以地區層級探討影響臺灣大腸直腸癌篩檢覆蓋率之因素

Factors Associating with Coverage Rate of Colorectal Cancer Screening in Taiwan at the Township Level

10.6342/NTU.2015.01694

游宇捷

大腸直腸癌篩檢 ； 糞便潛血檢查 ； 覆蓋率 ； 鄉鎮市區層級 ； 社區參與 ； 社會人口學 ； 醫療資源 ； CRC screening ； Fecal immunochemical test ； Coverage rate ； Township level ； Community participation ； Social demographic characteristics ； Health care services

臺灣大學流行病學與預防醫學研究所學位論文

2015年

碩士

季瑋珠

英文

研究背景： 癌症篩檢是一個能在癌症的早期階段進行偵測的有效檢測工具，能使癌症早期發現，早期治療，以達到良好的預後效果。然而，這樣的篩檢活動除了參與情形不佳外，也常常面臨健康不平等的問題。 研究目的： 在本篇研究中，我們以大腸直腸癌做為主要探討的對象，旨在以鄉鎮市區層級，了解其覆蓋率是否會受到該地區的社區建設與參與程度、社會人口學變項及醫療資源的分布程度所影響。 材料與方法： 本研究2009-2013年的橫斷式研究，以臺灣全國癌症篩檢系統和內政部統計處的橫斷式人口統計學研究資料，計算各年度各鄉鎮市區別大腸直腸癌之覆蓋率，並以此為主要依變項。獨變項則為地區的社區建設與參與程度、社會人口學變項及醫療資源的分布程度。為了能夠簡化社區建設與參與程度的變項和368個鄉鎮市區的都市化分類，我們亦進行因素分析與集群分析。最後再將依變項和獨變項以簡單及複線性迴歸模型進行分析，以了解大腸直腸癌篩檢覆蓋率與社區建設與參與程度、社會人口學變項及醫療資源的分布程度之間的關聯性。 研究結果： 我們將臺灣368個鄉鎮市區納入分析。大腸直腸癌篩檢覆蓋率約在8.5±1.5%。經由線性迴歸分析，我們可以發現較高程度的社區資金及社區建設、較低程度的家戶大小、老化指數、大學教育比例及都市化程度、及較多醫療照護資源等，與大腸直腸癌篩檢覆蓋率有正向之關係。 研究結論： 綜觀研究結果，地區的社區建設與參與程度、社會人口學變項及醫療資源的分布程度的確和臺灣大腸直腸癌篩檢覆蓋率有顯著相關。然而，從都市化的分析，我們也發現臺灣的大腸直腸癌篩檢存在著健康不平等的現象。藉由了解何種因素會影響大腸直腸癌篩檢覆蓋率，對於如何因地制宜，將資源有效分配，以改善低靡的篩檢參與現象，是我們往後需要努力的課題。

Background: Cancer screening is a good means to detect and treat cancer at early stage with available screening tool. However, the implementation of it often faces with criticism about health inequity. Colorectal cancer (CRC) is one of the leading cancers, and fecal immunochemical test (FIT) for the early detection of CRC is one of the major cancer screenings in Taiwan. However, most of previous studies focused on individual factors for the compliance of screening. Aim: Our purpose is to conduct a study with the regard to the association between the 3 groups of community factors at the township level, which are levels of community participation, social demographic characteristics and the amount of health care services, and coverage rate with FIT screenings of CRC. Materials and Methods: This is a cross-sectional study in 2009-2013, including 368 townships in Taiwan. We calculated the coverage rate in each township by 2 datasets, which were obtained from Taiwan Cancer Screening Registry System and Department of Statistics, Ministry of the Interior. In order to simplify the variables and reduce dimensions of the group of community participation, and reclassify the urbanization, we conducted principal component factor analysis and cluster analysis. Furthermore, simple and multiple linear regressions analyses were used to understand the relationships between CRC screening coverage rate and 3 groups of factors. Results: We included 368 townships in Taiwan in our study. The coverage of CRC screening is around 8.5% 1.5%. After conducting regression analysis at the township level, we found the following factors might have a positive impact on coverage rate of CRC screening: higher fund and development in community, lower level of household size, aging index, participation in university, and urbanization in social demographic characteristics, and higher amount of health care services. Conclusion: Community participation, social demographics characteristics, and the amount of health care services might associate with the coverage rate of CRC FIT screening. However, upon our research, CRC screening program might not compensate for the phenomenon of health inequity. By roughly realizing which factors might have influence on CRC FIT screening, we need to make further efforts to improve the participation in CRC FIT screening program according to different local conditions in Taiwan.

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