第二型糖尿病合併重度憂鬱症之盛行率和趨勢分析研究

A study of investigating the prevalence and trend of type II diabetes with major depression disorder

戴筱涵(Siao-Han Dai)

指導教授 ： 謝慧敏

高雄醫學大學/健康科學院/公共衛生學系公共衛生學碩士班/碩士(2015年)

摘要

背景: 台灣糖尿病和憂鬱症的盛行率在過去十年呈現持續上升趨勢，造成不利健康的影響和大量的醫療負擔。本研究主要透過健保資料庫數據分析，對第二型糖尿病和完全無糖尿病合併重度憂鬱症之流行病學研究做推估。

方法: 使用2005年健保資料庫，了解第二型糖尿病合併重度憂鬱症在不同時間點上所呈現之差異。研究對象從所有就醫人口裡找出至少一次診斷，且年齡大於或等於18歲。接著納保人根據國際疾病分類碼，篩選出每年糖尿病、重度憂鬱症、及一般人口且無任何糖尿病之患者，再從這些病患裡劃分第二型糖尿病和第二型糖尿病合併重度憂鬱症以及完全無糖尿病和無糖尿病合併重度憂鬱症之患者。計算2000年至2010年每年第二型糖尿病和非糖尿病之總盛行率人口數，及按不同年齡、性別對重度憂鬱症人口，計算總盛行率。最後以羅輯斯回歸分析找出可能的危險因子。

結果: 2000年至2010年第二型糖尿病合併重度憂鬱症盛行率。分別為5.05%、5.04%、4.87%、4.79%、4.68%、4.72%、4.60%、4.56%、4.44%、4.32%、4.18%。而非糖尿病合併重度憂鬱症之總盛行率，分別為3.33%、3.30%、3.28%、3.26%、3.18%、3.14%、3.14%、3.09%、3.05%、2.98%、2.91%。校正年齡後，第二型糖尿病無論年齡為何都比非糖尿病患者要來的高。性別方面，盛行率在第二型糖尿病合併重度憂鬱症的女性最高，而最低則落在非糖尿病合併重度憂鬱症的男性。第二型糖尿病合併重度憂鬱症比無重度憂鬱症在男性、年齡45歲以上具有統計顯著保護作用、另外居住城市、糖尿病合併症、慢性疾病綜合指標及相關憂鬱症用藥則有較高風險。無糖尿病合併重度憂鬱症比無重度憂鬱症在男性、年齡45歲以上有統計顯著保護作用、另外居住城市、糖尿病合併症、慢性疾病綜合指標以及憂鬱症相關用藥也都有顯著高風險在完全無糖尿病合併重度憂鬱症之患者。

結論: 第二型糖尿病患本身就是高危險群，而與重度憂鬱症合併後，可以發現有更高的盛行率在女性、和64歲以下之患者比起完全無糖尿病之人口，每年台灣花費在這些病人身上不僅僅是龐大醫藥費，還會帶動台灣整體經濟負擔以及政策上策略的考量，因此本研究提供相關數據，以利於進一步了解重度憂鬱症在台灣流行之情況。

關鍵字

糖尿病 ； 重度憂鬱症 ； 盛行率 ； 危險因子

並列摘要

Background: The prevalence of diabetes and depression in Taiwan show a continued upward trend in the past decade, causing a lot of medical costs and adverse health effects. In this study, mainly to analyze data from health-care database，estimating epidemiological studies of type II diabetes and completely non-diabetic patients with major depression.

Methods: Using the 2005 National Health Insurance database, understand the differences of type II diabetic patients with moderate to major depression disorder in different time . The study find out all of the population in the midst of a medical treatment at least diagnosis once , and greater than or equal to 18 years of age. The grantor use code based on International Classification of Diseases, screening diabetes every year, major depression disorder, and general patient without any diabetes.And then sieve out type II diabetes and in the division of type II diabetes and major depression disorder in these patients as well completely diabetics and non-diabetic patients with major depression disorder of. Calculated the total prevalence of type II diabetes and non-diabetic population each year from 2000 to 2010, and calculate the total prevalence of major depression disorder according to age, gender. Finally,using Logistic regression to identify possible risk factors.
Result: In 2000-2010，The prevalence Type II diabetes patients with major depression disorder is respectively, 5.05%, 5.04%, 4.87%, 4.79%, 4.68%, 4.72%, 4.60%, 4.56%, 4.44%, 4.32%, 4.18%.The total prevalence of non-diabetic patients with major depression disorder is 3.33%, 3.30%, 3.28%, 3.26%, 3.18%, 3.14%, 3.14%, 3.09%, 3.05%, 2.98%, 2.91%. After adjusting, regardless of age，type II diabetes come high than non-diabetics . Of gender, the prevalence of type II diabetes in patients with major depression disorder in women is highest, while the lowest falls on patients with major depression disorder in men without diabetes. Type II diabetes patients with major depression disorder in men older 45 years has a statistically significant protective effect than non-major depression disorder , live in City, diabetic complications, chronic diseases and related composite indicator has a higher risk of depression medication than Non-diabetic patients with major depression disorder.

Conclusion: Type II diabetes itself is a high-risk group, and after mergering with major depression disorder, you can find a higher prevalence in women, and in patients under the age of 64 compared to the population of these patients completely without diabetes. Each year the medical cost in Taiwan nor only huge , but also boost the overall economic burden in policy and strategy considerations. This study provides relevant data, in order to facilitate further understanding of the situation of major depression disorder in Taiwanese .

並列關鍵字

diabetes ； major depression disorder ； prevalence ； risk factors

參考文獻

Jiang, Y. D., Chang, C. H., Tai, T. Y., Chen, J. F., & Chuang, L. M. (2012). Incidence and prevalence rates of diabetes mellitus in Taiwan: analysis of the 2000-2009 Nationwide Health Insurance database. J Formos Med Assoc, 111(11), 599-604. doi: 10.1016/j.jfma.2012.09.014

參考文獻

英文文獻

American Diabetes, A. (2010). Standards of medical care in diabetes--2010. Diabetes Care, 33 Suppl 1, S11-61. doi: 10.2337/dc10-S011

Anderson, R. J., Freedland, K. E., Clouse, R. E., & Lustman, P. J. (2001). The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care, 24(6), 1069-1078.