- 學位論文
運用全民健保資料庫研究環境汙染中空氣污染細懸浮微粒與中波紫外光對於健康危害的風險
The affect on health risk and the relationship between atmospheric aerosol fine particles and Ultraviolet Radiation B caused by environmental pollution: A Taiwan's National health insurance database research
摘要
研究背景：隨著科技的日新月異，造成的環境汙染也隨之上升，空氣污染細懸浮微粒中PM2.5 物質與中波紫外光 (UVB) 對於各項疾病的危害風險性逐漸增加與醫療負擔成本逐年加重。本篇研究首次探討PM2.5對於正常眼壓青光眼 (NTG) 以及UVB對於憂鬱症的影響，以提供更多臨床診斷的依據。 研究方法：本研究主要的資料來源採用全民健康保險資料庫中，台灣縱向健康保險研究數據庫，空氣汙染物則是來自於台灣行政院環保署中所設立的空氣質量監測網路 (AQMN)。(AQMN)。觀察2008年至2013年病人疾病與暴露情況。篩選後研究族群分為病例組和對照組，利用常態檢定測定研究族群是否為常態分布，卡方檢定用於分析類別變項之間的相關性，雙尾t檢定用於連續變量之間的相關性。評估PM2.5暴露程度與NTG病人發生的風險相關性；使用泊松回歸模型，評估UVB暴露程度與憂鬱症病人發生的風險相關性。 研究結果：與對照組相比，隨著PM2.5的暴露濃度上升，正常眼壓青光眼發生風險逐層增加。與Q1層級相比，Q2層級的勝算比 (OR) 為1.009 (95% CI: 0.812–1.254)，Q3層級的OR為1.241 (95% CI: 1.241–1.537，Q4層級的OR為1.246 (95% CI: 1.008–1.539)。PM2.5的暴露濃度上升，相較於對照組會增加正常眼壓青光眼的發展風險，證明PM2.5對於眼睛疾病的危害。憂鬱症病人與1:4性別年齡配對的對照組相比，經由調整後除了正常濃度外風險降低外，風險逐層增加。與低濃度層級相比，正常濃度的發病率比值 (IRR) 分別為0.889 (95% CI: 0.835–0.947)，高濃度的IRR為1.134 (95% CI: 1.022–1.260)，較高濃度的IRR為1.711 (95% CI: 1.505–1.945)，極高濃度的IRR為2.785 (95% CI: 2.439–3.180) 。對於憂鬱症病人，相較於WHO制定的低程度水平的UVB暴露，正常水平UVB暴露組風險下降，高等水平隨著UVB的暴露程度上升，對於憂鬱症的發展風險也隨之增加，顯示過量的UVB暴露會導致憂鬱症的風險上升。 研究討論：研究說明了環境汙染對於疾病風險上的關係，更已經指出我們目前的生活環境早已進入高暴露量的環境汙染時代。室外活動時應戴口罩，室內活動時則注意通風及空氣過濾等問題，也建議病人在室內外活動接觸陽光時，要做好一定的防曬措施不僅是PM2.5和UVB的暴露，以及其他汙染物包含一氧化氮或是甲烷等。真正重要的除了後續的疾病照護以及預先防護，且更應該要正視環境污染所帶來的危害，以及改善環境汙染的排放及製造。
並列摘要
Background: With the rapid development of science and technology, the resulting environmental pollution has also increased. The harm of PM2.5 to various diseases has gradually increased. Ultraviolet Radiation B (UVB) has also caused acute and chronic health effects on the immune system. Glaucoma has a very high risk of blindness, and depression is also a modern global disease that increases the medical burden year by year. This study explores the impact of PM2.5 on normal tension glaucoma (NTG) and UVB on depression, providing a more clinical diagnostic basis and treatment options and methods. Method: The main source of data for this study is the National Health Insurance Database (NHIRD), and air pollutants are from the Air Quality Monitoring Network (AQMN) established by the Environmental Protection Agency of the Executive Yuan of Taiwan. The disease and exposure of patients from 2008 to 2013 were observed. The case group and the control group used Shapiro-Wilk test to determine whether the distribution was normal, the chi-square test was used to analyze differences between categorical variables, and the two-tailed t-test was used to analyze the differences between continuous variables. Multivariate logistic regression models were used to assess the risk of patients with NTG exposed to PM2.5, and Poisson regression models were used to assess the effect of UVB exposure in patients with depression. Result: NTG patients compared to the control group, as the exposure concentration of PM2.5 exposure increased, the adjusted risk of NTG increases gradually. Compared to the Q1 level, the odds ratio (OR) of the Q2 level was 1.009 (95% CI: 0.812–1.254), the OR of the Q3 level was 1.241 (95% CI: 1.241–1.537), and the OR of the Q4 level was 1.246 (95% CI: 1.008-1.539). In patients with NTG, the increased concentration of PM2.5 will gradually increase the risk of disease, and compared the control group, there is a high risk of development, which proves the harm of PM2.5 to eye diseases. Depression patients compared to the 1:4 sex-age-matched control group, In addition to the normal level of depression risk decreased, the rest of the level gradually increased. the incidence rate ratio of the normal level (IRR) were 0.889 (95% CI: 0.835–0.947), the IRR of the high level was 1.134 (95% CI: 1.022–1.260), the IRR of the very high level was 1.711 (95% CI: 1.505–1.945), and the IRR of extreme level was 2.785 (95% CI: 2.439–3.180). In patients with depression, the risk of exposure to the WHO normal concentration group decreased, and as the concentration of UVB exposure increased, the risk of developing depression also increased, showing that excessive UVB exposure can lead to the development of depression. Conclusion: Studies have shown the relationship between environmental pollution and disease risk, and have pointed out that our current living environment has already entered the era of high exposure to environmental pollution. Masks should be worn during outdoor activities, and attention should be paid to ventilation and air filtration during indoor activities. It is also recommended that patients take certain sun protection measures when they are exposed to sunlight during indoor and outdoor activities. Not only are they exposed to PM2.5 and UVB, but also other pollution substances such as nitric oxide or methane. What is really important is not only follow-up disease care and preventive protection, but also to face up to the harm caused by environmental pollution, and to improve the emission and production of environmental pollution.