台灣慢性腎臟疾病患者盛行率與醫療利用分析-以健保資料庫為例

Prevalence and Health Service Utilization of Chronic Kidney Disease in Taiwan - A Population-based Study

蔡秉諺(Ping-Yen Tsai)

指導教授 ： 李顯章

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2010年)

https://doi.org/10.6831/TMU.2010.00013

摘要

背景：末期腎臟疾(ESRD)病每年消耗健保338億台幣，對健保制度造成嚴重的衝擊，然而我國對末期腎臟疾病前期的慢性腎臟疾病(CKD)的盛行率仍然不甚清楚。
目的：推估台灣地區慢性腎臟疾病盛行率，並且推估若慢性腎臟疾病惡化成末期腎臟疾病造成的醫療利用變化。
方法：運用國家衛生研究院發行之全民健康保險資料庫，並利用可能成為末期腎臟疾病之慢性腎臟疾病診斷碼，以一年內發生兩次以上就診記錄且兩次間隔在3個月以上做為判斷條件，做為本研究之樣本，推估2001年~2005年慢性腎臟疾病在台灣地區的盛行率，並計算其醫療利用率。採用SAS 9.1.3統計軟體進行資料分析，統計方法包括獨立t檢定、變異數分析、邏輯斯迴歸、卜瓦松迴規及複迴歸等。
結果：在盛行率方面，2005年全人口標準化盛行率為每十萬人口1,717.9人，女性盛行率為每十萬人口1,889.2人、男性盛行率為每十萬人口1,550.3；男女性比為1.22；在醫療利用率上，經扣除精神科利用及意外事故門診費用後，慢性腎臟疾病患者男性每人每年平均花費56,905元、女性每人每年平均花費56,220元，，若進入長期透析則每人每年花費較未進入長期透析者增加619,760元，在平均門診就診次數上，男性32.73次、女性34.91次；再扣除透析利用費用後，男性每人每年平均花費36,985元、女性每人每年平均花費39,346元；非透析利用門診次數男性32.33次、女性34.46次，在總門診費用的複迴歸中，以經常利用醫院的層級別高者、及有共病者的花費較高；在總門診次數的複迴歸中，以性別、年齡、就醫區域、低收入者、經常利用醫院的教學別、經常利用醫院的層級別及有共病者的就診次數較高；在門診非透析利用的複迴歸中，以經常利用醫院的層級別、有共病者的費用較高；其次，在住院的比較上、性別、年齡、就醫區域、低收入者、經常利用醫院層級別、及有共病者的住院機會較高，在加護病房的入住機率中，年齡、經常利用醫院的權屬、有多重共病因子較高。
結論：國內慢性腎藏疾病的盛行率呈現升高趨勢，男性及老年人口盛行率更高，長期利用透析服務者，其總體醫療利用將大幅提高，建議主管機關應重視腎臟疾病。

關鍵字

慢性腎臟疾病 ； 末期醫腎臟疾病 ； 醫療利用 ； 盛行率

並列摘要

Background:End-Stage Renal Disease (ESRD) consumes TWD33.8 billion in health insurance each year; it leads to a serious impact on the health insurance system. However, the prevalence rate of chronic kidney disease (CKD) on early ESRD is still unclear in Taiwan.
Objectives:The current study aims to analyze the CKD prevalence rate between 2001 to 2005 in Taiwan and calculate its medical utilization.
Methods:Using the National Health Insurance Database published by National Health Research Institute, ESRD candidates extracted from CKD diagnosis code were collected as the study samples; the candidates must have at least two clinical visit records within a year, and the gap between the two visits must be three months or longer. Statistical Analysis Software (SAS) Version 9.1 was used for data analysis. The statistical methods included t-test, Chi-square test, ANOVA, chronological trend through Poisson regression, and logistic regression.
Results:Regarding the prevalence rate, the standardized prevalence rate was 1,717.9 per 100 thousand total population in 2005, 1,889.2 per 100 thousand females, and 1,550.3 per 100 thousand males; the male to female ratio was 1.22. Regarding medical utilization, after eliminating psychiatric and accidental event utilization, each CKD male patient spent TWD56,905 per year on average and each CKD female patient spent TWD56,220 per year on average. If long term dialysis is required, an additional TWD619,760 would be spent on each patient per year, as compared to those who did not require long term dialysis. Regarding average outpatient visit frequency, the results show 32.73 per male patient and 34.91 per female patient. After eliminating the dialysis utilization, each male spent TWD36,985 per year on average, each female spent TWD39,346 per year on average. The frequency of outpatient visits for non-dialysis utilization was 32.33 per male patient and 34.46 per female patient on average. In regression analysis of the total outpatient cost, higher outcomes were observed on frequent use higher accredited level and patients with disease complications; in regression analysis of the total outpatient frequency, higher outcomes were observed on gender, age, clinic visit location, patients with low income, frequent use hospital teaching status, frequent use hospital accredited level and patients with combined diseases; in regression analysis of non-dialysis outpatient clinics, higher outcomes were observed on the frequent use hospital accredited level and patients with combined diseases; furthermore, regarding hospitalization opportunities, higher outcomes were observed on gender, age, clinic visit location, patients with low income, frequent use hospital accredited level and patients with combined diseases; for ICU ward hospitalization opportunities, higher outcomes were observed on age, frequent use hospital ownership and patients with combined diseases.
Conclusions:An increasing trend is observed on the prevalence rate of CKD in Taiwan; it is even higher in males and older populations, and long term dialysis users, which greatly increases the total medical utilization. Authoritative organizations are recommended to pay more attention to CKD.

並列關鍵字

chronic kidney disease(CKD) ； End-Stage Renal Disease(ESRD) ； Health Service Utilization ； Prevalence

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