社區婦女下泌尿道症狀之自然病史及臺灣婦女骨盆機能障礙手術治療費用之研究

The natural history of lower urinary tract symptoms in community dwelling women and the inpatient surgical utilization of pelvic floor dysfunction in Taiwanese women

黃淑君(Soo-Cheen Ng)

指導教授 ： 陳進典

中山醫學大學/醫學院/醫學研究所/博士(2020年)

https://doi.org/10.6834/CSMU202000019

摘要

中文摘要
研究目的：(一) 針對臺中市區域之40歲以上社區民衆進行整合性骨盆底功能障礙症狀的盛行率(prevalence)的统計，並前瞻性的研究這些症狀的發生率(incidence)、緩解率(remission)和症狀持續率( symptoms persistence) 和症狀復發率( relapse)，為期三年的研究。亦評估這些下泌尿道症狀發生的危險因子。(二)利用全民健康保險研究資料庫，研究因骨盆底機能障礙而住院接受手術的人數和直接支出，並比較年齡上的差異。
研究方法：(一)從2012年一月至2012年12月，臺中市西區、南區40歲以上的社區民眾被邀請參與此為期三年的研究。本研究利用SF-36問卷調查社區民眾的健康狀況，OABSS和UDI-6問卷評估下泌尿道症狀，IIQ-7問卷則用來評估下泌尿道症狀對生活品質的影響。
(二) 利用全民健保研究資料庫從1999年到2011年的資料，統計在這13年，病人因尿失禁和骨盆器官脫垂而接受手術的人數和直接支出，並將年齡分層為小於65歲和大於等於65歲來進一步分析。
研究結果：(一)共有2411位40歲以上社區民眾，包括1469位女性(60.9%) 和942位男性，完成第一年的問卷的填寫。這些女性社區民眾中，21.1%有膀胱過動症，46.7%有應力性尿失禁，26.8%有急迫性尿失禁，28.3%有排尿困難的現象。有1290 (87.8%)社區婦女完成所有三年的問卷填寫，針對膀胱過動症的自然病史，第二年和第三年的盛行率為13.5% 和7.1%，緩解率為39.6% 和44.3%，而兩年症狀持續率為43.8%。年齡大於等於60歲是社區婦女持續有膀胱過動症的危險因子。
(二)從1999年到2011年，住院病人的數目從5278增加到6706，增加了27%。直接總支出(手術和住院費用) 增加了57%。然而如果比較小於65歲和大於等於65歲病人的直接總支出，會發現大於等於65歲病人的總支出增加了102.2%，而小於65歲病人的總支出只增加了38.3%。
結論：本研究發現40歲以上社區婦女罹患骨盆底功能障礙症狀(膀胱過動、排尿困难等)的盛行率相當高。老化(年齡大於等於60歲) 是膀胱過動症和排尿困難的共同危險因子。此外，本研究亦發現，骨盆機能障礙住院總支出的增加，主要的因素是大於等於65歲骨盆器官脫垂病人的使用率逐年攀升的關係。本研究提供重要的訊息，因為高齡人口在台灣不斷的成長，且在未來的10至20年將增加醫療的支出和負擔。所以瞭解40歲以上社區民眾下泌尿道症状的盛行率，可以為將來先製訂更好的醫療政策及改善醫療照顧。

關鍵詞: 骨盆機能障礙、盛行率、自然病史、年長婦女、醫療支出

關鍵字

骨盆機能障礙 ； 盛行率 ； 自然病史 ； 年長婦女 ； 醫療支出

並列摘要

Abstract
Objective：(i) The aim of this study is to evaluate the prevalence, the natural history including incidence, remission, persistence and relapse of lower urinary tract symptoms and identify its risk factors in community-dwelling women aged 40 years and above in central Taiwan.
(ii) we also evaluate the trends in the number of inpatient surgical procedures and health expenditures for pelvic floor dysfunction under the universal coverage of National Health Insurance (NHI) in Taiwan. We compared the difference between age cohort.
Methods and Materials：(i) From January 2012 to December 2012, community residents aged 40 years and above, live in the west and south area of central Taiwan were invited to participate in this three-year longitudinal cohort study. The SF-36 questionnaire was used to evaluate general health status, OABSS and UDI-6 for subjective perception of LUTS and IIQ-7 for impact of QoL.
(ii) Thirteen years of population-based NHI inpatient claims in Taiwan were used in this study from 1999 to 2011. The number of surgical procedures and average direct cost of inpatient fees for treating urinary incontinence and pelvic organ prolapse of each patient was calculated. Patient age was stratified as less than 65 years and 65 years or older for comparison.
Results：(i) A total of 2,411 community residents were recruited, of which 1469 (60.9%) were women and 942 (39.1%) were men. For the female residents, prevalence of stress urinary incontinence was 46.7%, urge urinary incontinence was 26.8%, overactive bladder was 21.1%, and voiding difficulty was 28.3%. There were 1290 (87.8%) female residents completed all the 3 years questionnaires. Regarding the natural history of overactive bladder, the second- and third-year incidence rates were 13.5% and 7.1%. The remission rates were 39.6% and 44.3%. and the two-year OAB persistence rate was 43.8%. Age≧60 was the only risk factor associated with persistent overactive bladder.
(ii) The number of inpatients for pelvic floor dysfunction increased 27%, from 5278 in 1999 to 6706 in 2011. The total direct cost of inpatient (surgical and admission) fees increased 57.2%. However, the expenditures for women 65 years or older increased 102.2% from 1999 to 2011but there was only a 38.3% increase in for those less than 65 years when we stratified by age.
Conclusion： Our study revealed that the prevalence of lower urinary tract symptoms in female community residents aged ≧ 40 years in central Taiwan are high. Aging (age≧60) is a common risk factor for these symptoms especially overactive bladder and voiding difficulty . Our study also revealed that the increasing expenditure on inpatient surgery for pelvic floor dysfunction is mainly due to the escalating utilization of inpatient surgical procedures in women aged 65 or older. Our study provides important information because the elderly population in Taiwan is growing. The aging society may cause increasing health care and financial burdens within the next 10 to 20 years. These results may provide important information for policymakers in Taiwan to pay attention to the impact of pelvic floor dysfunction in elderly women on health care costs in the future and aid in improve health care policies and intervention strategies in the future.

Key words: pelvic floor dysfunction, prevalence, natural history, elderly, medical expenditure

並列關鍵字

pelvic floor dysfunction ； prevalence ； natural history ； elderly ； medical expenditure

參考文獻

參考文獻

Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U et al. The standardization of terminology of lower urinary tract function: Report from the standardization sub-committee of the International Continence Society. Neurourol Urodyn 2002;21:167-178

Abrams P, Cardozo L, Fall M, et al. The standardization of terminology in lower urinary tract function: report from the standardization subcommittee of the International Continence Society Urology 2003; 61:37-49

Bump RC, Mattiasson A, Bo K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 1996; 175 (1): 10-17.

Berecki-Gisolf J, Begum N, Dobson AJ. Symptoms reported by women in midlife: menopausal transition or aging? Menopause 2009; 16: 1021-1029.