老年人運動行為與醫療資源利用、身心健康狀況關聯性之探討-以NHANES為例

研究目的根據世界衛生組織(WHO)相關報導指出運動量不足是全球死亡主要的風險因素之一，而規律運動能夠降低缺血性心臟疾病、糖尿病、乳腺癌、結腸癌、中風、高血壓及憂鬱症的風險。鑒於全球快速老化，美國頒布「Physical Activity Guidelines for Americans」針對老年人提出每週至少需進行150分鐘中等強度的身體活動，以促進身體健康。本研究主要目的為探討美國老年人運動行為與人口學特性、健康狀態之差異，並進一步探討不同運動行為與醫療資源利用及身心健康狀況之間的關聯性。研究方法本研究為橫斷面研究，使用美國National Health and Nutrition Examination Survey (NHANES)資料庫並選取其2007 -2014年內大於65歲的人進行分析比較並利用Physical Activity欄位將其分為-四組不同運動行為(a)兩種運動皆無、(b)中等強度運動、(c)激烈強度運動、(d)兩種運動皆有;進行探討。並採用卡方檢定及邏輯式迴歸分析來探討老年人不同運動行為對於醫療資源利用[就醫類型、一年內接受醫療照護次數、一年內是否住院]、身心健康狀況[相較一年前健康狀況、一年內有無接受心理治療、睡眠障礙]是否有所影響。研究結果本研究所有樣本人數為5389人，四組不同運動行為人數分布百分比分別為65.49%、28.71%、1.74%、4.06%，邏輯式迴歸分析的結果顯示性別、年齡、種族等人口學變項及健康狀態對醫療資源利用皆統計上具有顯著性的影響；兩種運動行為皆有者接受醫療照護次數超過4次以上是兩種運動行為皆無者的0.6倍(OR=0.641,95%CI:[0.434,0.947])；兩種運動行為皆有者有住院是兩種運動行為皆無的0.5倍(OR=0.531,95%CI[0.348,0.811])；而健康狀況方面，兩種運動皆有者相較一年前健康狀況更好是兩種運動行為皆無者的2.7倍(OR=2.740,95%CI[1.504,4.989])。一年內有無接受心理治療及睡眠障礙兩個變項則統計上不具有顯著性的影響。結論與建議透過本研究結果可得知，不同運動行為對醫療資源利用及健康狀況有顯著性的影響，尤其是兩種運動行為皆有者；而總結以上結論可更進一步提供老年人身體活動建議及衛教政策介入，以提升老年人身體活動層級，並預防疾病的發生及促進身心健康。

關鍵字

NHANES ；老人；運動行為；健康狀況；醫療資源利用

並列摘要

Purpose: World Health Organization (WHO) have reported that lack of physical activity is one of the major risk factors for mortality and regular physical activity can reduce the risk of cardiovascular diseases, diabetes, breast cancer, colon cancer, stroke, high blood pressure and depression. Due to the rapid global aging, United States announces the "Physical Activity Guidelines for Americans" to guide the elderly in physical activity at least 150 minutes a week to make health better. The purpose of this study was to explore the association between different physical activity behavior and medical resource utilization, physical health status and mental health status. Methods:This cross-sectional study was conducted by using the National Health and Nutrition Examination Survey (NHANES) database and selected elder subjects(more than 65 years) from 2007 to 2014 to analyze. 5389 Subjects were divided to four groups according to their intensity physical activity: (a) None physical activity (b) moderate(+) only, (c) vigorous(+) only, (d) moderate(+) and vigorous(+).An unconditional logical regression analysis was used to explore the association between different physical activity behavior and the medical resources utilization, physical health status and mental health status. Results: The distribution of the four different physical activity groups was 65.49%, 28.71%, 1.74% and 4.06% respectively. The results showed that sex, age, race ,and other demographic variables,the health condition and medical resources utilization were significant different among the groups (p<0.001).The odds ratio of receive healthcare in comparing the moderate(+) and vigorous(+) group to the none physical activity group times was 0.6 (OR=0.641, 95%CI:[0.434,0.947]；The odds ratio of overnight hospital patient in comparing the moderate (+) and vigorous (+) group to none physical activity group was 0.5 (OR=0.531, 95%CI [0.348, 0.811]). In terms of better health status, the moderate (+) and vigorous (+) group was 2.7(OR = 2.740, 95% CI [1.504, 4.989]) higher than none physical activity group health. There were no statistically significant effects in seen mental health professional and sleep disorders. Conclusion: This study showed that there were statistically significant better outcome in moderate (+) and vigorous (+) group. The above conclusions can further provide suggestions and policy intervention on the physical activity in elder population to enhance the physical activity level and prevent the occurrence of disease and promote physical and mental health status.