糖尿病病人合併憂鬱症或焦慮症長期趨勢、醫療資源耗用與醫療療效之探討

Temporal Trends, Medical Resources Utilization and Medical Outcomes among Diabetic Patients Comorbid Anxiety or Depression

孫金梅(Chin-Mei Sun)

《南臺灣醫學雜誌》 15卷2期 (2019/12) Pp. 87-97

https://doi.org/10.6726/MJST.201912_15(2).0003

摘要

目的：本研究目的為探討糖尿病患者合併憂鬱症或焦慮症之盛行率、醫療資源使用情形、醫療療效與其相關影響因子。方法：本研究採回溯性長期縱貫性世代研究分析之研究設計，以2003年至2013年間的全民健保學術資料庫為研究主體，研究對象選取糖尿病患者，總共為143,127人納入研究。依照研究對象再區分為有合併憂鬱症或焦慮症組樣本數3,396人和無合併憂鬱症與焦慮症組樣本數139,731人，利用線性複回歸以及Cox回歸模式研究其人口特性、臨床特性、醫療機構特性以及時間特性與醫療資源耗用以及醫療療效之相關影響因子。結果：研究結果發現在2013年的盛行率上升為每十萬人口3.17；其中女性2145人（63.2%）高出男性1251（36.8%），平均年齡為58.55±14.01歲。糖尿病病患合併憂鬱症或焦慮症之相關影響因素，不論是在人口學特性、臨床特性、醫療機構特性等皆有達顯著性的相關（P＜0.001）。糖尿病有合併憂鬱症或焦慮症病患發生併發症（高血壓、冠心病及慢性腎臟病）、90天再入院風險相較於無合併合併憂鬱症或焦慮症之病患達顯著性增加（P＜0.001）。結論：本研究期間發現糖尿病合併憂鬱症或焦慮症在醫療資源耗用較無合併憂鬱或焦慮為高。臨床醫護團隊對於糖尿病病患罹患憂鬱症或焦慮症時，應給予適當介入措施，以降低病患長期受憂鬱症或焦慮症等精神疾病所困擾，讓病患獲得更好的醫療照護，以利有效降低醫療資源耗用，進而使病患與家屬有更好的生活品質。

關鍵字

糖尿病 ； 憂鬱症 ； 焦慮症 ； 醫療資源耗用 ； 盛行率

並列摘要

Objective: This study aims to explore the prevalence, use of medical resources, medical efficacy, and other related influence factors of patients with diabetes combined with depressive or anxiety disorder. Methods: This study analyzed the Taiwan National Health Insurance Research Database (NHIRD) to conduct a retrospective longitudinal study from Longitudinal Health Insurance Database (LHID) 2003 to 2013. The patients were further separated into 3,396 diabetic patients with depressive and anxiety disorder and 139,731 diabetic patients without depressive and anxiety disorder. Using linear regression and Cox regression, we analyzed related impact factors including demographic characteristics, clinical features, characteristics of medical institutions, time characteristics, the consumption of medical resources, and medical efficacy. Results: Results of this study, showed the prevalence in 2013 increased to 3.17 every one hundred thousand people, the number of female patients were 2,145 (63.2%), and were higher than the male patients 1,251(36.8%).The average age was 58.55±14.01. All the influencing factors such as demographic characteristic, clinical features, and characteristics of medical institutions, reached significant correlation (P＜0.001). The utilization of medical resources of diabetic patients with depressive or anxiety disorder , such as clinic visits, clinic fee, days of hospitalization, hospitalization fee, and total medical fee all reached significant difference (P＜0.001). The likelihood for complications such as hypertension, coronary heart disease, and chronic kidney disease to occur in diabetes patients with depressive and anxiety disorder and risk of rehospitalization within 90 days shows a significant increase (P＜0.001) compared with diabetes patients without depressive or anxiety disorder. Conclusions: This study has discovered that diabetic patients with depressive and anxiety disorder consume more medical resources than patients with diabetes without depressive and anxiety disorder. Therefore, clinical health care teams should provide earlier more intervention measures to diabetic patients with depressive or anxiety disorder to decrease the burden of long-term mental issues such as depressive or anxiety disorder, and provided better medical care to lower the consumption of medical resources and furthermore promote better quality of life for patients and family.

並列關鍵字

diabetes ； depressive ； anxiety disorders ； medical resource utilization ； prevalence rate