台灣米酒降價對國人酒精相關疾病住院率之時間序列分析—城鄉、性別、年齡之分層探討

The Effect of A Large Reduction in Rice Wine Price on Alcohol-related Hospitalizations: A Time-Series Analysis

陳正哲(Cheng-Che Chen)

指導教授 ： 鄭守夏

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2014年)

https://doi.org/10.6342/NTU.2014.00422

摘要

台灣傳統文化將米酒視為生活必需的料理酒，廣泛用於食材，其健康風險未曾受重視。米酒是國內銷售量最大的蒸餾酒，每年總酒精供應量高於啤酒一倍。台灣於2000年因世界貿易組織規範曾將米酒比照蒸餾酒課稅大漲引發民怨；2009年不顧各國反對，將紅標米酒視為料理酒，價格自每瓶180元降為50元，2010年再降為25元，米酒銷量因而大增。本研究旨在探討台灣米酒降價對國人酒精相關疾病住院率的關聯。

經濟學家證實酒品價格變化會改變該地區的酒精銷量、個人飲用量、最終影響相關疾病與事故，以簡化模型串聯價格與健康的相關性，可做為酒稅政策研究的基礎。本研究運用台灣全民健保資料庫蒐集成人之酒精相關生心理疾病住院資料，進行自回歸移動平均(ARIMA)模型之時間序列分析，自2005年1月至2011年12月共84期，以2009年6月與2010年9月兩次降價建構介入模型，以脈動函數與階級函數區辨短期和長期衝擊，並進一步探討不同城鄉、性別、年齡層成人的住院率變化情形。

在米酒降價前，我國成人酒精相關疾病住院率已呈現下降趨勢，鄉村居民住院率高於都會區，男性高於女性、45-64歲中高年齡層高於其他年齡層。2009年6月初次米酒降價後，全國成人的相關住院率上升12.36% (95% CI: 3.29%~21.46%)：其中鄉村居民住院率增加幅度較都會區明顯而持續。男性住院率上升與降價政策有關，女性則無。各年齡層中僅65歲以上族群不受降價影響，中高年齡層(45-64歲)增加幅度達19.03%，青年族群也受到衝擊。2010年二次降價對各組住院率的解釋力均不顯著，可能歸因於降價幅度小且追蹤期數短。

本研究發現2009年台灣米酒降價與成人酒精相關疾病住院率增加有關，尤其在鄉村地區、男性與18-65歲族群。無論米酒是否為料理酒，均不應忽視其低價及龐大銷量伴隨的健康風險，政府單位應加以重視。

關鍵字

米酒 ； 價格變動 ； 時間序列分析 ； 酒精相關疾病 ； 台灣

並列摘要

Rice wine is a popular alcoholic beverage in Taiwanese diet culture. Taiwan rice wine (Mijiu) is the cheapest distilled beverage, which is used for both drinking and cooking. Due to its huge sale amount and profit, the production of rice wine was a controversial political and economic issue. After entering the WTO, Taiwan government radically raised the price of rice wine (with the tax equal to other distilled beverage) during 2001-2003 from 20 NTD to 180 NTD. Under the pressure of public request, Taiwan government reduced the price of rice wine to 50 NTD in June 2009 and to 25 NTD in September 2010. This study intends to evaluate the health impact of the price cut in Taiwan.

Health economists had developed the relationship linking alcohol tax, price, per capita consumption, and health outcomes. It was well documented that alcohol price change was associated with morbidity and mortality in a number of countries. This study employed time-series analyses on monthly aggregated hospitalization for alcohol-related diseases and disorders by using the nationally representative sample of a million beneficiaries in the National Health Insurance Research database (NHIRD) during 2005 and 2011. We examined the policy effect in June 2009 and September 2010 by the autoregressive moving average (ARIMA) intervention model, while taking the trends and seasonal variation into account, and applying the impulse-response functions to evaluate the short-term and long-term policy effects. Further analysis was conducted for specific sub-groups such as gender, age groups and living areas.

There was a declining trend of alcohol-related hospitalization rate among the adults prior to the rice wine price reduction while the mean levels were higher in rural, male, and aged 45-64 subgroups. After the first price reduction in June 2009, the mean hospitalization rates increased 12.36% (95% CI: 3.29%-21.46%), which represents an increase of 2.16 monthly hospitalizations per 100,000 person-months. The effect was larger among subjects living in rural area, and no long-term effect for urban adults. The rate also increased after first price reduction among men, but not women. The largest impact appeared among aged 45-64 subgroup with an increase of 19.03%, and the rates also increased in the aged 18-44 subgroup. The effect of the second price reduction in 2010 was not significant in all population groups.

We concluded that the price reduction of rice wine in 2009 led to increased alcohol-related hospitalizations, especially among male, aged 18-64, and people living in rural area. No matter how the rice wine was taken from food ingredient or drink, Taiwan health authorities should pay more attention to the alcohol-related health problems associated with the consumption of rice wine.

並列關鍵字

rice wine ； price change ； alcohol-related disease ； time-series analysis ； Taiwan

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