臺灣1997年至2010年動物叮咬傷研究

Animal bite and sting injuries in Taiwan, 1997-2010

丁瑞昇(Ruei-Sheng Ding)

指導教授 ： 蔡行瀚

共同指導教授 ： 白璐

臺北醫學大學/公共衛生暨營養學院/傷害防治學研究所/碩士(2014年)

https://doi.org/10.6831/TMU.2014.2014.00116

摘要

前言：動物叮咬傷是一個重要卻又容易被忽視的全球性議題，世界衛生組織指出：每年有超過1000萬人被動物咬傷。許多研究發現動物叮咬傷存在年齡性別差異及明顯的上升趨勢。臺灣擁有豐富的動物資源且人與動物互動頻繁，加上2013年動物狂犬病在臺灣的重現，使動物叮咬傷成為迫切需要了解的議題。
方法：使用1997年到2010年內政統計年報「人口年齡分配」及全民健保資料庫「住院」資料加以分析，同時以SPSS 19.0進行統計分析，檢驗性別、年齡、傷害類別和環境等流行病學特性，並做長期趨勢比較。
結果：研究期間共有2萬2,690筆動物叮咬傷住院資料，主要傷害類別為毒蛇咬傷、狗咬傷、蜂螫傷及無毒性節肢動物咬傷。住院者大多數為男性，佔61.7％，主要來自毒蛇咬傷；女性則主要來自狗咬傷。標準化後的整體住院率呈現明顯上升趨勢，男性住院率高於女性。住院平均年齡44.1歲，中位數46.6歲，呈偏態分佈；嬰幼兒住院率上升趨勢最為明顯，老人住院率超過標準化總平均住院率的2倍。最高的狗咬傷住院率發現在嘉義市，其他動物叮咬傷最高的住院率則在宜蘭縣。共有48％的病人至區域醫院且通常在一般外科病房住院治療，然只有14.7％的病人需要手術。病人的平均住院天數4.9天，平均住院醫療費用為新台幣1萬9,481元。住院死亡人數共25人，其中男性17人，女性8人。
結論：動物叮咬傷持續增長，應成為臺灣重要的公共衛生議題；重點可先放在毒蛇咬傷與狗咬傷的預防。嬰幼兒及從事農業的中高齡者為優先重視的高危險群。除加強民眾對此問題的正確感知與適當行為的教育外，動物出沒的環境監測也很重要。這個議題需要有更多的研究。

關鍵字

動物 ； 咬傷 ； 叮傷 ； 傷害 ； 全民健保資料庫 ； 住院 ； 毒蛇 ； 狗 ； 毒蜂 ； 蜂螫 ； 節肢動物 ； 台灣

並列摘要

Introduction: Animal bite and sting injury is an important but easily neglected problem worldwide, WHO point that more than 10 million people who are bitten by animals every year. Many studies found that animal bites and stings existed age / sex differences and had a significant upward long-term trend, although Taiwan is the home for abundant animal life and human-animal daily contact, and animal rabies reappeared in 2013, animal bite and sting injuries become an urgent issues which need to understand.
Methods: This study used “population by age report” from the Ministry of the Interior and “hospitalization data” from the NHIRD to analyze, and reviewed 14 years data from 1997 to 2010. The X2 test was conducted using SPSS 19.0 software to examine the differences in epidemiological characteristics according to gender, age, type of injury, and environmental characteristics. And P values of ＜.05 were considered significant.
Results: There were 22690 hospitalizations of animal bites and stings in the study period, and the majority came from “venomous snake bites”, “dog bites”, “hornets, wasps and bees stings” and “non-venomous arthropods bites”, and caused over 85% of hospitalizations during the 14 years. Males accounted for 61.7% and were more likely to be admitted by venomous snakebites, females more frequently admitted by dog bites. The age-standardized long-term trend in the 14 years presented a significant upward trend, and hospitalization rate of males was always greater than females. The age distribution was skewed with the mean of 44.1 years and median of 46.6 years. Infants and toddlers had the most significant upward long-term trend, and the hospitalization rate of the elderly was over 2 times than the overall standardized average rate. The highest hospitalization rate of dog bites was found in Chiayi City, and other three types of injuries were all found in Yilan County. 48.0% of cases were admitted into regional hospitals, and normally treated by surgical department, but only 14.7% of admitted patients needed surgery. The average stay per case was 4.9 days, and average cost per case was calculated to be 19,481 NT dollars. There were 25 fatalities from admitted patients in the 14 years, males accounted for 17 fatalities, and females 8 fatalities.
Conclusions: Animal bite and sting injuries continue to increase, and should be an important public health issue in Taiwan. The most important points can be placed on venomous snake bites and dog bite prevention. “Infants and toddlers” and “the elderly who engaged in agriculture” should be the priorities of high-risk groups. In addition to public education on accurate perception of the magnitude of the problem and appropriate behavior around animals, strengthening surveillance for environment where animals active is also important. Further studies focus on this issue will be needed in Taiwan.

並列關鍵字

animal ； bite ； sting ； injury ； NHIRD ； hospitalization ； snake ； dog ； hornet ； wasp ； bee ； Arthropod ； Taiwan

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