生活中危險因子對慢性腎臟相關疾病醫療使用之影響

The Influence Of Risk Factors On The Medical Care Utilization Of The Chronic Kidney Diseases

高子芸(Tzu-Yun Kao)

指導教授 ： 劉彩卿

國立臺北大學/公共事務學院/財政學系/碩士(2014年)

摘要

慢性腎臟病自1997年以來始終名列我國十大死因之一，由於國人不良的用藥與飲食習慣，造成腎臟負擔，使台灣洗腎人口佔世界排名居高不下，每年健保洗腎給付支
出，成了健保最大的負擔之一。若以生活中的危險因子、不良習慣等去評估罹患慢性腎臟相關疾病之高風險群，不僅能探討健保資料庫中慢性腎臟相關疾病患者之醫療使用情形，未來也能針對高風險群進行個案管理。

本研究旨在探討生活中危險因子對慢性腎臟相關疾病醫療使用之影響，使用2005年國民健康訪問調查及2005年全民健康保險資料庫進行橫斷面分析，並採用Duan(1983) 兩部模型法，本研究將自變數分為五組，第一部使用羅吉斯迴歸估計生活中危險因子造成慢性腎臟相關疾病醫療使用上發生之機率，第一組樣本共17966人、第二組、第三組及第四組樣本共17978人、第五組樣本共17923人；第二部使用負二項迴歸計算生活中危險因子與慢性腎臟相關疾病醫療使用次數之關聯性以及最小平方線性迴歸估計生活中危險因子造成個人醫療總支出上之結果，第一組樣本共963人、第二組、第三組及第四組樣本共964、第五組樣本共963人。

實證結果發現，性別、年齡、個人疾病史、成人健康檢查及食用成藥等皆對於慢性腎臟相關疾病醫療使用有所影響，因此未來若能針對慢性腎臟病之高危險群進行個案管理，以期早期發現，積極治療與介入，將有效延緩進入透析治療之時機與併發症之發生，降低晚期腎臟病之發生率，以維護國人健康並減輕健保財務負擔。

關鍵字

藥物濫用 ； 慢性腎臟病 ； 醫療利用

並列摘要

Chronic kidney disease has been ranked one of the top ten causes of death in Taiwan since 1997, which results in huge financial burden for patient individuals and National Health Insurance System. The bad eating habits and drugs abuse might be the major risks of such disease causing medical expenditures, but little research examines their impacts on the related utilization of medical care of chronic kidney disease.

The purpose of this study is to explore how risk factors, focusing on the characteristics of drinking, smoking, history of family disease, and personal factors affect the utilization of medical care. Data used in this study is selected from 2005 National Health Interview Survey (NHIS) and 2005 National Health Insurance Research Database (NHIRD) .Using a two- part model, we are able to estimate the probability of medical care use and the amount of sequent medical care use. In the first part ,we estimate the occurrence of medical care use by logistic regression. Then, in the second part,we analyze the outpatient visits by negative binomial regression,as well as the medical expenditure by using ordinary least square regression. In addition, we divide the sample into five groups to meet the different study purposes.

The results indicate that gender, age, the personal history of disease, the health exam and drugs abuse are significantly associated with chronic kidney disease related medical care use. Therefore, health authority needs to put more efforts on educating people the avoidance of drugs abuse and importance of preventive care to promote people’s health and improve the financial crisis of National Health Insurance.

並列關鍵字

chronic kidney disease ； utilization of medical services ； drugs abuse

參考文獻

BAKRIS, G. L. R., E. 2009. Hypertension and kidney disease, a marriage that should be prevented. Iranian Journal of Kidney Disease 3, 7-10.

BRUCE, M. A., BEECH, B.M., CROOK, E.D., SIMS, M., WYATT, S.B., FLESSNER, M.F., TAYLOR, H.A., WILLIAMS, D.R., AKYLBEKOVA, E.L., IKIZLER, T.A. 2010. Association of Socioeconomic Status and CKD Among African Americans: The Jackson Heart Study. American Journal of Kidney Diseases, 55, 1001-08.

CHANG, W. Z., CHU, H.T.,YANG, C.S.,CHEN, C.C. 2008. The factors of chronic kidney disease: diabetes,hypertension,smoking,drinking,betelnut chewing. JCMIT, 75-79.

CHEN, N., WANG, W.M.,HUANG, Y.P. ET AL. 2009. Community-based study on CKD subjects and the associated risk factors. Nephrology Dialysis Transplantation, 24, 2117-23.

CHIU, Y. L., CHIEN,K.L,LIN,S.L.,CHEN,Y.M.,TSAI,T.J.,WU,K.D. 2008. Outcomes of Stage 3-5 Chronic Kidney Disease before End-Stage Renal Disease at a Single Center in Taiwan. Nephron Clin Pract 109, 109-18.