桃竹苗地區中高齡髋骨骨折相關疾病之探討

Using Data Mining Technique to Explore Hip Fracture Related Diseases in Middle-age and Elderly People in Taoyuan , Hsinchu, and Miaoli Areas

徐鈺芬(Yu-Fen Hsu)

指導教授 ： 詹前隆

元智大學/資訊學院/資訊管理學系/碩士(2009年)

摘要

背景：臺灣已於1993年邁入高齡化社會，面對因老化或疾病導致行動不便所造成的跌倒傷害，又以髋骨骨折之影響最為嚴重；越明瞭髋骨骨折與其他疾病的關聯性，將更有助於衛生主管機關及醫療院所於疾病發生時的全方位整體照護，以實踐「全人照護」服務概念。
目標：本研究藉中央健康保險局北區分局健保申報資料與疾病管理資料，探討近年來桃園、新竹及苗栗縣市45歲以上髖骨骨折之發生率，並以資料探勘方法發現髖骨骨折與其它疾病的關聯性分析。
方法：資料來源為2003至2007年北區分局資料庫所提供之住院申報醫療費用清單明細檔及個案疾病管理資料，如：重大傷病、高血壓、糖尿病、慢性B型及C型肝炎、氣喘、居家照護及精神科社區復健及死亡資料；並依入院實際年齡篩選出45歲以上的中高齡人口，並搭配國際疾病分類碼前三碼找出髖骨骨折患者（主診斷820.X），利用微軟SQL Server2005 Analysis Service資料探勘技術與SPSS軟體統計分析。
結果：桃竹苗地區在五年內髖骨骨折人數計12442名、個案數計12800個，發生率為294.2×10-5 (男性248.7×10-5、女性341.8×10-5)。隨著年齡上升，發生率亦上升，45至64歲發生率為男性60.2×10-5、女性49.1×10-5，65至74歲發生率為男性307.4×10-5、女性454.4×10-5，75歲以上發生率為男性1049.0×10-5、女性1935.7×10-5。在性別發生率上，45至64歲以男性較高，發生原因為意外墜落及跌倒（發生地點多為家裡），次為交通事故（多為機動車交通事故），65歲以上則為女性發生率較高，而意外墜落及跌倒為其主因。男性各年齡層股骨頸骨折發生率小於股骨粗隆間骨折發生率，但唯有60至69歲女性，卻有股骨頸骨折增多現象，其股骨頸骨折發生率大於股骨粗隆間骨折發生率。
有其它病史的髖骨骨折患者計有4241筆資料，3907人，而與疾病關聯重要性依序為：45至64歲之糖尿病（ICD9碼 250.X）、高血壓（ICD9碼 401.X）、慢性腎衰竭（ICD9碼 585.X）、腦血管疾病後遺症（ICD9碼 438.X）、貧血（ICD9碼 285.X）、高血壓性腎臟疾病（ICD9碼 403.X）、骨質疏鬆症及其他骨軟骨疾病（ICD9碼 733.X）、尿道疾病（ICD9碼 599.X）、類風濕性關節炎其他多發性關節炎（ICD9碼 714.X）； 65至74歲之高血壓、糖尿病、腦血管疾病後遺症、高血壓性心臟病（ICD9碼 402.X）、慢性腎衰竭、骨質疏鬆症及其他骨軟骨疾病、貧血、尿道疾病、高血壓性腎臟疾病及75歲以上之高血壓、糖尿病、骨質疏鬆症及其他骨軟骨疾病、高血壓性心臟病、腦血管疾病後遺症、貧血、尿道疾病、慢性腎衰竭、電解質及體液疾患（ICD9碼 276.X）。
結論：桃竹苗地區65歲以上人口，女性髖骨骨折發生率皆高於男性。而女性65歲以上及男性70歲以上，股骨頸骨折及股骨粗隆間骨折均大幅增加，45至64歲男性比女性更易患股骨粗隆間骨折。由資料探勘分析得知：桃竹苗地區45歲以上有其它疾病的髖骨骨折患者均與糖尿病、高血壓、腦血管疾病後遺症、骨質疏鬆症及其他骨軟骨疾病、慢性腎衰竭及貧血、尿道疾病有關聯。且女性特別與糖尿病、高血壓、骨質疏鬆症及其他骨軟骨疾病、高血壓性心臟病有關聯，45至64歲男性則與腦血管疾病後遺症有高度相關。而未於文獻提及與髖骨骨折有相關者如：高血壓、貧血、高血壓性心臟病，則建議後續可臨床分析。

關鍵字

髖骨骨折 ； 全民健保 ； 資料探勘 ； 關聯法則 ； SQL Server 2005

並列摘要

Background: Taiwan has become an aging society since 1993. Among falling injuries related to mobility problems caused by aging and diseases, hip fracture is the most serious. Further and more in depth understanding of hip fracture and its relationship with other diseases can allow the department and bureaus of health and hospitals to provide more holistic health care for those in-need patients
Objectives：Using the NHI (National Health Insurance) claims and case disease management data obtained from the North Region Branch of Bureau of NHI, this study examined the incidence rate of the hip fracture for those who are over 45 years of age in areas of Taoyuan, Hsinchu, and Miaoli. Moreover, data mining method was used to explore and analyze the relationship between hip fracture and other diseases.
Methods:Data source from the North Region Branch of Bureau of NHI’s inpatient database and case management database from 2003-2007 was used. Data related to catastrophic illness, hypertension, diabetes, chronic hepatitis B and C, asthma, home care and community psychiatric rehabilitation service and death information were included in case management database. Moreover, the study identified patients for the age group of 45 y/o and over who had a first-time admission for a diagnosis of hip fracture (ICD9 code 820.X ) on discharge from January 2003 through December 2007. The study utilized Microsoft SQL Server 2005 Analysis Service data mining technique and SPSS to perform statistical analysis.
Results: There were a total number of 12442 hip fractures and 12800 individual cases in Taoyuan, Hsinchu, Miaoli areas within the past five years. The incidence rate was 294.2 per 100,000 per year. The incident rate increases with age. The incident rate for males between 45 to 64 y/o was 60.2 per 100,000 per year. For females, it was 49.1 per 100,000 per year. Between the age of 65 to 74, the incidence rates were 307.4 per 100,000 per year in males and 454.4 per 100,000 per year in females respectively. The incidence rates for males over 75 y/o was 1049 per 100,000 per year in males and 1935.7 per 100,000 per year in females. In terms of gender differences, the incidence rate was higher for males in the age group of 45-64 y/o. Most incidents were caused by accidental falls (mostly at home). Traffic accidents (mostly scooter accidents) was another main cause. For the age group of 65 y/o and over, the incidence rate was higher in the case of females. The major cause was accidental falls. The incidence rate of femoral neck fracture was lower than intertrochanteric fracture in the case of males of all age groups. However, for females between 60 to 69 y/o, the incidence rate of intertrochanteric fracture increased. Its incidence rate of femoral neck fracture of female was higher than intertrochanteric fracture.
There were 4241 data entries and a total of 3907 hip fracture patients with other diseases. The correlations between the rate of hip fracture and types of diseases are listed here from high to low: Between the age of 45-64 - diabetes（ICD9 code 250.X）, hypertension（ICD9 code 401.X）, chronic renal failure (CRF) (ICD9 code 585.X), late effects of cerebrovascular disease（ICD9 code 438.X）, Anemia（ICD9 code 285.X）, hypertensive renal disease（ICD9 code 403.X）, osteoporosis, malunion and nonunion of fracture（ICD9 code 733.X）, other disorders of urethra and urinary tract（ICD9 code 599.X）, rheumatoid arthritis and other inflammatory polyarthropathies. For the age group between 65-74 y/o - hypertension, diabetes, late effects of cerebrovascular disease, hypertensive heart disease（ICD9 code 402.X）, CRF, osteoporosis , malunion and nonunion of fracture, anemia, other disorders of urethra and urinary tract, hypertensive renal disease. For the age group over 75 y/o - hypertension, diabetes, osteoporosis, malunion and nonunion of fracture, hypertensive heart disease, late effects of cerebrovascular disease, anemia, other disorders of urethra and urinary tract, CRF, electrolyte and fluid disorders.
Conclusions: The incidence rate of hip fracture for females was higher than that of males in the population older than 65 y/o in Taoyuan, Hsinchu, and Miaoli areas.For females over 65 and males over 70, the incidence rate of femoral neck fracture and intertrochanteric fracture increased drastically. Between age of 45-64, the incidence rate of intertrochanteric fracture was higher in males. Using data mining technique, the study found that in the age group over 45, hip fractures patients with other diseases might suffer from the following diseases: diabetes, hypertension, late effects of cerebrovascular disease, osteoporosis ,malunion and nonunion of fracture, CRF, anemia, and other disorders of urethra and urinary tract. In particular, female cases were more associated with diabetes, hypertension, osteoporosis , malunion and nonunion of fracture, hypertensive heart disease. For males between 45-64 y/o, it was associated with late effects of cerebrovas- cular disease. For those diseases that have not been suggested being related to hip fracture in the literature such as hypertension, anemia and hypertensive heart disease, more clinical-based analyses is needed.

並列關鍵字

Hip fracture ； National Health Insurance ； Data Mining ； Association Rules ； Microsoft SQL Server 2005 Analysis Service

參考文獻

[6] 洪秀娟、楊榮森、曹昭懿：台灣髖部骨折之流行病學。台灣醫學 2005；9：29-38。

[12] 李瑋君、韓岳津、吳英黛、曹昭懿：骨質疏鬆相關骨折住院病患之健保申報分析。台灣醫學 2007；11：22-8。

[13] 林亞蓉、楊榮森、曹昭懿：臺灣全民健康保險制度下髋關節置換手術之醫療利用與費用。物理治療 2007；32：200-9。

[18] 吳淑儀：應用資料探勘技術於多重死因資料之疾病關聯分析。台南：國立成功大學公共衛生研究所碩士論文，2008。

[27] Chie WC, Yang RS, Liu JP, Tsai KS. High incidence rate of hip fracture in Taiwan: estimated from a nationwide health insurance database. Osteoporos Int 2004;15:998-1002.