影響台灣不同都市化程度地區高齡孕產婦妊娠併發症相關因素之探討

近年來，台灣婦女平均生育年齡逐年的提高。許多研究證實，高齡生育在生理及心理狀況相較適齡產婦弱，妊娠時期出現併發症的風險也較高。而台灣婦產醫療服務供應端（婦產專科醫師）卻逐年萎縮，因此本研究欲透過台灣高齡產婦在不同都市化程度地區間併發症是否存在差異性，進一步討論台灣婦產科供應端與都市化程度之間的關係。本研究為橫斷性研究。以國家衛生研究院「全民健康保險學術研究資料庫」選取2009年35歲以上產婦為研究對象，依照高齡產婦產檢地與就醫地，建立居住地估計方法。結果顯示，都市化程度較低地區的高齡產婦可能於婦產專科健康照護資源不足，妊娠相關併發症的風險大於高度都市化地區。可見都市化程度對妊娠健康是一項重要的影響因素，且各都市化層級間高齡產婦的健康狀況確實存在差異情形，這些差異可能源自於居住地區的環境或生活方式所致。因此，政府應盡快解決婦產科醫師地理分布不均的問題，且在健康相關政策或介入計劃的制定和執行時，也應考慮到地區的特性和併發症型態，方能更有效促進高齡生育的健康，進而改善城鄉健康的差距。醫療院所方面，可發展高齡產婦整合式醫療照護團隊，結合其他科，以提供高齡產婦更完整且良好的醫療環境。

關鍵字

全民健保資料庫；高齡產婦；都市化程度；居住地推估；妊娠併發症

並列摘要

In recent years, the average childbearing age of Taiwanese women has increased year by year. Many studies have confirmed that the physical and psychological conditions in the Advanced Maternal Age (AMA) compared to maternal-age in fertility are weak, and the risks of obstetric complications during pregnancy are higher. Taiwan maternity medical services the supply side (obstetrician-gynecologist) is reducing, so this study aimed to understand the obstetric complications among women over 35 years old, who live in different urbanization level during their Pregnancy and Puerperium., and further discuss the supply side and the relationship between the degree of urban about maternity medical. This is a cross-sectional study, analysis secondary data from the National Health Insurance database released by the National Health Research Institute. Based on location of hospital visit and prenatal examination, this study estimated the place-of-residence (urbanization level) from the Health Insurance Database of NHIRD in 2009. After controlling other factors, this study found that the risk of obstetric complications in remote region was higher than urban region. Place of residence is an important factor on AMA’s health, and each level of urbanization among older mothers do exist differences in health situations. Therefore, in the health policy or intervention program development and implementation, they should take into account the characteristics and complications of regional patterns in order to more effectively promote the reproductive health of AMAs, thereby, improving the health gap between urban and rural areas. About Hospitals, they can develop an integrated health care team of AMAs, in order to provide a complete and well medical environment.