台灣地區退化性關節炎病患接受非類固醇抗發炎藥物之流行病學探討

Epidemiology Analysis of Usage Prescriptions of Non-Steroidal Anti-Inflammatory Drugs of Osteoarthritis Patients in Taiwan

周正修(Cheng-Hsiu Chou) ； 顏銘傭(Ming-Yung Yen) ； 莊惠蓉(Hui-Jung Chuang) ； 廖文評(Wen-Ping Liao) ； 羅慶徽(Ching-Hui Loh) ； 陳永煌(Yeong-Hwang Chen) ； 周稚傑(Chih-Chieh Chou)

《中華職業醫學雜誌》 17卷2期 (2010/04) Pp. 81-91

https://doi.org/10.30027/CJOM.201004.0002

摘要

研究背景：藉著分析全民健保資料之世代追蹤檔，來探討國人退化性關節炎流行病學以及用藥情形，並比較不同年齡層、性別與各層級醫療院所間的差異。 研究方法：本研究是以來自國家衛生研究院所提供之全民健保資料庫，從2000年至2006年的一百萬人系統抽樣檔中，選取具退化性關節炎診斷碼及使用非類固醇抗發炎藥劑之病患作為研究對象，進行在台灣地區之流行病學分析。 研究結果：在所獲得資料中，本研究中退化性關節炎的病患接受非類固醇抗發炎藥劑(Non-Steroidal Anti-Inflammatory Drugs, NSAIDs)之處方數共2，696，438筆，男性占44.4%，女性佔55.6%。在年齡層方面，40歲至64歲年齡層接受NSAIDs處方數最高；然而每次處方之平均NSAIDs藥費及平均每張處方簽天數部分，隨年齡層增加，有上升的趨勢；醫療層級越高，所開立處方之天數越長藥費也越多。藥物分析部分，Arylalkanoic acids 類（如：diclofenac，sulindac等），在各醫院層級別中所使用比率皆為最多，且在不同年份無明顯變化。Coxibs類（如：celecoxib等），使用比例於2004年之前逐年遞增，以醫學中心增加幅度最大，但2005年後處方簽比例驟減。Coxibs藥物的處方數，隨醫院層別上升，其使用比例也增加。 結論：台灣地區退化性關節炎病患在NSAIDs處方上，女性多於男性，65歲以上年齡層接受NSAIDs平均處方之天數最長，平均處方藥費也最高。而由於近年來關於NSAIDs嚴重副作用的研究越來越多，且老年人之共病症情況較多，故醫師在處方前，一定要評估相關疾病的危險性，並應該避免高頻率和高劑量的使用。

關鍵字

全民健保資料庫 ； 非類固醇抗發炎藥劑 ； 退化性關節炎

並列摘要

Purposes: To explore the demographic characteristics and medication patterns of osteoarthritis patients from the sampling cohort data of National Health Insurance in Taiwan. Differences among age groups, genders and contracted categories of healthcare facilities are also analyzed.
Methods: We pooled one million beneficiaries of cohort data, from the year 2000 to 2006, which were released by the National Health Research Institute. Inclusion criteria were patients who had the diagnosis of osteoarthritis by ICD-9 codes and had been prescribed with Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Descriptive analysis was performed to investigate the prescriptions of NSAIDs.
Results: There were 2,696,438 NSAIDs prescriptions and male patients accounted for 44.4%, female, 55.6%. Descriptive analysis demonstrated that the age group of 40-64 was the top user of NSAIDs. However, the older the age group, the longer the prescribed days and the higher the medication cost. Medical centers accounted for the longest prescribed days and the highest mean cost of medicines. Arylalkanoic acids, such as diclofenac and sulindac, were the most often prescribed in all contracted categories of healthcare facilities, and there was no difference from 2000 to 2006. The prescriptions of Coxibs had increased rapidly, especially in medical centers. Nevertheless, the prescriptions had dropped markedly by and after the year 2005. We also found that the higher the academic level of contracted healthcare facilities, the larger proportion of the prescriptions of coxibs.
Conclusions: Medications for osteoarthritis were different among different patients’ genders, ages and contracted category of healthcare facilities. The prescriptions for females were more than those of males. The longer prescribed days and higher prescribed costs were discovered in the oldest age group. However, there is more and more evidence concerning the serious adverse effects of NSAIDs. Since the elderly has many comorbidities, we should evaluate the health conditions of patients thoroughly before prescribing NSAIDs. Also, we should decrease the frequency of use and dosage of NSAIDs.

並列關鍵字

Osteoarthritis ； Non-Steroidal Anti-Inflammatory Drugs ； NSAIDs ； National Health Insurance database