以全民健保資料庫探討臺灣高齡人口第二型糖尿病現況

由於生活及飲食習慣的改變，代謝症候群相關疾病已超越癌症，成為臺灣死因之首，其中的糖尿病對國人健康威脅尤為明顯，也為全民健康保險制度的財務造成沈重負擔。糖尿病的病程漸進、無明顯症狀，盛行率隨年齡增加而上升，以65歲以上人口最為嚴重，且有逐年增長的趨勢，預期糖尿病的醫療及照護需求將隨著人口老化而大幅增加。然而，依據糖尿病衛教學會資料顯示，糖尿病潛伏期較長，不少病人未正視糖尿病造成的影響，導致延誤就醫造成健康、甚至生命的損失，其中國際糖尿病聯盟指出全球糖尿病未確診比例高達46%，臺灣因為有健保成人健檢也有至少25%。有鑑於此，本文分析高齡糖尿病患者之醫療使用，提供政府及保險公司參考，用以制訂公共政策、開發相關保險商品，改善罹病患者的生活品質。本研究以臺灣65歲以上人口為研究對象，探討高齡人口之第二型糖尿病首發率、死亡率及盛行率，並評估這些數值在2005年至2013年的變化趨勢。本文根據全民健保資料庫的2005年百萬老年人抽樣檔，包含承保資料檔(ID)、門診處方及治療明細檔(CD)、住院醫療費用清單明細檔(DD)。另外，為使本文研究更具商業保險的可行性，加入降低道德風險等考量因素，本文參考慢性病連續處方箋，用於判斷第二型糖尿病的首發率。研究發現第二型糖尿病盛行率及首發率皆逐年上升，而且患病後未就醫者高達50%，顯見國人對糖尿病後管理之重視程度略顯不足。在醫療使用率方面，第二型糖尿病患者的醫療使用率高於非糖尿病患者，包含平均門診次數高約10次、平均住院點數高約一萬點等。本文亦探討第二型糖尿病與洗腎之關聯性，發現約有50%的女性新增洗腎患者曾經罹患糖尿病，這部分未來可列入疾病管理及預防。

關鍵字

全民健康保險；人口老化；第二型糖尿病；大數據；醫療利用

並列摘要

Due to the change in life style, the metabolic syndrome related diseases has surpassed cancer and become the leading cause of death in Taiwan. Among all these diseases, diabetes poses a major threat to people’s health, and it also causes a heavy financial burden to Taiwan’s National Health Insurance system. The prevelance rate of diabetes increases with ages, especially serious for the people over 65 years old, and it also increases with time. As a result, it is expected that the diabetes related medical utilization will boost with the aging population. However, according to Taiwanese Association of Diabetes Educators and International Diabetes Federation, many diabetes patients do not know that they have the diasease, which causes people delay their treatment time and loss of health, or even their lives. Thus, we aim to explore the medical utilization of diabetets patients, and provide the study results to Taiwan’s government and insurance companies suggestions to improve the life quality of patients. Our goal is to estimate the incidence rates, mortality rates, and prevalence rates of type II Diabetes in Taiwan. The study is based on the 2005 Taiwan’s Elderly Survey Database, Taiwan’s National Health Insurance Database. The data set includes Registry for beneficiaries (ID), outpatient visits (CD), and inpatient admissions (DD). It should be noted that, in order to avoid moral hazard, the diabetes patients are defined to be those with the chronic prescription. We found that the prevalence rates and incidence rates of type II Diabetes increase with ages and rise with time. About 50% diadetes patients did not visit doctors and this indicates that people need to pay more attention to their health. Also, we found that the medical utilizations of type II diabetes patients is higher than those of non-diabetic patients (e.g., 10 times in the number of outpatient visits) and about 50% of the kidney dialysis patients were also diabetes patients.