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  • 學位論文

台灣族群可歸因於可介入危險因子之疾病負擔

Burden of Disease Attributable to Modifiable Risk Factors in Taiwan Population

指導教授 : 林先和
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摘要


透過健康介入政策達到有效控制或預防引起慢性疾病的危險因子是促進國人健康的關鍵,為了擬定合適且正確的健康介入政策,首先必須瞭解各種可預防或可介入的危險因子對於國家整體的罹病風險或是死亡所佔的角色與重要性。 藉由台灣豐富的健康資料,本研究利用比較性風險評估(Comparative Risk Assessment, CRA)的架構推估及比較多個可預防或可介入危險因子對國人慢性非傳染病死亡負擔的影響,評估的危險因子包括血壓過高、血糖過高、血脂過高、肥胖、吸菸、飲酒、嚼檳榔、缺乏運動、PM2.5暴露、高鈉攝取、低蔬果飲食攝取與慢性B型肝炎和C型肝炎感染。另一方面,本研究亦透過健康資料的連結,建立一具族群代表性之研究世代並藉由部分族群可歸因分率(Partial Population Attributable Fraction, PAFp)與因果圓派加權模型(causal pie weighted model)的分析來評估抽菸、飲酒、糖尿病以及體重過輕等危險因子對台灣結核病疫情的影響。 分析結果顯示血糖過高、吸菸、血壓過高是造成國人死亡負擔最重要的危險因子,2009年約有14,900名死亡人口與血糖過高有關,其次是吸菸,影響了13,340名死亡人口,而血壓過高,分別貢獻約6,280名男性死亡人口以及4,910名女性死亡人口。而評估PM2.5暴露相關的死亡負擔也發現顯著的地區別差異,說明健康不平等議題的重要性以及多層次的預防介入計畫的必要性。在結核病負擔的評估上,考量危險因子的相關性並調整年齡、性別與其他社經地位因子後,部分族群可歸因分率估計結果發現有38.2%的結核病發生與吸菸、飲酒、糖尿病以及體重過輕有關,進一步利用因果圓派加權模型考量這些危險因子的交互作用發現,有15.8%的結核病發生來自吸菸與飲酒兩者並存的影響。 本研究提供了危險因子對於國人整體健康影響的量化評估證據,未來可結合成本效益分析,在資源有限之情形下,幫助衛生健康資源分布的政策依據參考。另外,本研究結果亦指出未來的疾病預防與健康促進必須有更多的跨部門、跨面向的合作與規劃,與聯合國提出的永續發展目標一致,強調政策擬定上多元整合的重要性。

並列摘要


To facilitate priority-setting in health policymaking and be best to allocate public health resources, we estimated the adult mortality burden attributable to 13 metabolic, lifestyle, infectious, and environmental risk factors in Taiwan. Also, for communicable disease, the impact of modifiable risk factors (tobacco smoking, alcohol use, underweight, and diabetes mellitus) on tuberculosis incidence was estimated individually and jointly. Taking advantage of the well-established health information system in Taiwan, the comparative risk assessment framework was applied to estimate mortality burden of non-communicable diseases attributable to individual risk factor or risk factor clusters, while a national representative cohort was built up for quantifying the joint impact of these potentially modifiable risk factors on tuberculosis in Taiwan. We found high blood glucose, tobacco smoking, and high blood pressure are the major risk factors for deaths from non-communicable diseases and injuries among Taiwanese adults. In 2009, high blood glucose accounted for 14,900 deaths (95% UI: 11,850–17,960). It was followed by tobacco smoking (13,340 deaths, 95% UI: 10,330–16,450), and high blood pressure (11,190 deaths, 95% UI: 8,190–14,190). A large number of years of life would be gained if the 13 modifiable risk factors could be removed or reduced to the optimal level. Also, the substantial geographic variation in PM2.5 attributable mortality fraction was found. The social inequalities in environment and health deserve more attentions. For the burden of tuberculosis incidence, the analysis of partial population attributable fraction found that tobacco smoking, alcohol consumption, underweight, and diabetes mellitus individually contributed 18.5%, 12.7%, 6.7%, and 7.5%, respectively, and jointly accounted for 38.2% (95% CI 19.6%, 54.1%) of TB cases in Taiwan. On the other hand, a significant interactive effect due to tobacco smoking and alcohol consumption was identified by causal pie weighted model; there are 15.8% of TB cases caused by the interaction between tobacco smoking and alcohol consumption. Our integrative analysis provides an aerial view of distribution and determinants of population health and helps the country to prepare for the new Sustainable Development Goals. Our findings underline the necessity to intensify the collaborative effort from the communicable and non-communicable health sectors as well as non-health sectors.

參考文獻


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