認知功能障礙患者合併尿液中塑化劑暴露醫療資源耗用分析之探討

A Study on Health-Related Quality of Life and Health Care Resource Utilization Among Cognitive Impairment's Patients with Urine of Phthalates

鍾欣伶(Hsin-Ling Chung) ； 鍾蕙如(Hui-Ju Chung) ； 翁世峰(Shi-Feng Weng)

《南臺灣醫學雜誌》 16卷2期 (2020/12) Pp. 82-93

https://doi.org/10.6726/MJST.202012_16(2).0004

摘要

目的：塑化劑（鄰苯二甲酸酯）已被證實在孩童間會影響神經發育，本研究為探討認知功能障礙合併尿液中塑化劑暴露患者之醫療資源使用與相關影響因子。方法：本研究為橫斷面研究，以美國次級資料庫National Health and Nutrition Examination Survey（NHANES）分析2011年至2014年共4年資料，分析60歲以上受試者共計3139人。並將其分為三組：有認知障礙與有塑化劑暴露者共1073人、有認知障礙與無塑化劑暴露者共354人及無認知障礙者共1712人；統計分析使用SPSS 20版軟體，利用卡方檢定、變異數分析與邏輯斯迴歸探討三組的醫療資源利用情形。結果：本研究結果顯示人口學變項及健康狀態對醫療資源利用皆有統計上具有顯著性影響。以醫療資源耗用來看，有認知障礙合併有尿液中鄰苯二甲酸酯暴露者在「過去一年住院有無」為無認知障礙者之1.55倍（95% CI=1.25, 1.94，P＜0.001），在「有無去過急診」是無認知障礙者之2.21倍（95% CI=1.22, 4.02，P=0.009）。結論：認知障礙者於尿液中鄰苯二甲酸酯暴露的有無，在醫療資源耗用中則有其顯著性差異。

關鍵字

認知障礙 ； 塑化劑 ； 醫療資源耗用

並列摘要

Objective: Phthalates have been confirmed that can affect neurodevelopment in children. The purpose of this study is to investigate influencing factors, physical, mental health and usage of medical resources that related to Alzheimer's disease combined with plasticizers in urinary. Methods: This study is a cross-sectional study based on the National Health and Nutrition Examination Survey (NHANES). Between 2011 and 2014, a total of 3,139 people were over age of 60 and divided it into three groups. 1073 people with cognitive impairment and plasticizer exposure, 354 people with cognitive impairment and no plasticizer exposure, and 1712 people without cognitive impairment; statistical analysis using SPSS 20 version software, chi-square test, variance analysis and logistic regression to investigate the medical resources utilization of the three groups. Results: Agraphic variables and health status have statistically significant effects on the utilization of medical resources. In terms of medical resource consumption, those with cognitive impairment and urinary phthalate exposure were 1.55 times (95% CI=1.25, 1.94, P＜0.001) more in ＂required hospitalization in the past year＂ than those without cognitive impairment. 2.21 times (95% CI=1.22, 4.02, P=0.009) in ＂have been or haven't been to emergency department＂. Conclusions: There is a significant significance in the consumption of medical resources between patients who with cognitive impairment combined urinary phthalate exposure or without urinary phthalate exposure.

並列關鍵字

cognitive impairment ； phthalates ； consumption of medical resources