Survival Analysis of Living Arrangements and Health Care Utilization in Terms of Total Mortality among the Middle Aged and Elderly in Taiwan

台灣中老年人居住型態安排和醫療照顧使用與全死因死亡率之存活分析

何淑熙(Shu-Hsi Ho)

《The Journal of Nursing Research》 16卷2期 (2008/06) Pp. 160-168

摘要

本研究主要目的是利用存活分析來探討台灣地區中老年人居住型態的安排和醫療照顧的使用對其死亡率的影響。並運用長期追蹤資料來研究，而資料來源是取自於「台灣地區中老年人保健與居住狀況調查」，以1996年50歲（含）以上、2,462位的受訪者為分析對象，配合1996到2003年間相同受訪者的官方死亡紀錄，設定觀察期間；並以Cox風險比例模型作實證分析。實證結果顯示，在其他外生變數固定下，較年輕的老人有較高的存活率；女性較男性長壽。此外，假設不考慮其他變項，本研究更提出：在居住型態的安排上，和配偶與孩子同住的中老年人，顯著的較獨居老人更能頤養天年；在醫療照顧的使用上，常買中藥或西藥品的中老年人顯著的有較高的存活率；但是，住院天數或看病次數多者卻有較低的存活率。故本研究結果支持居住型態的安排和醫療照顧的使用，會顯著的影響台灣地區中老年人的死亡率。此結論將有助於未來福利機構在協助中老年人居住安排及醫療資源運用等各項措施時的依據。

關鍵字

Cox風險比例模型 ； 存活率 ； 死亡率

並列摘要

The purpose of this study was to use survival analysis to examine the influence of living arrangements and health care utilizations on total mortality among the middle aged and elderly in Taiwan. A panel data design was applied to data to investigate whether living arrangements and health care utilizations were associated significantly to survival rates in the middle aged and elderly. Subject data was obtained from the Survey of Health and Living Status of the Middle Aged and Elderly in Taiwan, a study conducted in 1996 that encompassed observations on 2,462 individuals 50 years of age and older. Survey data was linked to 1996 2003 national death registry data. A Cox proportional hazard model was used to determine the relationship between mortality rate and age, gender, living arrangements and health care conditions. Principal empirical results confirmed that, after controlling for potentially confounding variables, the relatively younger elderly had a higher survival rate during the period 1996 to 2003. Females also had a longer life span than males in the same period. In addition, when other factors were excluded, this paper highlights that the middle aged and elderly living with their spouse and children enjoyed a significantly higher survival rate than those who lived alone. Furthermore, the findings showed that purchase of medicine (Chinese and/or Western) was positively correlated with survival rate and a lower survival rate for those with longer hospital stays and higher numbers of clinic visits. Findings suggest that living arrangements and health care utilization variables have strong and significant influences on the mortality rates for the middle aged and elderly. Research results should be useful in developing welfare strategies targeting living arrangement and health care services for the target group.

並列關鍵字

Cox proportional hazard model ； survival ； mortality

參考文獻

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Population projections for Taiwan area 2006-2051

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