Title

探討重症海洋性貧血罹患焦慮或憂鬱症之趨勢、醫療資源耗用與存活之研究

Translated Titles

Trend, medical resources utilization and survival of thalassemia major suffer from anxiety or depression disorders

Authors

劉雅燕

Key Words

重症海洋性貧血 ; 盛行率 ; 憂鬱或焦慮症 ; 醫療資源耗用 ; 存活率 ; thalassemia ; prevalence, ; anxiety or depressive disorders ; medical resource utilization ; survival rates

PublicationName

高雄醫學大學醫務管理暨醫療資訊學系碩士在職專班學位論文

Volume or Term/Year and Month of Publication

2015年

Academic Degree Category

碩士

Advisor

許弘毅

Content Language

繁體中文

Chinese Abstract

研究目的 海洋性貧血(Thalassemia)是全世界最常見的遺傳性疾病,在臺灣約有4%的國人為甲型海洋性貧血(α-Thalassemia)帶因者,而乙型海洋性貧血(β-Thalassemia)帶因者至少占總人口數之1.1%。定期輸血且每天使用排鐵劑是目前治療重度海洋性貧血的主流方法。而此種治療方式需要耗費大量的社會資源,且往往對家庭帶來龐大的心理及經濟壓力。因此,本研究目的有下列三點: 一、探討重症海洋性貧血趨勢分析及相關影響因子。 二、探討重症海洋性貧血罹患焦慮或憂鬱症之相關影響因子。 三、探討重症海洋性貧血罹患焦慮或憂鬱症之醫療資源耗用及存活之差異性分析。 研究方法 本研究利用國家衛生研究院釋出之「全民健康保險研究資料庫」之次級資料來源,採用百萬歸人檔資料,研究之樣本為1996年至2010年間健保住院、門診申報資料,主卅次診斷為重症海洋性貧血(ICD-9 2824),共798,823人次,經百萬歸人後總計為4,657例,研究期間為15年,本研究利用SPSS Version 20.0 for Windows統計套裝軟體執行統計分析,分為描述性統計(包括平均值、標準差及次級分配與百分比)與推論性統計(包括卡方檢定、獨立樣本t檢定、Logistic回歸分析、ES研究分析、GEE研究分析及K-M存活分析)等統計方法。 研究結果 研究結果闡述如下: 一、重症海洋性貧血的女性病患從1996年的57.1%顯著的增加至2010年的65.0%,其平均 年齡為34歲,以18-64歲占3,371例(72.4%)為最多,且從1996年的42.9%顯著的增加至2010年的76.1%,疾病嚴重度以0分所占比率(87.8%)為最多,在臨床特性中有糖尿病為主要合併症佔425例(9.1%),有罹患焦慮或憂鬱症佔826例(17.7%),且有罹患焦慮或憂鬱症從1996年的22.4%顯著的下降至2010年的4.4%;在醫療機構特性中,以醫學中心所占比率為最多;存活佔4, 224例(90.7%),從1996年的75.5%顯著的增加至2010年的94.4%。就盛行率之趨勢變化,其研究結果從1996年的每十萬人口0.24增加至2002年的2.12,但之後則有逐年下降之趨勢,至2010年下降至0.78 (P<0.001)。 二、重症海洋性貧血在罹患焦慮或憂鬱症之各個變項中(人口學特性、臨床特性、醫療機構特性、時間特性等變項),同時亦以PSM配對分析其重症海洋性貧血在罹患焦慮或憂鬱 症之各個變項,研究結果發現:只有性別、年齡、醫院服務量、醫師服務量及醫院層級之變項有其顯著差異(P<0.001)。 三、醫療資源耗用部分,研究結果發現:有罹患焦慮或憂鬱症之住院費用、門診費用、住院次數、門診次數及住院天數皆較高於無罹患焦慮或憂鬱症。再者隨著時間變化,有罹患 焦慮或憂鬱症之平均住院費用、平均門診費用及平均住院天數,其改善幅度為小至中幅 度增加;而相對的有罹患焦慮或憂鬱症之平均住院次數、平均門診次數,其改善幅度為小至中幅度下降。 四、存活狀況分別為:有罹患焦慮或憂鬱症其平均存活月數為72.0±4.5月,無罹患焦慮或憂鬱症其平均存活月數為41.1±3.9月,其存活月數以有罹患焦慮或憂鬱症高於無罹患焦慮或憂鬱症。而有罹患焦慮或憂鬱症的存活率在第一年為97.1%、第二年為89.9%、第三年為79.7% (P<0.001);相對於無罹患焦慮或憂鬱症的存活率在第一年為71.6%、第二年為58%、第三年為49.4% (P<0.001),二者間的存活率皆有顯著性的差異。 結論與建議 重症海洋性貧血1996-2002年盛行率有逐年增加之趨勢,2002-2010年則有逐年下降之趨勢,而有罹患焦慮或憂鬱症之醫療資源耗用,其改善幅度皆為小至中幅度的增加,且有罹患焦慮或憂鬱症其存活月數較高。面對這研究結果之顯著現象,建議隨著醫學的進步,重症海洋性貧血患者生命的延長、社會適應的問題也愈來愈重要,醫療供給者應有適當的介入性措施,讓家屬與病人獲得良好的醫療照護,適當的控制醫療資源使用狀況,進而為家屬與病人及社會創造雙贏的局面。

English Abstract

Objective: Thalassemia is the most common hereditary disease: α-Thalassemia is found in 4% of Taiwan’s overall population while β-Thalassemia is present in 1.1% of the population. Current treatment of this disease not only impacts society’s resources, but also affects the mental and well-being of a family. Therefore, the purpose of this study is comprised of the following three areas: 1.To investigate the trend and correlation factors associated with thalassemia; 2.To investigate the relationship between anxiety or depressive disorders with regards to thalsse-mia; 3.To investigate the relationship between anxiety or depressive disorders associated with tha-lassemia and the impact on social medical resources. Methods: The study utilized the National Health Insurance Research Database report released by the National Institute of Health (NIH) and information collected from one million in- and out-patient subjects over the years from 1996 to 2010. During this study period, a total of 798,823 patients with thalassemia major were recruited into the study. The SPSS Version 20.0 for Windows was used for descriptive statistical analysis (determining the mean, standard deviation, distribution and incidence), inferential statistical analysis (including the Chi-square test, student’s t-test, logistic regression model analysis, ES analysis, GEE analysis and K-M survival analysis) and other statistic methods. Results: Females suffering from thalassemia increased in numbers from 57.1% in 1996 to 65.0% in 2010. The average age was 34, with ages 18-64 making up the majority of 3.371 (72.4%) sufferers. There was a significant increase from 42.9% during 1996 to 76.1% at 2010. The greatest percentage was CCI=0 (making up 87.8%) and patients with diabetes, which accounted for 9.1%. The study saw an increase in the prevalence of the disease from 0.24 per population of hundred thousand in 1996 to 2.12 per population in 2002. This number decreased the ensuing years to 0.78 per population in 2010 (P < 0.001). Patients suffering from anxiety or depressive disorder accounted for 826 cases (17.7), which saw a decrease from 22.4% in 1996 to 4.4% in 2010. Rates were highest in medical institutions,especially when tested in medical centres, with a survival rate of 4,224 cases (90.7%). This increased from 75.5% in 1996 to 94.4% in 2010. Secondly, the variables believed to be associated with thalassemia and anxiety or depressive disorders (such as demographic characteristics, clinical differences and varying trends throughout periods of time) were compared using PSM analysis to determine what factors were significantly different for thalassemia and anxiety or depressive disorders. The study found that the sex, age, amount of medical and physician services as well as the hospital rating played a significant differ-ence in the study (P < 0.001). Thirdly, in regards to the amount of community resources spent, the study showed that the outpatient cost, hospitalization cost, amount of outpatient visits and amount of days spent at the hospital were greater for patients that had anxiety or depressive disorders than those who did not. Furthermore, the average cost for hospitalization, outpatient visits and length of hospital stay for patients with anxiety or depressive disorders was found to increase over time. The average number of hospitalizations and number of outpatient visits for patients with anxiety or depressive disorders was found to decrease over time. Fourthly, the study shows that survival rates for patients that have anxiety or depressive disorders, the mean survival rate after diagnosis is 72.0±4.5 months, whereas the rate is 41.1±3.9 months for patients without anxiety or depressive disorders. The length of survival for patients with anxiety or depressive disorders is longer than those without. For patients with anxiety or depressive disorders, the rate of survival for the first year was 97.1%, 89.9% for the second year and 79.7% for the third year (P < 0.001). Relatively, for patients without anxiety or depressive disorders, the rate of survival was 71.6% for the first year, 58% for the second year and 49.4% for the third year (P < 0.001). There was a significant difference in survival rates between the two groups. Discussion and suggestion: Between the years 1996 to 2002, there was a significant increase in prevalence of thalassemia, however, the trend decreased from the years 2002 to 2010. Patients with anxiety and depressive disorders utilized more of society’s medical resources, which this was shown to slightly improve over time. The same patients also had longer survivals than patients without anxiety or depressive disorders. Following the results of this study, the author suggests to monitor the advances of medicine and shifting social dynamics. Healthcare providers are advised to continue ensure that proper care and treatment is given to patients and their families to create the best situation possible.

Topic Category 醫藥衛生 > 醫院管理與醫事行政
健康科學院 > 醫務管理暨醫療資訊學系碩士在職專班
社會科學 > 管理學
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