兒童風濕疾病對於病人罹癌風險及其罹癌前醫療利用之探討

Population-Based Cohort Study on the Risk of Cancer and Percancerous Medical Utilization in Children with Rheumatic Disease

林佟威(Tung-Wei Lin)

指導教授 ： 馬震中

義守大學/醫學院/醫務管理學系/碩士(2016年)

摘要

目的：
風濕疾病的臨床表現是一種慢性的炎症，可能會增加罹癌風險，因此本研究目的在探討台灣地區兒童風濕病人罹癌之風險及其醫療利用之情形。
方法：
本研究採回溯性研究設計，運用次級資料來分析，資料來源為全民健康保險研究資料庫，觀察時間自2000年至2012年，研究對象為18歲(含)以下診斷為風濕疾病之病人，以紅斑性狼瘡、幼年特發性關節炎、修格連氏症候群/乾燥症候群、全身性硬化症、多發性肌炎、皮肌炎、血管炎及貝西氏病等八種常見的風濕疾病作為觀察對象，共蒐集1741位樣本；對照組方面，採性別與出生年進行四倍配對；以Cox models分析罹癌症的風險，並以T檢定分析病人罹癌前一年的醫療利用是否有所差異。
結果：
整體兒童風濕病人相較於兒童非風濕病人約多5.87倍罹癌風險，其中紅斑性狼瘡、幼年特發性關節炎、修格連氏症候群與血管炎的罹癌風險分別為5.66倍、9.49倍、9.64倍與4.9倍；治療藥物中，曾使用免疫調節劑者的罹癌風險約增加5.65倍，曾使用生物製劑的罹癌風險高出約26.01倍；在醫療利用方面，比較兒童風濕病人在罹癌前一年與罹癌前整體之醫療利用，發現有門診次數與費用增加但住院次數、天數與費用減少的情形，經T檢定後均未達顯著差異。
結論與建議：
綜合研究結果，本研究建議衛生主管機關應加強重視兒童風濕病人的醫療照護，以避免將來支出更多的社會成本。

關鍵字

兒童 ； 風濕疾病 ； 癌症 ； 醫療利用

並列摘要

Objective:
Chronic inflammation is the clinical manifestations of pediatric rheumatic disease and can increase the risk of cancer. The study is to investigate the risk of cancer and percancerous medical utilization in children with rheumatic disease.
method:
The design of this study is retrospective study with secondary data analysis. The sources of the data were drawn from National Health Insurance Research Database from 2000 to 2012 years. Patients under age eighteen and with a diagnosis of pediatric rheumatic disease, including systemic lupus erythematosus, juvenile idiopathic arthritis, Sjögren's syndrome, Scleroderma, Polymyositis, Dermatomyositis, Vasculitis and Behçet's disease. 1,741 participants were observed. Gender and age quadruple pairing were adopted in control group. Risk of cancer was analyzed by Cox Models; T test used to see the differences of medical utilization a year before acquiring cancer.
Results:
The ratio of the risk of cancer of pediatric rheumatic patients to the risk of cancer of non-pediatric rheumatic patients is 5.87 to 1; specifically, systemic lupus erythematosus(5.66), juvenile idiopathic arthritis(9.49), Sjögren's syndrome(9.64), and Vasculitis(4.9). Regarding drug utilization, the risk of cancer for those who used immunoregulatory drugs increases 5.65 times; while for those who used biologics, the risk of cancer increases 26.01 times. Comparing pediatric rheumatic patients, their medical utilization a year prior to cancer with their history of medical utilization before cancer, they found that number of outpatients visits and medical cost are on the increase, but a decrease in hospitalization numbers, days and cost. No significant differences were found by the T test.
Conclusions and Recommendations:
It is recommended that Ministry of Health and Welfare and health department of local city governments should put more efforts on the medical care of pediatric rheumatic patients to reduce social cost in the future.

並列關鍵字

Children ； pediatric rheumatic disease ； Cancer ； Medical utilization

參考文獻

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