糖尿病病人高診次利用之相關因素探討

目的：台灣因人口老化、慢性病人口以及重大傷病人口的增加，造成許多民眾產生高醫療利用的現象。糖尿病為盛行率相當高的慢性病，若合併其他共病症，常伴隨高醫療利用的情形。本研究目的主要在分析門診糖尿病病人發生高診次與否之相關因素。方法：本研究使用全民健康保險研究資料庫2010年2010年承保抽樣歸人檔為資料來源，從資料庫中擷取2011年門診主、次診斷ICD-9 CM前三碼為250有三次就醫紀錄且就醫次數≧100次之高診次病人為研究對象，利用病例對照研究法（Case-control Study）以1：4比例進行性別與年齡配對。使用條件式邏吉斯迴歸分析影響門診糖尿病病人發生高診次與否之相關因素。結果：2011年門診糖尿病病人共55,050人，其中高診次病人有387人。影響門診糖尿病病人高診次利用之因素，病人特性方面，居住於中都市化程度與低都市化程度相較於高都市化程度有較高的高診次勝算比（OR＝2.178與OR＝2.231）；低收入戶比非低收入戶有較高的高診次勝算比（OR＝5.220）；榮民榮眷比非榮民榮眷有較高的高診次勝算比（OR＝2. 031）。疾病特性方面，相對於對照組，罹患癌症有較高的高診次勝算比（OR＝2.003）；罹患視網膜病變有較高的高診次勝算比（OR＝3.718）；罹患腎病變比有較高的高診次勝算比（OR＝2.795）；罹患神經病變有較高的高診次勝算比（OR＝2.599）；罹患氣喘患有較高的高診次勝算比（OR＝6.570）；罹患憂鬱症有較高的高診次勝算比（OR＝4.729）；罹患焦慮症有較高的高診次勝算比（OR＝2.940）；罹患中風有較高的高診次勝算比（OR＝2.477）；罹患周邊血管病變有較高的高診次勝算比（OR＝2.133）；罹患風濕性關節炎有較高的高診次勝算比（OR＝3.393）。結論：居住地都市化程度低、經濟條件差、多重共病症等因素是影響門診糖尿病病人高診次利用的重要因素。政府單位對於經濟弱勢族群可提供更多的糖尿病相關醫療資源，醫療機構對於糖尿病人且同時共存其他特定疾病者在醫療處置時應同時予以考量。

關鍵字

糖尿病；高診次；危險因素；共病症

並列摘要

Objectives: The increasing population of older adults, patients with chronic diseases, and patients with catastrophic illnesses in Taiwan has resulted in the high utilization of medical resources. Diabetes is a chronic disease with high prevalence and often leads to a high utilization of such resources when patients have other comorbidities. The purpose of this study was to explore factors related to the high medical utilization of patients with diabetes. Methods: This study used the 2010 Longitudinal Health Insurance Database from the National Health Insurance Research Database as the source. Research participants were extracted from the database based on their medical records in 2011; these were patients who had received three primary or secondary diagnoses with an ICD-9-CM code that had 250 as the first three digits (i.e., 250.00–250.91). These patients exhibited high medical utilization and had each attended the hospital at least 100 times. A case–control study was conducted, and the case and control groups were gender- and age-matched at a ratio of 1:4. A conditional logic regression analysis was performed to examine relevant factors for the high medical utilization of patients with diabetes. Results: In 2011, the total number of patients with diabetes was 55,050, of which 387 exhibited high medical utilization. Factors contributing to high medical utilization among patients with diabetes were also examined. Based on patient demographics, a relatively high odds ratio (OR) regarding medical resource utilization was observed for those who lived in areas of moderate urbanization (OR = 2.178) and low urbanization (OR = 2.231) compared with those who lived in areas of high urbanization. Low-income patients (OR = 5.220) exhibited higher ORs than non-low-income patients did. Patients who were the dependents of veterans (OR = 2.031) had higher ORs than those who were not. Regarding disease characteristics, this study compared the ORs of patients with certain comorbidities and those in the control groups. The results showed that patients with the following comorbidities exhibited higher ORs regarding medical resource utilization: cancer (OR = 2.003), retinopathy (OR = 3.718), nephropathy (OR = 2.795), neuropathy (OR = 2.599), asthma (OR = 6.570), depression (OR = 4.729), anxiety (OR = 2.940), stroke (OR = 2.477), peripheral vascular lesions (OR = 2.133), and rheumatoid arthritis (OR = 3.393). Conclusion: Factors contributing to the high medical utilization of patients with diabetes included low urbanization at their place of residence, poor economic conditions, and multiple comorbidities. Relevant government units should provide economically underprivileged groups with more diabetes-related medical resources. Medical institutions should also consider providing additional resources to patients with diabetes and certain comorbidities when performing corresponding medical treatments.