事故傷害防治政策省思─1-25歲年齡層生命損失之探討

Rethinking Injury Prevention Policy: Viewpoint based on Years of Life Lost in the 1 Year Old to 25 Year Old Population

林郁虹(Yu-Hong Lin) ； 陳再晉(Tzay-Jinn Chen) ； 蔡明哲(Ming-Che Tsia) ； 陳慶瑞(Qing-Rui Chen) ； 梁玲郁(Ling-Yu Liang)

《北市醫學雜誌》 8卷3期 (2011/09) Pp. 19-32

https://doi.org/10.6200/TCMJ.2011.8.3.03

摘要

目的：分析我國1-25歲年齡層人口死亡資料，探討其自1997至2007年各年之生命損失人年（Years of Life Lost, YLLs）之變動趨勢，並將各類傷病造成之死亡負擔加以排序，以了解各類傷病造成的負擔大小，作為規劃此一年齡相關健康政策之參改。方法：利用1997至2007年全台灣死亡資料檔，以失能調整生命損失人年（Disability-Adjusted Life Years, DALYs）之分析方法，計算1-25歲年齡層中，死亡者之生命損失人年（Years of Life Lost, YLLs）並就各類傷病佔總傷病之死亡負擔百分率變化趨勢，探討不同時間呈現較大死亡負擔的傷病類別。結果：1997年至2007年11年間，台灣地區1-25歲年齡層死亡人數佔總人口群死亡人數3.0%；惟若以YLLs表示，則1-25歲年齡層死亡者造成的YLLs，佔總人口群死亡者YLLs之10.8%。1-25歲年齡層之死因以傷害為首，但11年間傷害所致之每千人YLLs呈現逐年下降；傷害造成的總人口群YLLs損失，31%來自1-25歲年齡層人口。1-25歲年齡層之YLLs前四死亡原因為車禍、癌症、溺水及自殺，其中自殺並呈現逐年上升趨勢。結論：本研究YLLs之價值判斷兩部分，值得進一步探討，第一引用日本人之預期餘命為基準，第二引用全球疾病負擔之年齡加權與折扣的生命價值量測係數，兩者是否均符合台灣人的價值觀值，值得進一步探討。本研究結果之最大生命損失四大原因，其理想管控目標為何，為值得進一步探討。未來研究應朝向計算衛生教育與健康介入措施之經費，進一步求得成本效益推估值，將有助於更合理經費分配。

關鍵字

生命損失人年 ； 壽命損失年 ； 失能調整人年 ； 失能損失人年

並列摘要

Objectives: The purpose of this study is to analyze mortality data for the age group of 1 year old to 25 years old in Taiwan in order to explore the annual trend in Years of Life Lost (YLLs) for this age group over the period of 1997 to 2007. The mortality burden for injury and disease categories are ranked and compared year by year. The intention of the research is to create a useful reference base that will help with the development of relevant health policies for this age group. Methods: This research is based on Taiwan's mortality data from 1997 to 2007. The DALYs (Disability-Adjusted Life Years) analytical methodology was adopted to calculate the Years of Life Lost (YLLs) from deceased persons who were members of the 1 year old to 25 years old age group and the total population. By observing the changes in mortality burdens in relation to specific injuries and diseases, the researcher can identify the injuries and diseases that impose greater mortality burdens at different time in the life of members of the population of Taiwan. Results: During the eleven years from 1997 to 2007, the number of deaths in the age group of 1 year old to 25 years old was 3.0% of the total deaths in Taiwan. However, the total YLLs that this age group accounted for was 10.8%. Injury was the most common cause of death in this age group. On examining the 11 years of data available to this research, the YLLs per 1000 individuals that were caused by injury declined year on year. The YLLs caused by injury in this age group made up 31% of all YLLs caused by injury for the whole population. The four leading causes of YLLs among 1-25 years old individuals were traffic accident, cancer, drowning and suicide. Among these four causes, the proportion of suicide-caused YLLs increased year on year. Conclusions: This study applies two methodologies in order to make YLL value judgments that are worthy of further discussion. The first method is based on the life expectancy concept prevailing in Japan. The second method applies the age-weighted value according to the Global Burden of Disease (GBD) and the discounted lifetime value coefficient. Further exploration is required to determine whether the two methods are consistent with the values of the Taiwanese people. Nevertheless, the study identified the four major causes of YLL. It will be worthwhile to further probe the ideal control objectives for these causes. In future studies, it is recommended that the funding requirements for health education and health promotion intervention measures should be calculated first, and then these calculations should be used as a basis for estimating cost efficiency. This approach will contribute to the development of more reasonable budget appropriations.

並列關鍵字

YLLs (Years of Life Lost) ； DALYs (Disability-Adjusted Life Years) ； YLDs (Years Living with Disability)