糖尿病病患接種流感疫苗成效之探討

目的本研究目的是藉由國家衛生研究院健保資料庫的次級資料分析，以探討糖尿病病患在流行感冒疫苗的接種前後對醫療利用、醫療費用以及併發肺炎和死亡率的影響。方法利用重複量數雙因子變異數分析（repeated measures two-way ANOVA）從國衛院健保資料庫的承保抽樣歸人檔共四組，選擇2002年擷取糖尿病(主診斷為ICD-9-CM 250.** )病人資料，擷取出定義為糖尿病：即任一個診斷碼前三碼為250.**且至少門診二次或住院一次之糖尿病個案。在糖尿病個案中於2002~2003兩年皆無接種流行性感冒疫苗的病人為比較組。在糖尿病個案中於2002~2003兩年皆有接種流行性感冒疫苗的病人為實驗組，再以對照組控制人口特質中的年齡和性別，以一比一配對同樣的性別與接近的年齡（± 3歲）擷取出實驗組的研究個案，再串連2001~2004年的門診處方治療明細檔與住院醫療費用清單明細檔資料、健保承保資料檔。結果糖尿病病人有無接種流感疫苗和接種前後與在門、急診就醫次數、住院天數及門、急診醫療費用、住院醫療費用無顯著差異。在比較兩組接種流感疫苗前後併發肺炎之差異上，在接種流感疫苗前後得到肺炎有顯著相關（p<0.0001）。而糖尿病病人是否有腎臟病、冠狀動脈心臟疾病、腦中風合併症，無接種流行性感冒疫苗病人其死亡風險是有接種流行性感冒疫苗病人的1.5至4倍。結論在醫療利用方面：糖尿病病患有接種流行性感冒疫苗者比沒有接種者急診、門診就診次數沒有較少，住院天數不會較短。在醫療費用方面：糖尿病病患有接種流行性感冒疫苗者比沒有接種者急診、門診、住院費用不會較低。在併發肺炎、死亡率方面：糖尿病病患有接種流行性感冒疫苗者比沒有接種者併發肺炎不會較低，糖尿病病患有接種流行性感冒疫苗者比沒有接種者死亡率會較低。

關鍵字

糖尿病；流感疫苗；醫療利用；醫療費用

並列摘要

Objective This present study aims to assess the effectiveness of the medical utilization and expenditures of influenza vaccine administered to diabetic patients in Taiwan using secondary analysis of database obtained from the National Health Insurance. Research design and methods A quasi-experimental design was constructed for the evaluation of the effectiveness of the medical utilization and expenditures of influenza vaccine administered to diabetic patients. The secondary data were extracted from the National Health Insurance during the years 2001-2004. The coding for the diagnosis of diabetes was according to the ninth revision of the International Classification of Diseases. The intervention group was defined that diabetic patients administered influenza vaccine during the consecutive year 2002-2003, the comparison group was the diabetic patients who did not administered influenza vaccine at the same time(2002-2003) after matching age (±3 years) and sex. Data of both groups was also linked to the OPD prescription and treatment files and inpatient medical expenditures. The repeated measures two-way ANOVA was used for the evaluation of the effectiveness of the influenza vaccine administration for a pre-and-post test study design. Results From the results of repeated measures of two-way ANOVA showed that influenza vaccination was not significantly associated with a reduction in the number of visits to a physician, emergency service, length of hospital stay, costs of physician, emergency visits, and hospitalization. There are 1.5 to 4 times of mortality rate in non-influenza vaccination diabetic patients with kidney disease、coronary artery disease and stroke than influenza vaccination diabetic patients. Conclusion From the perspective of medical utilization, vaccination was not significantly associated with reducing emergency and OPD visits. From the perspective of medical expenditure, vaccination was not significantly associated with emergency, OPD and hospitalization. Actually, there was existing significant reduction in mortality rate with vaccination and but not significant in complication with pneumonia.