縱貫性探討糖尿病及其相關慢性併發症之盛行率和長期醫療資源利用

Longitudinal study on diabetes and associated chronic complications prevalence and the impact on medical utilizations

林弦音(Hsuan-Yin Lin)

指導教授 ： 邱亨嘉

高雄醫學大學/健康科學院/醫務管理學研究所/碩士(2006年)

摘要

研究背景與目的：根據世界衛生組織2000年研究調查，全世界罹患糖尿病人數共有1億7,100萬人，其所導致併發症包括心血管疾病、神經病變、視網膜病變、腎病變和足部問題等耗用許多醫療資源。目前評估台灣地區糖尿病盛行率與醫療資源利用研究，Chen等(1992) 、Fu等(1993) 和Tai等(1991) 研究皆侷限於地區性研究，且對於糖尿病相關併發症所引發之醫療費用並無深入探討，本研究研究目的有四個分述如下。一、探討台灣地區2000年抽樣世代五年期間(2000年至2004年)糖尿病盛行率與發生率。二、探討台灣地區2000年抽樣世代當年度糖尿病患者，其罹患七大併發症盛行率，並比較糖尿病患者與非糖尿病者罹患七大疾病比例與風險。三、探討台灣地區2000年抽樣世代當年度糖尿病患者歸因於糖尿病與七大併發症醫療資源利用情形，並縱貫性探討此一糖尿病世代(closed cohort)五年間(2000年至2004年)醫療資源利用趨勢，並和非糖尿病者比較。四、預測七大併發症對於此一糖尿病世代長期(2000年至2004年)醫療利用因子與醫療利用趨勢探討，並和非糖尿病者比較。

研究方法：研究期間為2000年至2004年，研究對象為2000年承保抽樣歸人檔一組共5萬人樣本中，選取糖尿病病患共1,209人，並依據居住地區、性別、年齡與糖尿病組一對一匹配非糖尿病者，非糖尿病組人數與糖尿病病患相同。研究中七大相關併發症依據美國糖尿病協會研究報告中併發症種類，分為神經病變、週邊血管疾病、心血管疾病、腎臟疾病、內分泌/新陳代謝疾病、眼睛疾病和其他併發症共七類。醫療資源利用則包括門診次數、門診費用、住院次數、住院費用和總醫療費用。

研究結果：2000年糖尿病女、男盛行率趨勢皆隨年齡增加而上升後下降，50∼54歲後女性高於男性，2000年糖尿病盛行率為2.52%至2004年上升為4.44%，五年累積發生率為3.00%。各年度盛行率女性(2.71%∼4.47%)大於男性(2.33%∼4.42%)，發生率男性大於女性；各年度盛行率和發生率皆隨年齡越大而上升；各年度盛行率和發生率東、南部地區皆高於中、北部地區。糖尿病七大併發症中，心血管疾病盛行率最高為67.41%，糖尿病組罹患七大相關疾病危險性皆高於非糖尿病組。控制其他相關變項和時間因素後，七大併發症門診就醫次數部分，罹患神經病變者較無者多2.56次、罹患心血管疾病者較無者多3.46次、罹患腎病變者較無者多3.32次、罹患內分泌/新陳代謝疾病者較無者2.99次、罹患眼病變者較無者多6.52次，罹患其他併發症者較無者多3.40次；門診醫療費用部分，罹患神經病變者較無者多4,117元、罹患心血管疾病者較無者多11,770元、罹患腎病變者較無者多25,704元、罹患眼病變者較無者多17,661元，罹患其他併發症者較無者多4,853元；住院醫療費用部分，罹患眼病變者較無者住院醫療費用多52,137元；總醫療費用部分，罹患心血管疾病者較無者多13,995元、罹患腎病變者較無者多41,899元、罹患眼病變者較無者多29,210元。糖尿病組2000年至2004年門診費用、住院費用和總醫療費用皆逐年增加，控制相關變項和時間因素後，糖尿病組比非糖尿病組使用較多醫療資源，包括門診次數多4.73次、門診費用多15,223元、住院費用多43,422元、總醫療費用多28,265元。

討論與結論：糖尿病各年度發生率男性大於女性，因此至2004年男性罹患糖尿病人數超越女性。糖尿病七大併發症盛行率，以心血管疾病最高，總醫療費用以腎病變、心血管疾病和神經病變耗用最多。預測糖尿病七大併發症對糖尿病患者醫療利用影響，控制相關因素和時間因素後，週邊血管疾病並不影響糖尿病各醫療利用，其他六個併發症皆有較多門診醫療利用；罹患心血管疾病和腎病變者且有較多總醫療費用；罹患眼病變者且有較多住院醫療費用和總醫療費用，可見心血管疾病和腎病變為七大併發症中盛行率高且醫療資源耗用多的疾病。由本研究母群體抽樣歸人檔計算可得2000年總門診費用中，糖尿病佔母群體人口比例約為9.96%；總住院費用中，糖尿病佔母群體人口比例約為11.89%；總醫療費用中，糖尿病佔母群體人口比例約為10.55%，2000年糖尿病盛行率為2.52%，總醫療費用卻佔母群體約11%，且糖尿病引發相關併發症的高比例，使得糖尿病患者大多患有多重疾病，也因此容易有較多的醫療資源利用，故對於糖尿病所引發的醫療成本不容忽視。

關鍵字

糖尿病 ； 併發症 ； 盛行率 ； 醫療資源利用

並列摘要

Background and Objective－According to the world health organization’s survey, there are 171 million people with diabetes in 2000. Complications associated with diabetes mellitus raising medical utilizations, including heart disease, neuropathy, retinopathy, renal disease and diabetic foot disease. Current studies about prevalence of diabetes in Taiwan were limited in regional surveys (Chen,1992; Fu,1993; Tai,1991), and no published studies explored medical utilizations of complications resulting from diabetes. There are four purposes in this study: 1.The prevalence and incidence of diabetes in a random sampling cohort in Taiwan in year 2000. 2.The prevalence of complications associated with diabetes in a random sampling cohort in Taiwan in year 2000, and in comparison with subjects without diabetes. 3.The medical utilizations of diabetes and its complications in a random sampling cohort in Taiwan in year 2000, and in comparison with no diabetes. 4.To predict the medical utilizations with diabetes, and in comparison with no diabetes.

Research design and Methods－We conducted a retrospective longitudinal study, analyzed the incident and prevalent rate of diabetes in 2000-2004, and extracted 2,418 diabetes patients with their age-, sex-, and enrolling locale –matched control from dataset of Registry for Beneficiaries in year of 2000. The diabetes patient was defined by ICD-9-CM code 250.xx and verified with the diabetes pharmaceutical in year of 2000. Seven complications of diabetes included neurological symptoms, peripheral vascular disease, cardiovascular disease, renal complications, endocrine/metabolic complications, ophthalmic complications, and others that have defined by American Diabetic Association in 2003. Annual outpatient visits, cost of outpatient, frequency of admission, cost of admission and total cost were measured as the outcomes of medical utilizations. The Generalized Estimating Equations (GEE) approach was used for evaluating the longitudinal trend between diabetes complication and medical utilizations. All statistic analysis was used by SPSS 12.0 and STATA 8.0.

Results－Regardless of sex, the incident and prevalent rate of diabetes were raised with age, but decreased slightly in elderly in 2000. From 2000 to 2004, the prevalence was increased from 2.52% to 4.44% and the accumulate incident rate was up to 3.00%. After controlling other covariates and time, annual outpatient visits for neurological symptoms, cardiovascular disease, renal complications, endocrine/metabolic complications, ophthalmic complications, and others were 2.56, 3.46, 3.32, 2.99, 6.52 and 3.40 times higher than none. The annual cost of outpatient for neurological symptoms, cardiovascular disease, renal complications, ophthalmic complications, and others were NT$4,117, 11,770, 2,504, 17,661 and 4,853 higher than none. The annual total cost for cardiovascular disease, renal complications, and ophthalmic complications were NT$13,995, 41,899, 29,210 higher than none.

Conclusions－The male’s incidence of diabetes was always higher than female, and its prevalence was increased more quickly than female in the following year. The cardiovascular disease and renal complications showed higher prevalence in complication of diabetes and spend more medical cost in long term. The most important finding of this study was ophthalmic complications which also consumed much medical resource. Our study has proved the high association between complications of diabetes and medical utilizations especially in cardiovascular disease, renal complications, and ophthalmic complications. As the government faced to burden of diabetes, the most important thing was avoiding to deteriorate the health condition of diabetes patients.

並列關鍵字

Diabetes ； Complication ； Prevalence ； Medical utilizations

參考文獻

中文文獻

Bureau of Health Promotion Department of Health, R. O. C., http://www.bhp.doh.gov.tw/BHP/do/chinese/home.

Department of Health Executive Yuan, R. O. C., http://www.doh.gov.tw/statistic/index.htm.

Directorate-General of budget Accounting and Statistics Executive Yuan, R. O. C., http://www.dgbas.gov.tw/.

Ministry of the Interior, http://www.moi.gov.tw/home/.