社經發展與死亡：以彰化縣、南投縣、雲林縣為例

Socioeconomic Development and Mortality in Changhua, Nantou, and Yunlin

劉晏孜(Yen-Tze Liu)

指導教授 ： 江東亮

國立臺灣大學/公共衛生學院/公共衛生碩士學位學程/碩士(2017年)

https://doi.org/10.6342/NTU201703687

摘要

背景與目的：臺灣歷經社會經濟發展與健康轉型，國民所得與平均餘命雖隨著時間雙雙提升，但臺灣的地理健康不平等現象，尤其在中臺灣之彰化縣、南投縣、與雲林縣仍缺乏深入研究。本研究有三個目的：（1）呈現彰化縣、南投縣、及雲林縣自2000年到2015年來，縣層級與轄下鄉鎮市層級之社經發展趨勢；（2）分析地區社會經濟發展指標與健康之關係；及（3）探討是否存在區域之間的健康不平等。
方法：本研究屬於次級資料分析，自變項包括經濟與社會發展兩大面向。經濟發展選用四項指標：平均每報稅單位年度綜合所得、平均每戶每年家庭可支配所得、工商及服務業人均生產毛額、以及低收入戶比率；社會發展選用三項指標：15歲以上人口受高等教育比率、自來水供水普及率、以及每萬人口執業西醫師數。依變項為縣層級及鄉鎮市層級之標準化死亡率。先以描述2000到2015年彰化縣、南投縣、雲林縣及其轄下各鄉鎮市之社經發展與死亡率之變化趨勢，再以縱橫資料分析（panel data analysis）檢視社經發展與死亡率的關係，最後並以地理資訊系統視覺化呈現地區之死亡率變化。
結果：(1) 2000-2015年期間，雲林縣與南投縣之間年標準化死亡率差異不大，但皆顯著高於彰化縣（p = 0.002）；以2015年為例，雲林縣、南投縣、與彰化縣之年標準化死亡率分別為千分之5.07、千分之5.01、與千分之4.46。(2) 同一時期，各縣鄉鎮市之間年標準化死亡率差異不但明顯，而且逐年擴大，彰化縣、南投縣、與雲林縣的最高與最低比值，分別由1.25、1.97、和1.27增加至1.31、2.10、和1.36；（2）迴歸分析顯示，無論縣市層級或鄉鎮市區層級，社經發展程度越高，死亡率越低，其中以高等教育比率及平均綜合所得與標準化死亡率的相關最高。
結論：以彰化縣、南投縣、與雲林縣為例，無論在縣層級或鄉鎮市層級，標準化死亡率皆存在明顯差異。而社經發展程度越高，死亡率越低。其中又以教育程度與死亡率之相關性最高，顯示地區間存在健康不平等之現象。

關鍵字

社經發展 ； 年齡標準化死亡率 ； 彰化縣 ； 南投縣 ； 雲林縣 ； 健康不平等

並列摘要

Objectives: Along with the socioeconomic development and health reform in Taiwan, the GDP and life expectancy are both improved. However, the geographical inequality of health in Taiwan hasn’t been intensively researched before, especially among Changhua, Nantou and Yunlin in central Taiwan. Therefore, this study explores this issue through (1) Reveal the socioeconomic development trends in county and township level within Changhua, Nantou and Yunlin during 2000-2015. (2) Analyze the correlation between regional socioeconomic development and health. (3) Investigate the existence of geographical health inequality.

Methods: This study belongs to the secondary data analysis, with data from official government publications. The independent variables include 4 economic development indicators: (1) average annual income per individual income tax return unit, (2) average disposable income per house, (3) gross domestic production per capita of secondary and tertiary industry (4) low income ratio, and 3 social development indicators: (1) the higher education rate above 15 year-old, (2) tap water penetration rate and (3) number of doctors per 10,000 people. The main outcome measure is the age-standardized mortality rate. Descriptive statistical analysis and panel data analysis were applied to examine the relationship and effect. The geographic information system was also used for visualized presentation of the regional mortality changes.

Results: The results showed that: (1) The standardized mortality rate of Yunlin County, and Nantou County were both higher than Changhua County, and the difference was statistically significant (p = 0.002). Take the year 2015 as an example, the rate of Yunlin, Nantou and Changhua are 5.07‰, 5.01‰ and 4.46‰ respectively. (2) The difference of standardized mortality rate among townships was not only significant but also increased year by year. The highest and lowest ratio of Changhua, Nantou, and Yunlin were from 1.25, 1.97, and 1.27 to 1.31, 2.10, and 1.36 respectively, and (3) Findings from the panel regression analysis suggested the higher the degree of socioeconomic development, the lower the mortality rate regardless of the county level or township level and education was the most important factor.

Conclusions: The standardized mortality rate differs obviously from either county or township level. The higher socioeconomic development is, the lower mortality rate it is. The most important factor in terms of mortality rate is education. Socioeconomic development is important to decrease the mortality in Changhua, Nantou, and Yunling, showing that there is health inequality among these regions.

並列關鍵字

socioeconomic development ； age-standardized mortality rate ； Changhua County ； Nantou County ； Yunlin County ； health inequality

參考文獻

呂宗學、陳端容、江東亮:釐清健康不平等相關名詞。台灣衛誌 2015; 34:115-118

江東亮：公共衛生與健康不平等：三個歷史的教訓。臺灣公共衛生雜誌. 2015;

李宜家, 林慧淳, 江東亮. 地區剝奪程度、個人社經地位與臺灣男性成人的吸菸

王信忠, 金碩, 余清祥. 小區域死亡率推估之研究. 人口學刊. 2012(45):77-110.

李昱燐、江東亮：「社經發展與死亡:以臺東縣為例」，2006。