糖尿病合併精神疾病患者盛行率、醫療資源耗用、死亡率及相關因子探討

研究背景與目的：根據世界衛生組織估算全世界罹患糖尿病人數，於2000年糖尿病人口高達1億7,100萬人，推估至2030年可能會成長至3億6,600萬人。糖尿病的照護不善容易引起諸多合併症，間接增加糖尿病患者的醫療資源利用以及社會資源耗用，而合併症中有關糖尿病合併精神疾病並不少見，但探討糖尿病患者合併精神疾病之直接及間接成本的相關文獻則相對較少。2000年世界衛生組織估算，全世界每年有320萬人死於糖尿病及其併發症，目前大部分文章都是探討糖尿病患者死亡率，少有專門針對糖尿病患者合併精神疾病的死亡率研究設計與結果。本研究目的為探討糖尿病患者合併精神疾病之盛行率、醫療資源使用情形、死亡人數的變化和相關因子。研究方法：資料來源為全民健康保險研究資料庫二十萬人口的次級資料，研究期間為2000年至2004年，選取糖尿病患者，再區分為合併任何精神疾病、合併憂鬱症和合併焦慮症，研究其盛行率、醫療資源使用情形（門診次數、門診費用、住院次數、住院費用和門住診總費用）、死亡人數的變化和相關因子。研究結果：本研究結果2000年至2004年間糖尿病患者合併任何精神疾病（憂鬱症；焦慮症）盛行率19.69％-21.28％（3.39％-3.90％；11.80％-13.30％）。2000年至2004年糖尿病合併任何精神疾病（憂鬱症；焦慮症）患者每年平均門診次數為41.56-46.89次（44.23-52.20次；42.81-50.37次）；每年平均門診費用46,850-59,910元（50,693-76,943元；46,446-60,355元）；每年平均住院次數0.80-0.88次（0.93-1.02次；0.56-0.73次）；每年平均住院費用30,272-53,956元（36,803-56,134元；25,726-32,426元）；每年平均門住診總費用77,123-113,866元（87,496-133,077元；74,875-92,781元）。本研究結果發現糖尿病患者合併任何精神疾病（憂鬱症；焦慮症）在門診次數呈現正相關的項目，包括年齡和疾病特性（疾病特性；年齡和疾病特性），呈現負相關則為時間因素（性別；時間因素）。糖尿病患者合併任何精神疾病在門住診總費用呈現正相關的項目，包括性別、投保金額、疾病特性和時間因素（時間因素；投保金額、疾病特性和時間因素）。糖尿病患者合併任何精神疾病在住院與否呈現正相關的項目，包括投保金額、疾病特性（都會區別和疾病特性；疾病特性）。糖尿病患者合併任何精神疾病與糖尿病患者無合併任何精神疾病相比較及糖尿病患者合併焦慮症與糖尿病患者無合併焦慮症相比較，其死亡機會較低；而糖尿病患者合併憂鬱症與糖尿病患者無合併憂鬱症，其死亡機會則無統計顯著差異。結論：研究期間內糖尿病患者合併各類精神疾病盛行率皆比非糖尿病患者為高。糖尿病患者合併精神疾病醫療資源使用皆較糖尿病患者無合併精神疾病為高。糖尿病患者合併精神疾病醫療資源使用的相關因子包括有性別、年齡、投保金額、疾病特性和時間因素。糖尿病患者合併任何精神疾病與糖尿病患者合併焦慮症其死亡機會較低。影響死亡的相關因子包括性別、年齡、都會別、投保金額和疾病特性。

關鍵字

糖尿病；精神疾病；憂鬱症；焦慮症；盛行率；醫療資源使用；死亡率

並列摘要

Background and Objective: According to the world health organization’s survey, there are 171 million people with diabetes in 2000. The diabetic patients (DP) will increase to 366 million people in 2030. The comobility of diabetes would increase the medical utilization. Some of the comobility is the mental illness (MI), but there are few papers discussed about the direct and indirect cost of DP with MI. According to the world health organization’s survey, there are 3.2 million people died due to diabetes and complications in 2000. Most of the papers are discussed about the mortality of diabetes, and few are focus on the mortality of DP with MI. The purposes of the study are estimated the prevalence, medical utilization, mortality and related factors of DP with MI. Method: We use the National Insurance Research Database including 200 thousands people to conduct a retrospective longitudinal study from 2000 to 2004. We select DP, DP with MI, DP with depression disorder (DD) and DP with anxiety disorder (AD) from the database. After that we estimate the prevalence, medical utilization (outpatient use, outpatient expenditure, inpatient use, inpatient expenditure and total expenditure), mortality and related factors of them. Results: The prevalence of DP with MI (DD ; AD) during 2000 to 2004 is 19.69％-21.28％ (3.39％-3.90％; 11.80％-13.30％). The average annual outpatient use of DP with MI (DD; AD) during 2000 to 2004 is 41.56-46.89 (44.23-52.20; 42.81-50.37). The average annual outpatient expenditure of DP with MI (DD; AD) during 2000 to 2004 is NT $46,850-$59,910 (NT $50,693-$76,943; NT $46,446-$60,355). The average annual inpatient use of DP with MI (DD; AD) during 2000 to 2004 is 0.80-0.88 (0.93-1.02; 0.56-0.73). The average annual inpatient expenditure of DP with MI (DD; AD) during 2000 to 2004 is NT $30,272-$53,956 (NT $36,803-$56,134; NT $25,726-$32,426). The average annual total expenditure of DP with MI (DD; AD) during 2000 to 2004 is NT $77,123-$113,866 (NT $87,496-$133,077; NT $74,875-$92,781). The positive related factors of outpatient use in DP with MI (DD; AD) are age and character of illness (character of illness; age and character of illness), and the negative related factors is time (sex; time). The positive related factors of total expenditure in DP with MI (DD; AD) are sex, insurance amount, character of illness and time (time; insurance amount, character of illness and time). The positive related factors of admission in DP with MI (DD; AD) are insurance amount and character of illness (urbanization and character of illness; character of illness). The mortality is lower in DP with MI and DP with AD compared with DP without MI and DP without AD. There is no difference in mortality between the DP with DD and DP without DD. Conclusions: The prevalence of MI is higher in DP compared with non-DP. The medical utilization is higher in DP with MI compared with DP without MI. The related factors of medical utilization in DP with MI are sex, age, insurance amount, character of illness and time. The mortality is lower in DP with MI and DP with AD. The related factors of mortality are sex, age, urbanization, insurance amount and character of illness.

並列關鍵字

Diabetes ； Mental illness ； Depression disorder ； Anxiety disorder ； Prevalence ； Medical utilization ； Mortality

參考文獻

英文文獻

Google Scholar

1. American Diabetes Association. (1998). "Economic Consequences of Diabetes Mellitus in the U.S. in 1997." Diabetes Care 21(2): 296-309.

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2. Banerjea, R., L. M. Pogach, et al. (2009). "Mental illness and substance use disorders among women veterans with diabetes." Womens Health Issues 19(6): 446-456.

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3. Berger, B., G. Stenstrom, et al. (1999). "Incidence, prevalence, and mortality of diabetes in a large population. A report from the Skaraborg Diabetes Registry." Diabetes Care 22(5): 773-778.