台灣地區早產與低出生體重嬰兒死亡趨勢分析

The trends of preterm and low birth weight infant mortality in Taiwan.

陳泰安(Tai-An Chen)

指導教授 ： 楊俊毓

高雄醫學大學/健康科學院/公共衛生學研究所/碩士(2005年)

摘要

摘要
背景：早產與低出生體重兒為造成新生兒死亡主要原因之一，也是用以當做一個國家衛生與福利優劣之指標。

研究目的：觀察台灣地區民國84年至92年間，早產兒與低出生體重兒死亡趨勢之情形。並進一步依性別、季節與地區別區分，觀察早產兒與低出生體重兒死亡趨勢之變化。

材料與方法：本研究為描述性研究，資料來源為合併內政部之出生資料檔與死亡資料檔，研究期間為民國84年1月至92年12月止，研究對象為出生後1個月以內死亡、懷孕週數介於20至36週、出生體重介於500至2499公克之嬰兒，在各變項與出生體重和懷孕週數方面，以卡方統計求其死亡相對危險性，在死亡趨勢方面，以簡單迴歸觀察趨勢是否有下滑，並進一步依性別、季節與地區以作觀察，死亡趨勢之變化。

結果：在性別與出生體重方面，男嬰與女嬰具有明顯差異(OR=1.14)；在性別與懷孕週數方面，男嬰與女嬰不具有明顯差異(OR=1.02)；在季節與出生體重及懷孕週數方面，夏季早產兒或低出生體重兒死亡相對危險性都明顯高於冬季(OR=1.21和OR=1.17)；地區別與早產兒及低出生體重兒方面，北部地區與東部地區均有明顯之差異(OR=0.77和OR=0.84)；母親年齡15至19歲與30至34歲，早產兒或低出生體重兒死亡率，均較母親年齡20至24歲高；隨著懷孕週數與出生體重增加，早產兒與低出生體重兒死亡率愈低；在死亡趨勢方面，早產兒與低出生體重兒死亡趨勢均有顯著下滑(P<0.01)，在男嬰與女嬰方面均是如此。早產四季死亡之趨勢均有顯著下滑，低出生體重兒四季死亡之趨勢，冬季死亡趨勢下滑並不明顯。地區別早產兒死亡趨勢方面，台北市、北部地區與中部地區有明顯下滑；地區別低出生體重死亡趨勢方面，也是台北市、北部地區與中部地區有明顯下滑。

討論與結論：近幾年來，台灣地區的早產兒與低出生體重死亡之趨勢，都有顯著下滑的情形，這可能是因為加強產前與早產兒照護、醫療助產工具或藥物的使用，與青少女(年齡低於20歲)懷孕生產的比例下降所致。但在季節別早產與低出生體重兒死亡死亡趨勢方面，雖然所觀察之結果，死亡趨勢於某些季節有顯著下滑的現象，但影響原因至今仍不明確。又在地區別方面，東部地區早產與低出生體重兒死亡趨勢，並沒有明顯之下滑，但在台北市與北部地區，死亡趨勢則有明顯往下的現象，可能的原因為地區間彼此人口特性有所差異，與醫療方式、醫療院所病床設施差異所致。

關鍵字

死亡趨勢 ； 早產 ； 低出生體重 ； 季節 ； 性別 ； 地區別

並列摘要

Abstract
Background：
Premature and low birth weight (LBW) are the major factors causing infant mortality. They are also indicators of the health and welfare status in a country.

Purpose：
The purpose of this study is to investigate the trend of the premature and the LBW infant mortality. In addition, we stratified the mortality by sex, season and area to see whether the trends are different.

Material＆methods：
We combined the birth registration data and the death certification data from 1995 to 2003. The study population are the premature and the low birth weight infants who died within one month after birth. The infants whose gestational age was between 20 and 36 weeks were defined as premature; the infants whose birth weight was between 500 to 2499 g were defined as LBW. We use the X2 to calculate the odds ratio and simple linear regression to describe the trend of the mortality.

Results：
We found that the mortality in male LBW infants is higher than female ones (OR=1.14, p<0.05), but we do not found the same relationship in the mortality of premature. Analysis of seasonality by premature and LBW shows that the mortality in summer is significantly higher than in winter (OR=1.21, 1.17, respectively). And the mortality is also different between northern region and eastern region. With the increasing of gestational age and birth weight, the mortality decrease. In addition, during the studying period, the mortality trends of premature and LBW both decrease significantly.

Conclusions：
Recently, the trends of the mortality of premature and low birth weight infant have significant decreases. The reasons might be the introduction of the better methods in prenatal, perinatal and premature cares. When the mortality are stratified by region, we only see the trends decreased significant in Taipei City and the northern region. The possible reasons may as a result of the different levels of the medical resources. We also found the trends are not the same in different seasons, but further investigation are needed to explain this finding.

並列關鍵字

low birth weight ； mortality trend ； preterm ； season ； sex ； area

參考文獻

英文參考文獻

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