以全民健康保險資料庫研究肺結核病與慢性非傳染性疾病之長期交互作用

由於抗生素藥物的進步，慢性非傳染性疾病已逐漸取代傳染病成為全球各地的主要死因。由於慢性疾病的本質上緩慢進展的特性使然，慢性非傳染性疾病和其相關的治療可以和傳染病產生長期的複雜的交互作用。若欲研究此交互作用，需要觀察很大的母群體，進行長時間的追蹤，受限於研究資源而不可行。以全球性的觀點切入，肺結核病是所有的傳染性疾病中造成最多死亡的重要疾病，在台灣也是重要的公衛議題。台灣的全民健保是強制性的社會健康保險，納入全國超過96%的人口，自1996年實施以來，全面性的涵蓋所有的醫療照護。全民健保研究資料庫包含了全民健保歷年來所累積的健康資訊，經國家衛生研究院匯整後發行，非常適合用來研究慢性疾病間的交互作用。但是全民健保研究資料庫僅包含診斷碼和記帳資料，要在此資料庫中標定特定疾病診斷，需要特殊的方法以增加診斷的特異性和敏感性。本計劃建立了一個研究平台，可以提供臨床專家和資訊科技專家共同合作並有效率的溝通，我們應用此研究平台開發出臨床上重要的慢性疾病如慢性阻塞性肺病、糖尿病、肺結核以及相關共病的標定條件，並客觀量化相關的治療，進行時間相依的統計分析。我們使用本研究平台，分析肺結核及其治療如何影響慢性阻塞性肺病的風險、慢性阻塞性肺病的治療藥物、以及糖尿病治療的醫囑遵從性對感染肺結核風險的影響，結果有重要的臨床發現，顯示本研究平台有很好的前曕性和效益。未來我們將再結合更多臨床領域的專家，擴展研究的範疇，進一步分析例如結核病復發的風險、公衛政策的效益評估、以及臨床工作人員院內曝觸結核感染等議題，使健保健康資訊的應用達到更大的研究效益。

關鍵字

肺結核；慢性阻塞性肺病；糖尿病；臺灣全民健保資料庫

並列摘要

Chronic noncommunicable diseases (CNDs) have become the major cause of death and disabilities worldwide. Because of the nature course of these slowly progressing CNDs, the long-term interaction between the CNDs, their associated treatment and communicable disease (CDs) is complex. It requires large cohort with very long period of follow-up to investigate these interaction. Among the CDs, the pulmonary tuberculosis (TB) is the leading cause of death worldwide and also an important issue in public health in Taiwan. The National Health Insurance (NHI) is a mandatory nationwide health insurance program, offering comprehensive medical care coverage to more than 96% of Taiwanese residents since 1996. The NHI research database (NHIRD) provides a nationwide population suitable for such studies. However, the NHIRD contains only claim data and requires special approach to define the diagnoses of CNDs when compared with classical cohort study. We established a study platform using NHIRD and developed comprehensive diagnostic criteria for pulmonary TB and important CNDs such as chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM) and other co-morbidities. The investigation on the long-term interaction between the pulmonary TB, DM, and COPD showed promising results. Future works to extend the scope of the present study platform to address the issues such as TB recurrence, efficacy of public health policy, and nosocomial hazard for health care workers will be done.

並列關鍵字

pulmonary tuberculosis ； chronic obstructive pulmonary disease ； diabetes mellitus ； Taiwan National Health Insurance Research Database

參考文獻

53. Luh K-T. Taiwan Guidelines for Tb Diagnosis and Treatment. 4th ed. Taipei, Taiwan: Centers for Disease Control, R.O.C. (Taiwan), 2011.

Boutayeb A. The Double Burden of Communicable and Non-Communicable Diseases in Developing Countries. Trans R Soc Trop Med Hyg 2006; 100:191-9.

2. Sorensen JB, Demaio A, Ostergaard LR, Nielsen KK, Bygbjerg IB, De Courten M. Non-Communicable Diseases: Harnessing the Current Opportunities. Scand J Public Health 2012; 40:579-81.

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以全民健康保險資料庫研究肺結核病與慢性非傳染性疾病之長期交互作用

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