青少女所生嬰兒(六個月大)對醫療利用率之相關探討 ----台灣出生世代研究結果

Medical utilization of 6-month-old infants born to adolescent mothers – Results of the Taiwan birth cohort study

羅斤汎(Jin-Fan Luo)

指導教授 ： 李孟智

中山醫學大學/醫學院/醫學研究所/碩士(2013年)

https://doi.org/10.6834/CSMU.2013.00005

摘要

背景： 青少女懷孕衍生出許多社會、公衛議題，近年來除重視青少女本身，更關心其所生子女的健康，而醫療利用率亦可作為評估指標。
目的：
本研究欲了解青少女懷孕所生之子女是否較易有不健康的生產結果以及是否因為母親本身特質、小孩出生結果及養育行為的不同，對6 個月嬰兒的醫療利用率造成影響及兩組嬰兒疫苗接種情況。
研究設計：
本研究的資料來源為「台灣出生世代研究(Taiwan Birth Cohort Study,簡稱TBCS) 」中，2005 年7 月1 日到2006 年6 月30日所收集的嬰兒出生及六個月的資料。排除先天性缺陷、人工生殖科技及多胞胎的嬰兒，出生結果資料完整的青少女母親組（＜20 歲）共818 位，成年組母親（20-34 歲）共16996 位符合收案的條件，資料以SPSS PC 18.0 統計軟體進行統計，統計方法含次數、百分比、平均值±標準差進行描述性統計，t 檢定、X2檢定進行雙變項分析，並使用羅吉斯迴歸或多層次羅吉斯迴歸，分析影響門診、急診及住院的相關預測因子。
結果：
青少女母親所生嬰兒於六個月大時門診就醫比率顯著高於成年母親，
但於急診與住院無顯著差異。疫苗接種部分，兩組接種率均達98％以上，但於B型肝炎免疫球蛋白、小兒麻痺疫苗（口服或注射）、白喉百日咳破傷風混合疫苗、Ｂ型嗜血桿菌疫苗(自費) ，青少年母親所生小孩的接種率顯著較低。於醫療利用率的單變項分析中，發現對青少女母親而言，母親教育程度高中以上的小孩，門診就醫風險顯著增加；成年母親組中，本國籍母親及白天由父母親照顧者，急診就醫風險顯著增加。比較兩組6 個月小孩醫療利用率，經調整母親、小孩及養育因素之後，於多層次羅吉斯回歸分析發現：母親年齡愈小且夜間由父母親照顧的小孩，門診及急診就醫的風險顯著較高。
結論：
青少女懷孕有較高比率發生早產及低出生體重，經調整母親、小孩及養育因素後，母親年齡小、懷孕時有喝酒、低產檢次數、第一胎及夜間由父母親照顧的小孩門診就醫風險顯著較高。另外母親年齡小、懷孕時有抽煙、本國籍、早產、男性胎兒及夜間由父母親照顧的小孩急診就醫風險顯著較高。住院則以母親年齡小、低教育程度、男性胎兒、早就產、第一胎及夜間由父母親照顧的小孩，住院風險顯著較高。瞭解青少女生育的結果及各種因素對6 個月小孩醫療利用率的影響，以期能提供醫療及公共衛生政策的參考。

關鍵字

出生世代 ； 出生結果 ； 醫療利用率 ； 母親因素 ； 小孩因素 ； 養育因素

並列摘要

Adolescent pregnancy is known to cause serious consequences for the health of the girl and her infant, and is a challenge that the public health and society must face. Important information regarding the health of the adolescent mother and her child can be revealed by analyzing their medical utilization rate.
Objective:
This study aims to investigate whether the birth outcome of adolescent pregnancy is less positive than that of adult pregnancy. It also explores the differences in maternal health, birth outcome, and parenting education between the adolescent and the adult mothers, and its effects on the medical utilization and immunization rate of their six-months-old baby.
Research design:
Data of the newborn and six-months-old baby was derived from the questionnaire interviews of Taiwan Birth Cohort Study (TBCS), from July 1st 2005 to June 30th 2006. Eight hundred eighteen adolescent mothers (younger than 20 years old) and 16,996 adult mothers (between 20 to 34 years old) with complete birth information were included for study. Data was analyzed using SPSS PC for Windows v.18.0. Percentage, mean, standard deviation, x2 test, logistic regression and multiple levels logistic regression were used in this study.
Results:
Six-month-old babies of adolescent mothers had higher outpatient visit rate when compared to babies of adult mothers. The immunization rates of babies exceeded 98 percent. However, hepatitis B immune globulin, oral polio vaccine, inactivated polio vaccine, diphtheria and tetanus toxoid with pertussis vaccine, and haemophilus influenzae type B vaccine (self-paid) immunization rate were significantly lower among the babies of adolescent mothers. The medical utilization rates for the six-month-old children of adolescent and adult mothers were considerably different. The potential factors involved in these differences might include: 1) maternal influences, 2) infancy factors, and 3) parenting factors. In multiple levels logistic regression, after adjusting for covariates, babies of younger mothers and those cared by biological parents at night had higher risk of outpatient and emergency service use.
Conclusion:
Adolescent pregnancy results in more premature birth and low birth weight. After adjusting for covariates in the multiple variable model, outpatient service utilization rate was higher for the babies of mothers who were younger, who drank during pregnancy, who received fewer prenatal examinations, who were their first birth, who baby cared at night personally. Emergency service utilization rate was higher for the babies of mothers who were younger, who smoked during pregnancy, who gave premature birth, who baby cared at night personally, which had Taiwanese nationality, whose baby was male. Hospitalization rate was higher for the babies of mothers who were younger, who had lower educational level, who gave premature birth, who were their first birth, who baby cared at night personally, whose baby was male. The birth outcomes of adolescent mothers and factors resulting in higher health utilization rate of babies may assist in future medical service and public health planning.

並列關鍵字

Birth cohort ； birth outcomes ； medical utilization rate ； maternal factors ； infancy factors ； parenting factors.

參考文獻

王秀紅、楊詠梅(2002)。東南亞跨國婚姻婦女的健康。護理雜誌，

王煥琛（1998）。青少年性的發展與輔導研討。台灣教育，566，14-23。

王瑞霞（1999）。正視未婚少女懷孕問題•台灣醫學，3(3)，338 - 341。

王瑞霞（2000）。青少年性健康促進。護理雜誌，47（1），26~31。

江東亮主編（2010）。台灣嬰幼兒健康圖像．台北：行政院衛生署國