糖尿病患者的門診牙科利用及其相關因素-分析2000-2004年全民健保資料庫

Dental Care Use and Associated Factors among People with Diabetes Covered under the Taiwan National Health Insurance Program, 2000-2004

孫鼎茂(Ting-Mao Sun)

指導教授 ： 嚴雅音

高雄醫學大學/口腔醫學院/口腔衛生科學研究所碩士班/碩士(2009年)

https://doi.org/10.6832/KMU.2009.00105

摘要

背景:糖尿病是目前常見的慢性病之一，且發生率不斷的上升，而其併發症往往造成龐大醫療費用的負擔，再者糖尿病患者常伴隨的口腔疾病如牙周炎、牙齦炎、齲齒、口乾症和口內念珠菌的感染，然而國內對於糖尿病患者的牙科利用研究甚少，故欲對糖尿病患者的牙科利用作進一步的的分析與探討。

研究目的:了解糖尿病有無的五年牙科利用的趨勢與處置型態，並探討其在不同社會人口與地區特質的分佈，以作為擬訂糖尿病患者口腔照護政策的參考依據。

研究方法: 採用國家衛生研究院2000-2004年全民健保資料庫承保人抽樣檔。研究樣本限定為五年皆有投保者、三十五歲以上、且台灣戶籍居民者為分析對象，並使用一次以上糖尿病門診(國際疾病碼250與648.0) 定義糖尿病分組:非糖尿病組(無糖尿病門診紀錄者)、間斷糖尿病組(至少有一年糖尿病門診紀錄者)和持續糖尿病組(連續五年皆有糖尿病門診紀錄者)。採描述性、變異數分析與多元邏輯斯迴歸分析以了解糖尿病分組的牙科利用情形。

研究結果: 台灣地區35歲以上居民五年牙科利用率僅有64.0%，而持續糖尿病組、間斷糖尿病組其五年牙科利用率比非糖尿病患高(71.9%，66.9%，63.5%)。經調整性別與年齡後發現，間斷糖尿病組牙科利用高於非糖尿病組(aOR=1.43；95%CI = 1.35 -1.51 )，持續糖尿病組高於非糖尿病組(aOR=1.96；95%CI =1.82- 2.12)。其次不論是否為糖尿病患者皆是大於65歲以上、第三類投保類別、投保地點於低都市化與低牙科醫療資源的民眾其利用牙科利用率很低，其利用不均的特性皆相似；僅有非糖尿病組女性高於男性，而糖尿病組卻男女無差異。特別發現持續糖尿病組的在拔牙處置利用率皆比間斷糖尿病組與非糖尿病組高。

結論:台灣地區35歲以上居民健保牙科利用低於歐美國家，持續糖尿病者組與間斷糖尿病組的牙科利用比非糖尿病患者高，尤其拔牙處置的差異大。其次無論是否為糖尿病者其牙科利用不均的特質相似。因此可知國內成人普遍有低牙科利用的問題，而糖尿病患者更苦於口腔疾病，也顯示其對口腔照護的需求，此結果可提供衛生當局重視國內成人低牙科利用與致力於提升糖尿病患者牙科照護。

關鍵字

牙科 ； 牙科利用 ； 糖尿病 ； 牙科處置

並列摘要

Background
Diabetes is one of the most common chronic diseases worldwide and the incidence of diabetes is increased rapidly. Moreover, the complications of diabetes often cause enormous burden on medical expenditure. Oral health complications of diabetes include severe periodontitis, gingivitis, caries, xerostomia and candida infection. To our knowledge, there were few studies to access the utilization of dental care among diabetes. Therefore, this study was wanted to analyze and discuss the dental use of diabetic patients.

Study objective
To realize the trend of dental care use and dental procedures (scaling, operative dentistry, endodontic and extraction) among non-diabetes, suspend-diabetes and persist –diabetes in five years and compare their associated factors. The policy of dental care can be made by these results.

Results
The results showed that diabetic patients had 5-years utilization rate of dental care than non-diabetic patients (71.9% of persist-diabetes, 66.9% of suspend-diabetes, and 63.5% of non-diabetes). However, people have diabetes or not, the characteristics of dental use were similar. Only has the gender aspects to differ from, when the male suffered from diabetes, the utilization of dental care were not different with the female.After adjusting for age and gender, when compared with non-diabetes were least to use dental care than suspend-diabetes (adjusted odds ratio (aOR)=1.35-1.51) and and persist-diabetes (aOR=1.82-2.12). Moreover, suspend-diabetes and persist-diabetes were less likely to use dental procedures than non-diabetes. In addition, aged 65 and older, category III, those lived in city and low dental resource were less likely to use dental procedures. For extraction procedure, the utilization rate is highest for persist-diabetes.

Conclusion
The people aged above 35 in Taiwan were less likely to use dental care than those in European and American countries. Persist-diabetes and suspend-diabetes were more likely to use dental care than non-diabetes, especially for extraction procedure. Nevertheless, the disparity of dental care use had similar characteristic between diabetes and non-diabetes. Diabetic patients had higher incidence of oral diseases, and had more demand for dental care. Therefore, we should pay more attention to the low dental utilization rate and take more effort to promote the dental care use among diabetic patients.

並列關鍵字

dental care use ； diabetes ； dental procedures ； dental

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