.428(mean pre-week temperature)+ 0.015(population density)；and (3)The 2006 epidemic in Fongshan , which had a total of 329 reported cases, cost about 5.98 million dollars. Approximately patient costs were found to be 16469.58 dollars for a confirmed case.
Conclusion：Among the various variables which would effect the occurrence of disease, such as Breteau index, temperature, and population density, only a prior week of precipitation can explain the outbreak of dengue by model. To fully evaluate the economics of prevention programs, epidemiologic and mosquito control data related to program effectiveness should be taken into account.

並列關鍵字

dengue fever ； epidemiological characteristics ； expenditures

參考文獻

1. Organization(WHO) WH. Dengue and dengue hemorrhagic fever.: Geneva: WHO 2000.

2. 民國76至94年台灣登革熱病例發生數一覽表. In: 疾病管制局, ed.

3. Navarro-Sanchez E, Despres P, Cedillo-Barron L. Innate immune responses to dengue virus. Archives of medical research. 2005 Sep-Oct;36(5):425-35.

4. Kao CL, King CC, Chao DY, Wu HL, Chang GJ. Laboratory diagnosis of dengue virus infection: current and future perspectives in clinical diagnosis and public health. J Microbiol Immunol Infect. 2005 Feb;38(1):5-16.

5. Stephenson JR. Understanding dengue pathogenesis: implications for vaccine design. Bull World Health Organ. 2005 Apr;83(4):308-14.