同期接種流感疫苗與肺炎鏈球菌疫苗之效果評估：以台灣75歲以上的老人為例

The Evaluation of Medical Utilization in Immunizing Influenza and Pneumococcal Vaccines Coincidentally:Population older than 75 years old

劉人尹(Jen-Yin Liu)

指導教授 ： 張育嘉

亞洲大學/健康學院/健康管理研究所/碩士(2011年)

摘要

背景與動機：流行性感冒每年皆會在全世界引起大小不等之流行，若罹患流行性感冒，極有可能引起續發性細菌感染，而續發性細菌感染中又以肺炎鏈球菌感染為大宗，罹病嚴重者或高危險群易因此而死亡，故我國已陸續針對高危險群提供免費流感疫苗與肺炎鏈球菌疫苗接種，並建議二疫苗應同一期間接種，以期降低相關疾病之罹患與死亡。目前國內研究皆個別針對流感疫苗接種成效與肺炎鏈球菌疫苗接種成效進行評估，尚未有研究致力探討二疫苗同期接種之效果，故對於同期接種二疫苗是否比僅接種流感疫苗還要更有成效？目前猶未可知。鑑於上述，本研究以75 歲以上老人為例，探討同期接種流感疫苗與肺炎鏈球菌疫苗是否更能有效降低呼吸系統相關疾病之醫療利用，並藉此了解我國實施二種疫苗接種計畫所帶來之政策成效。
研究方法：本研究利用國衛院所提供之2007-2009 年全民健保資料庫進行分析，據2008 年75 歲以上老人疫苗之接種狀態區分「僅接種流感疫苗」與「同期接種流感疫苗與肺炎鏈球菌二種疫苗」，並以傾向分數配對法，配對出可比較之二組研究對象。在控制研究對象之個人特質與過去就醫利用等因素後，比較不同接種狀態之75 歲以上老人在觀察期間(2009/1/1-2009/9/30)中因呼吸系統相關疾病所致之醫療利用情形。
研究結果：在門診醫療利用方面，僅接種流感疫苗組與同期接種流感疫苗和肺炎鏈球菌二種疫苗組在呼吸系統相關疾病的門診利用率、門診次數及門診費用皆無差異。至於住院方面，同期接種流感疫苗和肺炎鏈球菌二種疫苗組比僅接種流感疫苗組有較少的住院醫療利用，在呼吸系統疾病方面，減少22%的住院利用率、27%住院次數、33%住院天數、11%住院費用；在肺炎部分減少23%的住院利用率、30%住院次數、36%住院天數、8%住院費用；在慢性阻塞性肺部疾病方面減少33%的住院天數。
結論：本研究結果顯示，雖然同期接種流感疫苗和肺炎鏈球菌二種疫苗未能有效降低門診醫療利用，但對於疾病嚴重程度相對較高之住院醫療利用，卻可以有效的降低，故整體而言，同期接種二疫苗之成效較僅接種流感疫苗來的佳，亦代表我國二種疫苗政策的實施比過去僅推行流感疫苗接種計畫時可帶來更多成效，因此建議衛生相關單位應積極宣導與提倡同期接種流感疫苗和肺炎鏈球菌疫苗，進而維護我國高齡老人之健康。

關鍵字

流感疫苗 ； 肺炎鏈球菌疫苗 ； 接種成效 ； 傾向分數配對法

並列摘要

Background and Motivation: Each year, influenza often causes various scales of epidemics. Influenza is very likely to cause a secondary bacterial infection in which streptococcus pneumonia infections accounts for the largest part. Severe morbidity or high-risk group may die of this infection. So Taiwan has started to provide high-risk groups with free influenza vaccination and pneumococcal vaccination and recommended that two vaccines be vaccinated in the same period to reduce the risk of suffering and death. Currently, most of the domestic studies focus individually on the assessment of effectiveness and results of influenza vaccination and pneumococcal vaccination and have no study on the effectiveness of two vaccinations coincidentally. So it is not clear whether the two vaccinations coincidentally are more effective than only one vaccination. The purpose of this study is to explore whether influenza vaccination and pneumococcal vaccination coincidentally would reduce more in the medical utilization of respiratory system-related diseases comparing with the only influenza vaccine. Those outcomes can facilitate the understanding in the effectiveness of policy in implementation of two vaccination programs in Taiwan.
Methodology: In this study, we used national health insurance research database for analyses from National Health Research Institutes during 2007-2009. The vaccination status was divided into “only influenza vaccination” group and “influenza vaccination and pneumococcal vaccination coincidentally” group and used the propensity score matching method for the comparison in two groups who were over 75 years old in 2008. After controlling the factors of subjects’ personal characteristics and the prior year medical utilization, we compared the medical utilization for respiratory system diseases among different vaccination status of the elderly aged over 75 in the study period (2009/1/1-2009/9/30).
Results: In the outpatient medical utilization, there were no significant differences in whether OPT use, frequencies and costs for the respiratory system diseases from the outpatient services between “only influenza vaccination” group and “influenza vaccination and pneumococcal vaccination coincidentally” group. Regarding for hospitalization utilization, the patients in the “influenza vaccination and pneumococcal vaccination coincidentally” group had 22% less likelihood in whether hospitalization use of , 27% less hospital admissions of, 33% less hospitalization days of , 11% less hospitalization cost of respiratory system diseases comparing with the “only influenza vaccination” group. In the part of pneumonia, the outcomes were similar in 23% less likelihood in whether hospitalization use, 30% less hospital admissions, 30% hospitalization days, and 8% less hospitalization cost. In addition, the hospitalization days for chronic obstructive pulmonary diseases reduced by 33%.
Conclusions: Although the results showed that “influenza vaccination and pneumococcal vaccination coincidentally” could not reduce the outpatient medical utilization significantly; however, it shows great potential to reduce the hospitalization utilization. Generally speaking, the effectiveness of vaccination in the “influenza vaccination and pneumococcal vaccination coincidentally” group is better than in the “only influenza vaccination” group. Hence, the implementation of two-vaccination policy in Taiwan could bring more benefits than the previous influenza vaccination plans. It is therefore proposed that the health authorities should actively educate and promote the influenza vaccination and pneumococcal vaccination in the same period to safeguard the health of senior people.

並列關鍵字

influenza vaccine ； pneumococcal vaccine ； vaccine effectiveness ； propensity score matching method

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