探討慢性阻塞性肺病併發失智症之發生率、醫療利用與療效之長期縱貫性分析

Medical utilization and outcomes of chronic obstructive pulmonary disease complicated with dementia:a long-term longitudinal study

洪加芬(Chia-Fen Hung)

指導教授 ： 許弘毅

高雄醫學大學/健康科學院/醫務管理暨醫療資訊學系碩士在職專班/碩士(2016年)

摘要

研究目的
慢性阻塞性肺病患者與失智症都是屬於慢性且需長期照護之疾病，最近研究顯示，慢性阻塞性肺病患者之失智症的後續風險較高。合併更頻繁之急性惡化之慢性阻塞性肺病和失智症之間性有很大的相關性(Kuang-Ming, Liao et al ,2015)，另一研究顯示，慢性阻塞性肺病患有顯著增加失智症風險(Chun-Hung ,Chen et al ,2015) 。因此本研究目的:
一、慢性阻塞性肺病併發失智症發生率及病人與醫療屬性之長期趨勢分析
二、探討慢性阻塞性肺病併發失智症之醫療利用及其相關影響因素
三、探討慢性阻塞性肺病併發失智症之醫療療效及其相關影響因素

研究方法
本研究利用國家衛生研究院釋出之「全民健康保險研究資料庫」 之百萬歸人檔資料，研究樣本自2000至2012年健保住院與門診資料，針對慢性阻塞性肺病（ICD-9-CM處置碼分別為496）併發失智症（ICD-9-CM處置碼分別為2900, 2941）之病患為主要研究對象，年齡小於40歲(AD與PD也排除)與嚴重精神障礙(ICD-9-CM codes 291–298)被排除。並利用SPSS Version 20.0 for Windows統計套裝軟體進行統計分析。

研究結果
 慢性阻塞性肺病併發失智症在人口學特性(年齡、性別、疾病嚴重度、都市化程度社經地位)與機構特性(醫院層級)均隨時間增加而增加
 慢性阻塞性肺病併發失智症盛行率：由 2000年每千人口3.1增加到2012年120.8
 慢性阻塞性肺病併發失智症女性比男性醫療費用較少(少8,605.7元)
 ≧75歲慢性阻塞性肺病併發失智症醫療費用最高 ( 16,220.6元)
 社經地位較高慢性阻塞性肺病併發失智症醫療費用較少(少9,530.9元)
 慢性阻塞性肺病併發失智症後第二年至第四年與第一年比較總醫療費用增加，有顯著差異(P<.0001)，和第五年與第一年比較，無統計差異
 慢性阻塞性肺病併發失智症存活率(119±1.3個月)與慢性阻塞性肺病存活率(138.2±0.2個月)比較，慢性阻塞性肺病併發失智症存活率低，有顯著差異( P < .0001)
結論與建議
慢性阻塞性肺病併發失智症盛行率由 2000年每千人口3.13顯著增加到2012年120.89
慢性阻塞性肺病併發失智症男性患者(60.5%)多於女性，超過75歲佔最多(50.4%)
人口學特性與機構特性與慢性阻塞性肺病併發失智症的醫療資源耗用及醫療療效均有顯著相關因應高齡化社會，更需提早預防與治療
對健康保險政策單位的建議:
慢性阻塞性肺病併發失智症盛行率逐年增加，加上慢性阻塞性肺病併發失智症存活率低，因應人口老化日益嚴重問題，建議應盡早從學校教育開始介入推廣知識衛教與預防宣導， 及早預防慢性阻塞性肺病併發失智症發生並降低死亡率
對資料庫的建議:
因變項資料不足，限制分析結果，因此未來研究可藉由加上臨床收案的方式，來補強資料庫不足的研究變項(包括病患的社經地位、照護資源、個人所得、健康狀態、臨床數據以及用藥資訊等重要變項)，才能對於疾病嚴重度更瞭解與分析，讓研究能更深入的探討，提供台灣公共衛生及醫療體系更重要性的資訊

關鍵字

慢性阻塞性肺病 ； 失智症 ； 醫療利用 ； 醫療療效

並列摘要

Objective:
Chronic obstructive pulmonary disease and dementia is a chronic and require long-term care of the disease , recent studies have shown a higher subsequent risk of chronic obstructive pulmonary disease in patients with dementia . The more frequent acute deterioration of patients with chronic obstructive pulmonary disease and between dementia has a great correlation (Kuang-Ming, Liao et al, 2015), other studies have shown that chronic obstructive pulmonary disease with a significant increase dementia risk (Chun-Hung, Chen et al, 2015). Therefore, this study Objective :
1. chronic obstructive pulmonary disease complicated with dementia incidence and long-term trend analysis of the patient and the medical properties
2. chronic obstructive pulmonary disease complicated with dementia of medical utilization and associated factors
3. investigate the medical outcomes of chronic obstructive pulmonary disease complicated with dementia and the Related Factors

Methods:
In this study, the National Institutes of Health released the " National Health Insurance Research Database ," one million people return profile data , the study sample from 2000-2012 inpatient and outpatient health care data for chronic obstructive pulmonary disease (ICD-9-CM disposal code respectively 496 ) concurrent dementia (ICD-9-CM codes disposal were 2900 , 2941 ) as the main object of patients younger than 40 years (AD and PD are excluded ) with severe mental disorders (ICD- 9-CM codes 291-298) were excluded. And using SPSS Version 20.0 for Windows statistical software package for statistical analysis.

Result:
 chronic obstructive pulmonary disease complicated by dementia in the demographic characteristics ( age, sex , severity of disease , the degree of urbanization, socioeconomic status ) and institutional characteristics ( hospital level ) are increases over time
 chronic obstructive pulmonary disease complicated with prevalence of dementia : from 3.1 per thousand population in 2000 to 120.8 in 2012
 chronic obstructive pulmonary disease complicated by dementia, fewer women than men medical expenses ( less 8,605.7 yuan )
 ≧ 75 years old with chronic obstructive pulmonary disease complicated by dementia highest medical expenses ( 16,220.6 yuan )
 higher socio-economic status of chronic obstructive pulmonary disease complicated by dementia medical expenses less ( less 9,530.9 yuan )
 After chronic obstructive pulmonary disease complicated with dementia, the second year of the fourth year and first -year comparison of the total health care costs increase , there are significant differences (P <.0001), and compared with the first five years, no statistical difference
 chronic obstructive pulmonary disease complicated by dementia survival rate (119 ± 1.3 months ) and chronic obstructive pulmonary disease survival (138.2 ± 0.2 months ) compared with chronic obstructive pulmonary disease complicated by dementia low survival rate , there are significant differences ( P <.0001)
conclusion and suggestion
chronic obstructive pulmonary disease complicated by prevalence of dementia by the year 2000 significantly increased to 3.13 per thousand population in 2012 120.89
Chronic obstructive pulmonary disease complicated by dementia in male patients (60.5%) than women, accounting for up to 75 years (50.4%)
Learning characteristics and institutional characteristics of the population and chronic obstructive pulmonary disease complicated with dementia consumption of medical resources and medical efficacy were significantly related to response to an aging society, but also need early prevention and treatment
Health Insurance Policy Unit's recommendations:
Chronic obstructive pulmonary disease complicated with dementia prevalence increases every year, coupled with chronic obstructive pulmonary disease complicated by dementia low survival rate, in response to the growing problem of an aging population, it is recommended as soon as possible from the school began to intervene in the promotion of health education and prevention knowledge propaganda , early prevention of chronic obstructive pulmonary disease complicated with dementia occur and reduce mortality
The repository of advice:
Due to lack of data variables, limit analysis, future research can therefore be combined with clinical cases recorded in the way, to reinforce insufficient data bank of variables (including the patient's socio-economic status, care resources, personal income, health status clinical data and drug information, and other important variables) in order to better understand the disease severity and analysis, allows researchers to more in-depth discussion can provide Taiwan public health care system more information

並列關鍵字

chronic obstructive pulmonary disease ； dementia ； medical utilization ； outcomes

參考文獻

一、中文部分：

1. 傅中玲(Jong-Ling Fuh)(2008)。台灣失智症現況。台灣老年醫學暨老年學雜誌，3(3)， 169-181。

2. 劉景寬(Ching-Kuan Liu)、戴志達(Chi-Ta Tai)、林瑞泰(Ruey-Tay Lin)、賴秋蓮(Chiou-Lian Lai)(2000)。台灣失智症的流行病學。應用心理研究，(7)， 157-169。

3. 吳蕙屏(Hui-Ping Wu)、范國聖(Kuo-Sheng Fan)、蔡宗益(Tzung-Yi Tsai)(2012)。臺灣慢性阻塞性肺疾病患者憂鬱症發生率之世代追蹤研究。

4. 全球慢性阻塞性肺病倡議組織 http://www.goldcopd.org/wcd-home.html