從文獻回顧探究職業傷病監測系統的低報與選擇性偏誤

Under-reporting and Selection Bias in Occupational Injury and Illness Surveillance System, A Literature review

陳秉暉(Ping-Hui Chen)

指導教授 ： 陳保中

國立臺灣大學/公共衛生學院/職業醫學與工業衛生研究所/碩士(2019年)

https://doi.org/10.6342/NTU201900609

摘要

中文摘要
研究背景：職業傷病的低報與伴隨而來的選擇性偏誤，始終是一個艱難的挑戰，許多國家都因此使用各種通報機制從不同資料來源取得可信的資料。雖然過去的研究曾經討論個別通報機制的運作、通報機制的分類或職業傷病的低報來源，但沒有已知的研究曾經系統性地討論不同種類通報機制中職業傷病的低報來源，以及這些通報機制如何交互作用並共同建構一個理想的職業傷病監測系統。
研究方法：包含臺灣、日本、韓國、新加坡、澳洲、美國、英國、德國和法國的九個國家被選為研究對象，根據可搜尋到的網路資料，我們將這幾個國家運作中的通報機制辨識出來，之後將這些通報機制進行分類，並根據Webb所提出的濾篩模型(Filter model)，將這些通報機制拆解為五種濾篩，後續的討論就著重在這五種濾篩如何在各種通報機制中導致職業傷病的低報與選擇性偏誤，以及這九個國家如何克服這些濾篩。
結果與討論：我們辨識出17個通報機制，包含7個補償為基礎的通報機制、6個職業安全法為基礎的通報機制與4個醫療行為為基礎的通報機制，且超過半數的國家，9個國家中有6個，有超過兩種以上的通報機制。
在各種通報機制中，這五種濾篩有不同的濾篩效果，且各國都有許多可以解決低報的有效手段，並有職業傷病統計資料跨國或跨年的比較可以驗證其效果。尤其那些職業傷病發生率較高、可合理解釋為較少低報問題的歐洲國家，他們克服低報問題並得到精確統計資料的方法，無疑十分值得學習，特別是對於職業傷病發生率最低的亞洲國家來說。
結論：共有三種通報機制，包含補償為基礎、職業安全法為基礎和醫療行為為基礎的通報制度，且各種機制都有其自身的濾篩，與因能涵蓋不同職業傷病而在職業傷病監測系統中不可取代的腳色。對於主管機關來說，要建構一個理想的職業傷病監測系統，建置其他運作良好的補充性通報機制，和克服個別通報機制的濾篩同等重要；而對於研究者來說，在使用通報機制的統計資料前，須熟悉此通報機制能涵蓋的職業傷病類型，且若要取得一個較完整的職業傷病圖像，彙整不只一個通報機制的統計資料很可能是必要的。

關鍵字

職業傷病 ； 監測 ； 通報

並列摘要

Introduction: Under-reporting of occupational injury and illness(OII) and accompanied selection bias have always been a difficult challenge, and each country has come up with various reporting mechanisms to obtain reliable data from different sources. Although operation of individual reporting mechanism, categorization of reporting mechanisms and sources of under-reporting have been discussed by previous studies, no searchable study has systematically discussed sources of under-reporting in different types of reporting mechanisms and how these reporting mechanisms interact and all together construct an ideal OII surveillance system.
Methods: Nine countries, including Taiwan, Japan, Korea, Singapore, Australia, the United States(US), the United Kingdom(UK), Germany, and France, were chosen as study targets. Based on searchable online information, we identified all active reporting mechanisms among these countries. We then carried out categorization of reporting mechanism and broke it down into five types of filters, according to modified filter model of Webb et al. Discussion is then focused on how these five types of filters lead to under-reporting and accompanied selection bias in each type of reporting mechanism and how these nine countries overcome them.
Results: 17 reporting mechanisms, including 7 compensation-based reporting mechanisms (CBRM), 6 OSH-Act-based reporting mechanism (OBRM), and 4 medical-practice-based reporting mechanisms (MBRM), are identified, and over half countries, six of nine, have more than two types of reporting mechanism.
Five types of filters have different filtering effects in each type of reporting mechanism, and there are many effective practices to overcome under-reporting, supported by temporal or international comparison of yearly statistics on OII. While European countries have much higher incidence rate of OII, which is more reasonably explained by less under-reporting, how do they get accurate statistics and overcome under-reporting is worth learning, especially for Eastern Asian countries with lowest incidence.
Conclusions: There are three types of reporting mechanism, CBRM, OBRM, and MBRM, and each has its own filters and irreplaceable role in OII surveillance system due to different coverage of OII. For authorities concerned, to construct an ideal surveillance system, establishing other well-functioned complementary reporting mechanisms is as important as enhancing permeability of each reporting mechanism’s filters. For researchers, it is important to get familiar with OII coverage of certain reporting mechanism before utilization of its reported statistics, and pooling data from more than one reporting mechanisms may be necessary for a more comprehensive picture.

並列關鍵字

Occupational injury and illness ； Surveillance ； Reporting

參考文獻

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