背景與目的:腦血管疾病在台灣102年國人十大死因佔全國第三,嚴重影響醫療成本及照護負擔,過去研究指出,腦中風後患者若接受復健治療,可有較好之預後。過去少有研究針對腦中風患者之居住地做詳細判斷與分類,且利用據母體代表性之大型資料庫做為樣本來源,來探討各層級之都市化程度與腦中風有無住院復健與復健治療次數之相關性,因此本研究欲了解四種不同之都市化程度與腦中風有無住院復健與復健治療次數之相關性以及患者居住都市化程度與住院復健之使用是否會因性別、是否初次腦中風而有所影響。 方法:本研究為回溯性世代研究,以次級資料庫進行分析,採用國家衛生研究院之2005年百萬承保抽樣歸人檔(LHID2005)之2005年、2006年全民健康保險研究資料庫進行分析。選取2005與2006年曾因腦中風住院之患者,在排除居住地不詳者,共5,530人,而住院期間有使用復健之患者,共2,249人。居住地判斷則以被保險人基層醫療利用次數最高之地區定義為人口居住所在地,並加以辨別該地區之都市化程度後做城鄉等級分類。多變項之統計方法採多元羅吉斯迴歸與多元線性迴歸分析。 結果:腦中風患者居住地都市化程度與有無住院復健並無顯著相關,而不同都市化地區之腦中風患者,平均復健次數皆在12-14次間。多變項分析加入控制變項前,以都會地區為顯著之預測因子,但加入所有控制變項後,則以城鎮地區為顯著之預測因子,其都市化程度越高,復健次數也越多,在某種程度上呈正相關。而患者居住地都市化程度並不會因性別與是否初次腦中風而對住院復健之有無與復健次數有所影響。 結論:居住地之都市化程度確實有些微影響腦中風患者接受復健之次數,該如何提高偏遠地區患者之可近性與都會地區醫療過度使用之情形,可能顯示過往之計畫政策需稍作修正,該如何做到公平、平衡,是未來擬定政策團隊之目標方向。
Background and Objective: Cerebrovascular diseases was ranked as the one of the major causes of death for Taiwan’s population and incurred considerable health care costs. To date, no study has specifically examined the relationship between the extent of urbanization and utilization for stroke rehabilitation services in Taiwan. The aims of this study are: 1) to examine the relationship between the extent of urbanization and inpatient rehabilitation utilization, and 2) to determine if this relationship differs by gender and number of strokes. Methods: Data for this retrospective cohort study came from 2005 and 2006 wave of the Longitudinal Health Insurance Database 2005 maintained by the National Health Research Institute. 5530 patients suffered from stroke and hospitalized during 2005 and 2006 were included in the analysis. 2249 patients received inpatient rehabilitation during their hospital admission. The area where the participants received most of their primary care utilization was defined as their area of residence and its extent of urbanization was coded according to a previously developed algorithm. Multivariate logistic and multivariate linear regressions were used for analysis. Results: The extent of urbanization for stroke patients’ residence is not associated with whether a stroke patient received inpatient rehabilitation services. Compared with stroke patients who lived in the remote area, stroke patients who lived in the township area received significant higher intensity of inpatient rehabilitation. The relationship between extent of urbanization and intensity of rehabilitation did not differ for stroke patients of different gender. Nor did it differ for those who had their first stroke compared to those with repeated strokes. Conclusion: The government should try to improve the health care access for stroke patients who lived in the rural area.