高血壓病人罹患失智症之研究探討

背景：高血壓病人應長期服藥以控制血壓穩定，若血壓控制不好則會影響全身血流灌注狀況，長久下來會造成心血管和腦血管病變，同時也會使中老年人認知能力退化而增加得到失智症的機會。目的：探討台灣40歲以上高血壓病人門急診及住診罹患失智症之盛行率，及高血壓病人門急診及住診罹患失智症者在人口學特質、高血壓合併症（冠狀動脈疾病、腦中風、糖尿病）、醫療利用及住院預後之影響因子。方法：本研究利用2009年、2010年及2011年全民健保資料庫以門急診處方及治療明細檔（CD）、門急診處方及治療醫令明細檔（OO）、住院醫療費用清單明細檔(DD)、住院醫療費用醫令清單明細檔（DO）等次級資料進行分析。以描述性統計、卡方檢定檢定、獨主樣本t檢定、及邏輯式回歸分析各年度之控制變項是否影響高血壓罹患失智症。結果：2009年、2010年及2011年台灣40歲以上高血壓病人門急診罹患失智症之盛行率為2.0％、1.9％、1.7％；臺灣2009年、2010年及2011年40歲以上高血壓住院患者罹患失智症之盛行率為1.3％、1.4％、1.3％。臺灣40歲以上高血壓門急診患者罹患失智症共同影響因子為性別、年齡、合併症(冠狀動脈疾病、腦中風、糖尿病)、就醫層級、就醫次數及就醫費用。臺灣40歲以上高血壓住院患者罹患失智症共同影響因子為年齡、合併症(冠狀動脈疾病、腦中風、糖尿病)及就醫層級；而在住院次數及住院天數在各年度影響有差異，另在性別方面則無影響。結論：本研究結果顯示高血壓病人罹患失智症之機率，在一些相關影響因子下證實有顯著意義，建議臨床在治療高血壓病人同時給予失智症衛教或宣導，以預防及延緩失智症的發生。

關鍵字

高血壓；失智症；盛行率；影響因子

並列摘要

Background: Hypertension patients need long-term medication to control blood pressure, if blood pressure is not in good control may affect the whole body perfusion conditions, time after time it will cause cardiovascular and cerebrovascular disease, as well as cognitive degeneration in the elderly and may have more chance to get dementia. Objective: To explore (1) the prevalence of dementia of older than 40-year old Taiwanese hypertension patients treated in Outpatient、emergency department and hospitalized patients, (2) the demographics of hypertensive patients with dementia who were treated in Outpatient, emergency department and hospitalization patients, (3) whether hypertension complicated with coronary artery disease, stroke, diabetes patients may have higher prevalence of dementia compared with hypertension alone patients, (4)medical utilization and affecting factors of prognosis after hospitalization. Methods: In this study, we used 2009, 2010 and 2011’s National Health Insurance database, which including (1) prescription and treatment detail files(CD) of Outpatient and emergency department ,(2)prescription and medical order detail files(OO) of Outpatient, emergency department,(3) lists of hospital medical expenses detail files(DD),(4) lists of hospital medical expenses medical order detail files. We analyzed above 4 subclasses data. With descriptive statistics, chi-square test, independent samples t-test and logistic regression analysis we analyzed each year’s control variables to explore whether hypertensive patients will get dementia or not? Results: The prevalence of Taiwan hypertensive patients who were older than 40-year old and treated in Outpatient and emergency department got dementia in year 2009, 2010 & 2011 were 2.0%, 1.9% and 1.7%. At the same time, the prevalence of same-aged hypertensive patients who were treated in hospitalization and got dementia were 1.3%, 1.4% and 1.3%. The common affecting factors of Taiwanese hypertensive who were older than 40-year old and treated in Outpatient and emergency department and got dementia were sex, age, complications (coronary artery disease, stroke, diabetes) and medical utilization. The affecting of numbers and days of hospitalization were different in different years. Sex was not an affecting factor. Conclusion: The results of this study showed that the probability of hypertensive patients suffering from dementia was related to some significant affecting factors. We recommend while treating hypertensive patients we must give health education or advocacy about dementia at the same time, in older to prevent and delay the occurrence of dementia.