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  • 學位論文

台灣空氣污染與氣喘疾病相關性之研究

The study on the relationship between air pollution and asthma in Taiwan

指導教授 : 白佳原

摘要


氣喘是一種反覆發作的氣流阻滯病變,它是經由外在或內在的刺激因素,刺激呼吸道產生慢性氣道發炎反應。臨床上會出現咳嗽、胸悶、呼吸困難、喘鳴音,急性大發作時可導致嚴重呼吸困難,呼吸衰竭,甚至死亡。目前全世界約有三億人口罹患氣喘,日益增加的病人除了造成個人與家庭的困擾外,更增加了健康照護系統的負擔。台灣在氣喘病患的醫療支出方面,每年以百分之十五的速度快速攀升,耗費至少五十億元以上,造成政府沈重的醫療財務負擔。 氣喘發生的相關危險因子中,空氣污染是常見的外在刺激因素,因為空氣污染物會刺激呼吸系統以致誘發疾病。台灣是一個地狹人稠,人口密度高的海島,即使是都市地區也多鄰近工業區,加上汽機車所排放的污染物,對健康的影響不容小覷。國內外研究證實在高空氣污染的環境下,民眾的死亡率、癌症、心血管疾病、呼吸疾病致病率有顯著的影響。但相關的研究多為短期、部分縣市做為研究對象,研究的疾病也多以呼吸道疾病為主,較缺乏長時間、大區域針對氣喘疾病的研究。 本文擬探究台灣地區2000-2009 年空氣污染物濃度變化對於氣喘病人門急診就診率之影響。資料來源為環保署一般空氣品質監測站(共五十四個監測站)所測得之每月空氣污染物測值(包括:O3、PM10、NO2、SO2、CO),及中央健康保險局委託國家衛生研究院之健保資料庫百萬抽樣歸人檔,擷取ICD-9-CM 前三碼為493的氣喘病患資料,分析監測站的氣喘病患女性34,527人,男性33,934人,並利用多變項卜瓦松迴歸分析(Poisson Regression Model, PR)進行相關探討。 本研究之重要結論:氣喘病人男性多於女性,就診人數逐年上升。在一年四季中,以春季和冬季氣喘病患的就診率最高。四個年齡族群中,以小孩及65歲以上老人的就診率最高,青年及壯年族群就診率較低。五種指標污染物在四季的濃度變化,SO2、NO2、CO、PM10皆以春季、冬季污染物濃度最高,NO2和CO的污染濃度有逐年下降的趨勢,O3的濃度則逐年上升。空氣污染物NO2、CO、PM10濃度變化與氣喘就診率有顯著相關。

並列摘要


Asthma is an illness of air-flow obstruction that occurs repeatedly, caused by external or internal stimulating factors, which results in a chronic airway inflammation reaction. Clinical symptoms of asthma include cough, chest tightness, short of breath, wheezing; severe dyspnea, respiratory failure or even death could occur during acute exacerbation. Over 300 million people were diagnosed to have asthma worldwide, which not only trouble the patient and their family, but also create a huge burden to the health-care system. The medical expenditure of asthma in Taiwan rose rapidly in a rate of 15% increase per year; 5 billion Taiwanese dollars annually, which makes a great economic burden to the government. Among the risk factors of asthma, air pollution is the most common external stimuli, because air pollutant stimulates the airway system which induces the disease. Taiwan is an island with very high population density, with most of the city cited near the industrial zone, along with the pollutants from the motor vehicles, could cause a great influence on human health. Studies across the world proved that environment with highly polluted air have a great influence in the rate of mortality, cancer, cardiovascular disease and respiratory disease. However, study that focus on long term effect within a bigger region is lacking in asthma while most of the previous studies focus on short term, regional area and discuss the whole respiratory system diseases. Out study aim to explore how the air pollutant concentration in Taiwan region during 2000 to 2009 influence the visiting rate of the outpatient clinic and the emergency department. The air quality data of the monthly air pollutants including O3、PM10、NO2、SO2、CO were obtained from the Ambient air quality monitoring station (54 monitoring station in total) of Environmental protection administration (EPA); the patient data including 34527 women and 33934 men diagnosed under the ICD-9-CM of asthma (code 493) were obtained from claims data of the sampled registry of beneficiaries of National Health Insurance; and the Poisson Regression Model was used for statistical analysis. This study concludes: men were diagnosed more often than women, with rising rate of visiting rate; the outpatient/emergency department visiting rate were higher during spring and winter; children and elders aged above 65 years old have higher visiting rate compared with the young and middle-aged population. As for the change in the concentration of five pollutants among four seasons, the concentrations for SO2、NO2、CO、PM10 were the highest during spring and winter; concentrations of NO2 and CO had a tendency to decline annually while the concentration of O3 rises. There are statistical significance between the change of concentrations of NO2、CO 、PM10 and the outpatient/emergency department visiting rate for asthma.

參考文獻


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