子宮內膜癌手術病人發生率、醫療資源耗用、死亡率分佈趨勢及影響因素之探討

研究目的　　依據衛生署國民健康局2012年公佈，台灣地區子宮內膜癌年齡標準化發生率之長期趨勢顯示發生率從1979年0.69％增加至2009年13.03％。子宮內膜癌對婦女健康造成相當大的影響，隨之而來大量的醫療資源耗用，成為國內重要的公共衛生議題，若能有效預測癌症病患罹病後之醫療費用分析，將有利於未來醫療資源規劃。一、探討子宮內膜癌手術病人發生率之分佈趨勢。二、探討子宮內膜癌手術病人醫療資源耗用分佈趨勢及其重要影響因子。三、探討子宮內膜癌手術病人死亡率分佈趨勢及其重要影響因子。四、比較國內外子宮內膜癌手術病人醫療資源耗用及死亡率之差異性分析。研究方法利用國家衛生研究院釋出之「全民健康保險研究資料庫」，進行回溯性(Retrospective)次級資料的縱貫研究分析，研究對象為子宮內膜癌手術病人，研究期間為1996年01月01日至2010年12月31日共15年，總樣本數12,956人。從「全民健康保險研究資料庫」中，選取國際疾病分類第九版診斷子宮內膜癌代碼為(182、233.2)的病人資料，由「資料檔(ID)」取得病人基本資料、醫事機構代號(HOSP_ID)中取得「醫事機構基本資料檔(HOSB)」、醫院評鑑等級(HOSP_GRAD_ID)及「住院醫療費用清單明細檔(DD)」，進行資料整理與串聯。研究資料以SPSS for Windows 19.0 統計套裝軟體做為分析工具。研究結果一、子宮內膜癌手術病人發生率： 1996∼2010年間，子宮內膜癌手術病人平均年齡為53.5歲，發生率每十萬人口中從3.71增加至13.9，有逐年上升之趨勢。二、1996∼2010年間，子宮內膜癌手術病人之平均住院天數隨著時間有下降之趨勢(P＜0.001)。三、將子宮內膜癌手術病人以每5年區分一個時期T1(1996~2000)、T2(2001~2005)、T3(2006~2010)，醫療總費用有逐時期增加的趨勢。四、子宮內膜癌手術病人之年齡、CCI、住院天數與死亡率有顯著相關(P＜0.001)。五、子宮內膜癌手術病人一年存活率92.89%、三年存活率85.78%、五年存活率83.17%。結論與建議本研究運用「全民健康保險研究資料庫」，探討1996~2010年間子宮內膜癌手術病人之發生率、醫療資源耗用及死亡率分佈趨勢及影響因素，研究發現國內子宮內膜癌手術住院天數有逐年下降以及各階段死亡率分佈結果，與國外主要國家之研究相似，也顯示國內醫療與國際醫療水準一致。本研究亦建議透過本研究瞭解子宮內膜癌手術病人住院天數逐年下降，但醫療費用卻逐漸上升，如何在良好的醫療照護品質中又能有效的控制醫療資源耗用，可做為主管機關規劃醫療資源預算和未來衛生政策推動參考。

關鍵字

子宮內膜癌手術病人；發生率；醫療資源耗用；存活率

並列摘要

Purposse According to the Department of Health Bureau’s report, age-standardized incidence rate of endometrial cancer in Taiwan increased form 0.69% in 1979 to 13.03% in 2009. Therefore, the purposes of the study were: 1. To investigate the incidence of endometrial cancer surgery patients; 2. To investigate significant important factors of medical resource utilization of endometrial cancer surgery patients; 3. To discuss significant important factors of mortality of endometrial cancer surgery patients; 4. To compare the differences of medical resource utilization and mortality of endometrial cancer surgery patients. Methods A retrospective longitudinal study of secondary data analysis was done using the "National Health Insurance Research Database" released by the National Institute of Health. During the study period (from January 1, 1996 to December 31, 2010), there were a total of 12,956 endometrial cancer surgery patients included in the study. We selected the ninth edition of International Classification of Diseases Code for the diagnosis of endometrial cancer (182, 233.2). We gathered patient data from “data file (ID)” to obtain patient information, Medical Institution Code (HOSP_ID) for medical institution basic data file (HOSB), hospital level (HOSP_GRAD_ID) and “hospitalization medical expenses detailed file list (DD)” for data sorting and concatenation. The SPSS for Windows 19.0 statistical software package was employed for the data analysis. Results 1. From 1996 to 2010, the mean age of endometrial cancer surgery patients was 53.5 years, with incidence rate increased from 3.71/105 to 13.9/105. 2. During the same period, the average length of stay significantlly and gradually decreased over time (P <0.001). 3. Total health care costs significantlly increased from T1 (1996 ~ 2000), to T3 (2006 ~ 2010) (P <0.001). 4. Age, Charlson co-morbidity index (CCI), and length of stay are significantly associated mortality (P <0.001). 5. Endometrial cancer surgery patients have 1 year survival rate of 92.89%, 3 years 85.78%, and 5 year 83.17%. Conclusion This population-based study of endometrial cancer surgery patients showed the increased incidence and medical resource utilization, and patient and hospital attributes are associated with mortality. We also found that the period of hospital stay decreased in these patients. There are various stages of declining mortality rates and distribution, similar to results of studies done in major foreign countries. It showed that local practices are consistent with international medical standards. This study also suggested by that although declined hospitalization for endometrial cancer surgery patients, there is gradual increase in health care costs. It is best to understand that good medical care quality can effectively control medical resource utilization for future planning of medical resources budgets and health policies.