台灣地理區域社經差異與糖尿病患罹病、死亡的關聯性探討

Relationships between Morbidity and Mortality in Diabetes and Socioeconomic Conditions in Taiwan

張順全(Shun-Chuan Chang) ； 賴美淑(Mei-Shu Lai) ； 徐豈庸(Ci-Yong Syu)

《醫護科技學刊》 7卷2期 (2005/04) Pp. 140-148

https://doi.org/10.6563/TJHS.2005.7(2).3

摘要

目標：應用小地理區域分析(small area analysis)方法，探討各地區別國人糖尿病罹患、診治及死亡之狀況，及其與各地理區域社經地位差異之關聯性。方法：利用全民健康保險門診處方治療明細資料檔及住院醫療費用清單資料檔為主，擷取2000年該等檔案糖尿病患資料為基本檔，並串連戶籍檔得到其相關資料，並參考病人用藥資料及數理模式找出糖尿病確定病例。再就病患所在鄉鎮市區都市化程度，分別探討各地區糖尿病相關指標與各地區社經地位之關聯分析，最後完成建立小地理區域社經地位差異與糖尿病罹病、診治及死亡狀況的關聯模式。結果：分為兩大部分：描述探索性結果發現各地區盛行率、死亡率與各地區社經地位差異有關，且依洛倫滋曲線顯示，糖尿病死亡率在各都市化程度分級的分佈不均程度大於盛行率的分佈不均程度。即糖尿病死亡可能較罹病更受到區域社經地位差異的影響；模式驗證性結果證實控制人口變項性別、年齡及盛行率因子後，都市化程度越落後的地區估計參數值越大，即糖尿病死亡相對風險越高。結論：盛行率、死亡率一直被廣泛用來衡量各地理區域醫療照護需求的指標，本研究中，加入各地區糖尿病住院率因子，更進一步發現各地理區域社經地位不同造成健康狀況差異的內涵，確實與各地區醫療可近性和醫療服務利用量的差異息息相關。衛政單位在落實糖尿病全面照護政策之際，應考慮各小地理區域間之差異，才能使醫療資源分配更加合理適切。

關鍵字

糖尿病 ； 死亡率 ； 盛行率 ； 小地理區域分析

並列摘要

Objectives: This study applied small area analysis to examine regional differences for diabetes morbidity, diagnosis, and mortality in Taiwan. It also investigated the association between such health indicators and socioeconomic conditions in different districts in which patients live.
Methods: The database for diabetic patients was selected from two datasets: Outpatient claimed data about detailed treatments from the National Health Insurance (NHI) as well as Inpatient claims data for Year 2000. These datasets were cross-referenced with the residential addresses of diabetic patients. The accuracy of all database for diabetic patients was assessed by previous study [11], and levels of urbanization regions in which patients live were also analyzed. The Results in the development of small area difference analysis for diabetes morbidity, diagnosis and mortality are derived from hierarchical poisson regression.
Results: Lorenz curve results showed that the distributional heterogeneity of each level of urbanization might be dramatically stronger than those of diabetes morbidity level, i.e., the probable effect of the socioeconomic conditions in different districts on diabetes mortality is more obvious than on diabetes morbidity. The regression model further verified that while controlling sex, age, and prevalence factors (morbidity), the estimation of the parameter at less urbanized area is larger than those of developed urban areas, namely, the relative risk of diabetes mortality at less urbanized area is higher.
Conclusion: Morbidity and mortality are useful for evaluating the district's basic medical demands. In addition, diabetes inpatient data from different urbanized areas were adapted to investigate how geographic-based utilization of diabetes inpatients affects its health status. Based on analytical results, we concluded that while implementing diabetes health care measures, we must deliberate the different needs between small areas in Taiwan to ensure that the medical resources allocation can be more rational and feasible.

並列關鍵字

Diabetes mellitus ； mortality ； morbidity ； small area analysis

參考文獻

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