台灣地區四十歲以上成人健康危害行為情況對於自覺疾病狀況及醫療利用率影響之探討

The Effects of Health Risk Behaviors on Perceived Disease Status and Medical Utilization among Adults 40 and Older in Taiwan

柯富勝(Fu-Sheng Ko)

指導教授 ： 張明正

亞洲大學/健康學院/健康管理研究所/碩士(2006年)

摘要

本研究主要探討台灣地區四十歲以上成人吸菸、嚼食檳榔、飲酒等三種健康危害行為情況對自覺疾病狀況及醫療利用率之影響。所涉及之影響因素除了此三種健康危害行為外，尚包括人口與社會經濟特性，因而本文進一步探討在控制其他有關因素下，此三種健康危害行為情況對自覺疾病狀況及醫療利用率之淨影響。
本研究主要利用民國九十年度『國民健康訪問調查』的資料，篩選出四十歲以上者為研究對象。並配合卡方及複迴歸統計方法加以分析。
分析結果顯示：（1）2001年台灣地區四十歲以上的民眾吸菸率為29.6%、飲酒率為25.8%、嚼食檳榔率為10.3%；有一種健康危害行為的比例為22.4%、有兩種健康危害行為的比例為13.6%、有三種健康危害行為的比例為5.3%。（2）民眾自覺有一種疾病的盛行率為27.3%、有兩種疾病的盛行率為14.2%、有三種以上疾病的盛行率為12.1%，也就是說有一種疾病以上的盛行率高達53.6%，而平均每人患有0.98個疾病數。（3）民眾過去一年每人平均住院利用次數為0.17次，急診利用次數為0.17次，而過去一個月每人平均門診利用次數為1.38次。（4）健康危害行為情況會隨著不同人口與經濟社會特性而有顯著差異，具有較多健康危害行為的族群特徵為：較年輕者、男性、無正式教育、未婚、鄉下地區、大台北地區。（5）健康危害行為情況對於疾病數、急診利用次數沒有顯著影響，但對住院、門診利用次數有顯著負向影響。
其中在控制相關因素後，健康危害行為情況對於疾病數、急診利用次數沒有顯著影響，但對住院、門診利用次數有顯著負向影響。此現象與預期結果相反，可能與本文所利用以分析之橫斷面資料有關。更具體來說，具有健康危害行為者若病情較嚴重者可能大都已死亡，因而在橫斷面資料所呈現者可能較無疾病者、疾病程度較輕者，或者是還沒發病者，自覺沒有疾病問題，以致醫療利用次數也較少。
因此本研究建議未來要探討健康危害行為對疾病數及醫療利用影響的研究採用長期追蹤的研究方法，且納入更多種類的健康危害行為，以便能更明顯看出其之間的影響關係。也建議衛生單位針對有健康危害行為者加強健康檢查，更明確了解自身的健康狀況。

關鍵字

健康危害行為 ； 自覺疾病狀況 ； 醫療利用

並列摘要

The focus of this study was on people among adults 40 and older in Taiwan and the effects of the perceived disease status and the rates of medical utilization, if they smoked cigarettes, chewed betel nuts, or drank alcoholic drinks. Besides these three kinds of factors, there were others that may affect the result such as the demographics and the social economy. For this reason, this study looked further into the net effects of the above three factors by controlling the other factors.

The data resources of this study came from the National Health Interview Survey (2001), and selected people over the age of 40 for the samples. This study was analyzed by statistical ways in Chi-square Test and Multiple Regression Analysis.

Results showed the following: (1) The rate is 29.6 percent for smoking, 25.8 percent for drinking and 10.3 percent for chewing in Taiwan 2001. And the rate for only one of the three factors is 22.4 percent, both of the three is 13.6 percent, and all of the three is 5.3 percent. (2) In the perceived disease status, the prevalence rates of one disease is 27.3 percent, two diseases is 14.2 percent, and over and above three diseases is 12.1 percent. In other words, the prevalence rates of people who were over the age of 40 had over and above one disease is very high, 53.6 percent, and the average is 0.98 diseases per person. (3) In the medical utilization, during the past year, the average of the hospitalization was 0.17 times per person, and the emergency treatment was 0.17 times. And during the past month, the average of outpatient services was 1.38 times per person. (4) The health risk behavior had a significant difference with the change of the demographics and the social economy. The severe group in health risk behavior is as follows: younger, male, less-educated, unmarried, countryside, and Taipei area. (5) By controlling the other factors, the health risk behavior didn’t have any significant affects about the number of diseases and the frequencies of emergency, but it had a significant negative affection in the frequencies of hospitalizations and outpatient treatments.

For the 5th point given above, the result didn’t match our expectation. It was probably related to the cross-section data which this study used to analyze. In more concrete speaking, people who had health risk behavior might have died already, if their illnesses were more serious. Thus the cross-section data just showed the people who were either truly healthy, or believed to be healthy, or had minor illnesses. And this reason led into the less medical utilization.

In this conclusion addressed above, this study advised the other researchers who will do the same kind of study in the future that they should analyze with a long-term traceable methods, and should add more factors into the study to show the effects clearly. This study also advised the health organizations that they should improve the physical examination for the people who had health risk behavior to understand their physical status explicitly.

並列關鍵字

health risk behavior ； perceived disease status ； medical utilization

參考文獻

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