台灣智能障礙者罹患食道疾病之影響因素

智能障礙是一種終身的身心障礙，因先天健康不平等，導致他們帶給家庭、社會及整個醫療體系巨大的負擔。許多研究指出，智能障礙者在口腔疾病、感官方面疾病、營養方面疾病、甲狀腺疾病、精神疾病、癲癇、逆流性食道炎、骨質疏鬆症等都有較高的罹病率。食道疾病是智能障礙者常見的疾病之一，但其病情卻很常被低估，逆流食道炎的發生率，一般正常人為2%，若對象為智能障礙者則提高至10%。目前國內缺乏利用全國代表性的樣本探討智能障礙者罹患食道疾病的研究。本研究採用次級資料，利用國衛院2004-2007年健保資料庫中門診處方及治療明細檔（CD）、門診處方醫令明細檔（OO）、醫事機構基本資料檔（HOSB）、承保資料檔（ID）、ATC藥品分類檔探討人口特性與誘發因素對於智能障礙罹患食道疾病之風險。結果：台灣地區智能障礙罹患食道疾病的盛行率為1.6%，其平均年齡為42.8歲，有83.6%的個案有服用抗癲癇或鎮靜劑藥物；智障程度為極重度者、年齡越高、有重大傷病、有服用抗癲癇或鎮靜劑藥物者罹患食道疾病之風險較高。伴隨人口老化、平均餘命之延長，未來於策劃智能障礙者健康促進照護計畫時應有全方位之考量，以提升智能障礙者之健康照護品質。

關鍵字

智能障礙；食道疾病；健康不平等；醫療利用

並列摘要

Intellectual disabilities are a type of lifelong disabilities. Patients' mental handicap will cause the insufficiencies of their cognition and self-care ability, resulting in being in vulnerable position in society. Also, due to the innate health disparity, they bring a huge burden to their families, the society and the entire health care system. Gastroesophageal reflux disease (GERD) is clinically a disease often seen in patients with Intellectual disabilities, but its severity is usually underestimated. Factors inducing the disease include scoliosis, cerebral palsy, and taking anti-epileptic drugs or sedatives like benzodiazepines. If not treated, GERD will probably lead to serious complications, such as asthma, chronic cough, lung fibrosis and esophageal adenocarcinoma. This research used the health insurance database of National Health Research Institutes from 2004 to 2007, to explore the risk of causing esophageal diseases by demographic characteristics and inducement factors, and further analyze the medical utilization trend of the outpatient services for patients with both intellectual disabilities and esophageal diseases. The results indicated that in 2007, there were 1,684 patients with intellectual disabilities having esophageal diseases. The prevalence was 1.6%. Patients with profound intellectual disabilities, older, Catastrophic Illness, and taking anti-epileptic drugs or sedatives had a higher risk of getting esophageal diseases. The average annual medical cost of patients with both intellectual disabilities and esophageal diseases was NT$ 2,767, and the frequency that each of them went to the doctor was averagely 2.6 times a year. As the population age and life expectancy extends, there should be comprehensive consideration in planning the health promotion care project for patients with intellectual disabilities in the future. We suggest that decision-makers receive educations and trainings for related professions, and conduct esophageal disease screening to high-risk groups; caregivers should have cognition to esophageal diseases, and more importantly, inform medical units of patients' actual conditions, to promote the health care quality of patients with intellectual disabilities.