台灣常見兩種婦癌之篩檢行為及相關醫療耗用與生活品質

研究目的瞭解影響國內三十歲以上婦女接受子宮頸癌與乳癌篩檢之相關因素，探討有無做篩檢者之醫療耗用及健康相關生活品質，進而分析影響醫療耗用及健康相關生活品質之因素。研究方法本研究採橫斷性研究法，依90年「台灣國民健康訪問調查」資料庫採用回溯性方式作研究，此調查係全台灣地區性抽樣調查，包括居住台灣地區各縣市年滿十二歲以上之本國及人口，共20830人。本研究依篩檢建議年齡，選取三十歲以上婦女共6683人。自變項為人口學變項、社經地位、健康狀況、健康行為；依變項為子宮頸癌篩檢、乳癌篩檢、醫療資源耗用(包括西醫門診次數、有無住院、有無急診、有無中醫門診與醫療總費用)及健康相關生活品質(依據SF-36)。採用二項式對數迴歸、獨立樣本t檢定、線性迴歸分析探討相關影響因子與比較醫療耗用及健康相關生活品質。研究結果未做子宮頸癌篩檢者有2481人(37.2%)，有做子宮頸癌篩檢者有4202人(62.8%)。影響子宮頸癌篩檢之因子方面，年齡、婚姻狀態、教育程度、高血脂、有子宮卵巢疾病、有生過小孩、有接受賀爾蒙、有接受全身健檢、有接種流感疫苗、有乳房自我檢查(OR=2.92, 95%CI=2.53-3.38)、有乳房醫師觸診(OR=5.97, 95%CI=4.87-7.33)、有接受骨密度檢查(OR=2.40, 95%CI=1.98-2.91)為顯著因子。有接受乳房超音波檢查有943人(14.1%)，有接受乳房攝影者有551人(8.2%)。影響乳癌篩檢之因子方面，年齡、有乳房自我檢查(OR=1.69, 95%CI=1.39-2.05; OR=1.74, 95%CI=1.38-2.19)、有乳房醫師觸診(OR=30.23, 95%CI=24.21-37.74; OR=17.18, 95%CI=13.09-22.56)、有接受骨密度檢查(OR=1.75, 95%CI=1.43-2.14; OR=1.97, 95%CI=1.58-2.45)、有接受直腸鏡檢查(OR=3.00, 95%CI=1.95-4.61；OR=2.76, 95%CI=1.79-4.25)為乳房超音波與乳房攝影之共同顯著因子。此外，子宮卵巢疾病（OR＝1.46, 95%CI=1.03-2.08）亦為影響乳房攝影之顯著因子。醫療資源使用之影響因子方面：1. 西醫門診次數部分，年齡大、有罹患慢性病者(中風、高血脂除外)、接受荷爾蒙治療、過去一年內接受過全身健檢、過去一年內接受過流行感冒預防注射者、接受子宮頸抹片、接受乳房超音波檢查者門診次數較高；家戶收入高於五萬、嚼檳榔者門診次數較低。2.住院部分，有罹患慢性病者、有大便潛血檢查習慣者住院比例較高；有骨密度檢查習慣、有運動習慣者住院比例較低。3. 醫療總費用部分，年齡大、有罹患慢性病者、有接受流感疫苗注射者、有接受大便潛血檢查或直腸鏡檢查者醫療費用較高；有運動習慣者醫療費用較低。健康相關生活品質(HRQL)方面，整體生理健康平均分數為51.54，整體心理健康平均分數48.23。年齡為顯著影響因子，年紀越大整體生理健康越差，而整體心理健康越佳。此外，家戶月收入越高、教育程度越高、沒有慢性病、沒有子宮卵巢疾病、沒有接受賀爾蒙治療、有運動習慣、沒有抽煙或嚼檳榔者其生理及心理構面之生活品質均較佳。結論與建議子宮頸癌篩檢者有六成多，有接受乳房超音波檢查有14.1%，有接受乳房攝影者有8.2%。其中子宮頸抹片比例最高，推測可能與政府提供免費檢驗之制度有關，未來建議可以將乳房篩檢列入免費之健康篩檢項目之中。有乳房自我檢查、有乳房醫師觸診、有接受骨密度檢查為子宮頸抹片、乳房超音波與乳房攝影之共同顯著預測因子。醫療耗用呈現集中現象，主要為老年人口與慢性病患者，有運動習慣者其住院比例較低、醫療總費用較少，因此可以透過媒體宣導及推行相關政策教育民眾建立健康生活習慣，以減少罹患慢性病之比例，進而減少醫療使用。健康行為為影響健康相關生活品質之因子，運動習慣者生活品質較佳。政府單位及醫療人員應配合相關政策，鼓勵民眾建立正確健康行為，進而提升生活品質。

關鍵字

子宮頸癌篩檢；乳癌篩檢；醫療資源耗用；健康相關生活品質

並列摘要

Objective: The objective of this study is to understand the predictors of cervical cancer and breast cancer screening among Taiwanese women thirty years and older. This study also investigates medical utilization and health related quality of life (HRQL) and their predictors. Methods： Data for analysis are collected from ”National Health Database of the investigation of the promotional knowledge, attitudes and behaviors of citizen’s health in Taiwan in 2001 “, including 20830 Taiwanese 12 years and older. We select 6683 Taiwanese women 30 years and older according to the guideline-suggested screen age. Independent factors include demographics, socioeconomic status, health status and health behavior; dependent factors include cervical cancer screen, breast cancer screen, medical utilization and the HRQL(SF-36). The results of this cross-sectional study are analyzed by binary logistic regression, independent t analysis and linear regression. Results： There are 2481(37.2%) women who received cervical cancer screen and 4202(62.8%) who didn’t. The predictors include：age, marital status, dyslipidemia, uterian and ovarian disease, birth of child, hormone replacement therapy, general health examination, influenza vaccine, breast self examination(OR=2.92, 95%CI=2.53-3.38), breast examination by physician(OR=5.97, 95%CI=4.87-7.33), and bone marrow density (BMD) examination(OR=2.40, 95%CI=1.97-2.91)。 There are 943(14.1%) women who received breast ultrasound and 551(8.2%) who received mammography. The predictors of breast ultrasound and mammography include：age、breast self examination(OR=1.69, 95%CI=1.39-2.05; OR=1.74, 95%CI=1.38-2.19, respectively)、breast examination by physician(OR=30.23, 95%CI=24.21-37.74; OR=17.18, 95%CI=13.09-22.56, respectively)、BMD examination(OR=1.75, 95%CI=1.43-2.14; OR=1.97, 95%CI=1.58-2.45, respectively) and rectoscope(OR=3.00, 95%CI=1.95-4.61；OR=2.76, 95%CI=1.79-4.25, respectively)。Uterian and ovarian disease is also an predictor of mammography（OR＝1.46, 95%CI=1.03-2.08）。 The predictors of medical utilization include：1. Number of clinic visits：age，chronic disease(except stroke and dyslipidemia)、hormone replacement therapy、general health exam、influenza vaccine、pap smear and breast ultrasound are positive predictors；family income above 50000 and betel nuts chewing are negative predictors。2. Hospitalization：chronic disease and stool occult blood exam are positive predictors；BMD examination、exercise are negative predictors。3. Total medical cost：age、 chronic disease、influenza vaccine、stool occult blood exam and rectoscope are positive predictors；exercise is negative predictor。 The average score of general physical health is 51.54，the average score of general mental health is 48.23。For HRQL，age is an obvious predictor，while the older have better general physical health and worse mental health。Women with higher familial income、better education、no chronic disease、no uterian and ovarian disease、no hormone replacement、more habit of exercise、no smoking or betel nuts chewing have better quality of life in physical and mental dimensions。 Conclusions and Suggestions： The cancer screen rate is 62.8% for pap smear, 14.1% for breast ultrasound and 8.2% for mammography。Since the higher pap smear rate may be due to free of charge, the government can consider to promote free breast cancer screen in the future. Breast self examination、breast examination by physician and BMD examination are common predictors of pap smear, breast ultrasound and mammography. The elderly and chronic disease patients are main users of medical utilization. The women who have exercise have lower admission rate and lesser medical cost. The government should encourage the public to build up health lifestyle to decrease chronic disease and medical cost. Health behavior is predictor of HRQL. The women who have exercise have better life quality. The government should encourage the public to build up health lifestyle to improve life quality.