後期慢性腎臟病在台灣鄉鎮市區之地理分布差異:全國性之研究

Geographic variations of township-specific prevalence of late-stage chronic kidney disease in Taiwan: A nationwide population study

葉玉雄(Yit-Sheung Yap)

指導教授 ： 莊弘毅

高雄醫學大學/健康科學院/公共衛生學研究所/碩士(2014年)

摘要

研究背景: 在台灣，有關鎮區程級之後期慢性腎臟病盛行率的地理分布研究甚少。因此，本研究主旨為探討後期慢性腎臟病（IIIb－V期）的地理分布差異及顯示高盛行率危險區域。
研究方法：本研究利用參與2009年及2010年成人預防保健且幾乎大於40歲之成年人資料（兩年分別為1,657,883 and 1,529,624的參與者），計算台灣372鄉鎮市區（n >30）的後期慢性腎臟病盛行率．本研究將2010年的後期慢性腎臟病盛行率當作訓練樣本組，以（平均－標準差）及（平均＋標準差）為界限點分為三個程級，再將同樣的界限點運用在被設為驗證樣本組的2009年之程級區分，以便達成最後結果之校正．接著，結合兩年的程級然後區分為五大危險區域等級．另外，本研究也使用適合度檢定及以上類似的方法，將兩年以標準疾病比區分的程級結合，再劃分成數個危險區域組別．
結果:　2010年及2009年的後期慢性腎臟病盛行率分別為6.3%及6.9%．使用平均±標準差程級區分方法而得到的五大危險區域之盛行率中位數分別為3.8%（低）, 4.1%（中低）, 5.9%（中等）, 7.4%（中高）及9.6%（高）．另外，使用適合度檢定方法得到的結果顯示，共有56個鄉鎮區連續兩年都有顯著的高盛行率，其中20個鄉鎮區的兩年標準疾病比都介於1與1.5之間，12個鄉鎮區兩年的標準疾病比則都大於等於1.5。總結來看，後期慢性腎臟病具有地理分布差異，高危險區域主要落在中部、南部西邊山區及南部東邊沿海區。
結論：後期慢性腎臟病具有地理分布差異。因此，需要更多的研究來探討分布差異的原因以及更多的慢性腎臟照護政策應實施在這些高危險區域。

關鍵字

地理分布差異 ； 後期慢性腎臟病 ； 鄉鎮區程級 ； 標準疾病比

並列摘要

Background: Although there are reports documenting geographic variations of end-stage renal disease, studies of regional patterns of chronic kidney disease (CKD) prevalence at the township level are lacking. Hence, this study aimed at investigating the geographic differences of late-stage CKD (CKD stages 3b-5) and its high-risk region.
Methods: Prevalence rates of late-stage CKD for 372 townships (n >30) were calculated for 1,529,624 and 1,657,883 subjects in year 2010 and 2009 respectively, who almost aged 40 years or older and participated the adult preventive service program. Township-specific prevalence rates of late-stage CKD in year 2010 were divided into three grades by using (mean–SD) and (mean+SD) as cut points; year 2009, defined as validation set, used the cut points to validate the results. Grades of both years were combined and categorized into five risk regions. Additionally, standardized morbidity ratio (SMR) groups of both years were also combined and categorized into different risk groups, with using goodness-of-fit analysis and the similar methods as mentioned previously.
Results: The prevalence of late-stage CKD in year 2010 and 2009 were 6.3% and 6.9% respectively. The median prevalence rates for five risk regions which defined as lower, low, medium, high and higher were 3.8%, 4.1%, 5.9%, 7.4% and 9.6% respectively. Additionally, fifty-six townships had significantly higher rates of prevalence for the two consecutive years, including 20 townships with 1≤SMR<1.5 and 12 townships with SMR≥1.5. Geographic variations were observed, notably high rates of disease in areas of the central, southwestern mountainside and southeastern seaside.
Conclusion: There was geographic variation of late-stage CKD. Further studies should investigate the causes behind the geographic difference and more CKD preventive care should be launched in these high-risk regions.

並列關鍵字

geographic variations ； late-stage chronic kidney disease ； township-level ； standardized morbidity ratio

參考文獻

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