骨質疏鬆症合併憂鬱症其健康相關生活品質與醫療資源利用之探討-以NHANES資料庫為例

A study on Health-Related Quality of Life and Health Care Resource Utilization Among Osteoporosis Patients with depression : The National Health and Nutrition Examination Surveys

許惠茹(Hui-Ru Hsu)

指導教授 ： 翁世峰

高雄醫學大學/健康科學院/醫務管理暨醫療資訊學系碩士班/碩士(2017年)

摘要

研究背景與目的
骨質疏鬆症被世界衛生組織(WHO)視為引發嚴重疾病的主要原因，如:髖部、脊椎骨折，而憂鬱症是全世界三大疾病之一。過去研究主要針對此兩種疾病的相關性與因果關係探討，少有以骨質疏鬆症合併憂鬱症為目標族群進行分析。因此，本研究目的:(1)探討骨質疏鬆症合併憂鬱症患者之健康相關生活品質；(2)探討骨質疏鬆症合併憂鬱症之醫療資源利用。
研究方法
本研究為橫斷面研究，以美國次級資料庫National Health and Nutrition Examination Survey (NHANES)分析2005年至2010年與2013年至2014年(8年)間，40歲以上受試者，共計9776人。並將其分為四組:(a)骨質疏鬆症(+)與憂鬱症(+)(142人)(b)骨質疏鬆症(+)與憂鬱症(-)(999人)(c)骨質疏鬆症(-)與憂鬱症(+)(767人)(d)骨質疏鬆症(-)與憂鬱症(-)(7868人);在健康相關生活品質採用美國CDC研發的HRQoL-4工具；統計分析使用SAS軟體，利用複迴歸與邏輯斯迴歸探討四組的健康相關生活品質、醫療資源利用是否有所不同。
研究結果
本研究中有骨質疏鬆症合併憂鬱症的人當中84.51%為女性，平均年齡64.01歲。與沒有罹患此兩種疾病的人相比，骨質疏鬆症合併憂鬱症過去30天內身體不舒服天數多10.94天;心理不舒服天數多14.13天;因為心理或身體不舒服導致你無法維持日常生活的天數多10.25天;健康狀態較差/普通機率是7.40倍(95% CI=4.80~11.4，P<0.001);一年內使用醫療資源4次以上機率是3.25倍(95% CI=2.12~5.00，P<0.001);一年內有住院機率是2.71倍(95% CI=1.89~3.90，P<0.001)。
結論與建議
本研究透過美國數據發現到骨質疏鬆症合併憂鬱症，其生活品質相較其他族群是最差的，醫療資源利用也是最多的，將來可以利用台灣健保資料庫做對照，比較是否有相同結果產生。未來可以進一步探討當醫療資源利用越多，能否改善與產生更好的生活品質，抑或是導致死亡率下降。

關鍵字

骨質疏鬆症 ； 憂鬱症 ； 健康相關生活品質 ； 醫療資源利用 ； NHANES

並列摘要

Background:
Osteoporosis has been recognized by the World Health Organization (WHO) as the leading cause of serious disease problems, such as hip or vertebral fractures. In addition, depression is one of the three major diseases in the world. Althought many studies have focused on the correlation and causation of these two diseases there has been limited analysis for osteoporosis complicated with depression as the target group. The purpose of this study was: (1) to explore health-related quality of life among osteoporosis with depression patients; (2) to explore medical resources utilization among osteoporosis with depression patients.
Method:
This cross-sectional study used the National Health and Nutrition Examination Survey (NHANES) to analyze patients, who are over 40 years old from 2005 to 2010 and 2013 to 2014 (8years). A total of 9776 patients were classified into four groups: (a) osteoporosis (+) and depression (+) (N=142); (b) osteoporosis (+) and depression (-)(N=999); (c) osteoporosis (-) and depression (+)(N=767); (d) osteoporosis (-) and depression (-)(N=7868).The health-related quality of life was determined to use the HRQoL-4 tool developed by the Centers for Disease Control and Prevention in U.S. Multiple regression and logistical regression analysis were to analyze health-related quality of life and medical resources utilization between groups.
Result: Among all of the patients with osteoporosis (+) and depression (+), 84.51% were female, and the mean age was 64.01 years old. In comparing the group of osteoporosis (+) and depression (+) patients to the group of osteoporosis (-) and depression (-) patients, there were 10.94 more days in wores physical health, 14.13 more days in worse mental health, and 10.25 more days in inactive days due to physical or mental health during the past 30 days. The risk was 7.40 times (P <0.001) higher for poor / general health status, 3.25 times higher (P<0.001) for receive healthcare over past year, and 2.71 times higher (P<0.001) for overnight in hospital in osteoporosis (+) and depression (+).
Conclusion:
This study through NHANES found that patients with osteoporosis and depression, whose quality of life compared to other groups is the worst but medical
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resources utilization is the most. In the future, we can use the National Health Insurance Research Database as a comparison to measure whether the results will be the same. Also, we can be further explored when we use more medical resources, we can improve and produce better quality of life, or lead to a decrease in mortality.

並列關鍵字

Osteoporosis ； Depression ； Medical resources utilization ； Quality of Life ； NHANES

參考文獻

Chie, W. C., Yang, R. S., Liu, J. P., & Tsai, K. S. (2004). High incidence rate of hip fracture in Taiwan: estimated from a nationwide health insurance database. Osteoporos Int, 15(12), 998-1002. doi: 10.1007/s00198-004-1651-0

Lau, E. M., Lee, J. K., Suriwongpaisal, P., Saw, S. M., Das De, S., Khir, A., & Sambrook, P. (2001). The incidence of hip fracture in four Asian countries: the Asian Osteoporosis Study (AOS). Osteoporos Int, 12(3), 239-243. doi: 10.1007/s001980170135

英文部分

Al-Sari, U. A., Tobias, J., & Clark, E. (2016). Health-related quality of life in older people with osteoporotic vertebral fractures: a systematic review and meta-analysis. Osteoporos Int, 27(10), 2891-2900. doi: 10.1007/s00198-016-3648-x

Ankita Modi, Deborah T. Gold, Xiaoqin Yang, Chun-Po Steve Fan, & Shiva G. Sajjan. (2015). .