糖尿病病患罹患結核病之相對危險性及其相關因素

Relative Risk of Diabetes Mellitus for Tuberculosis and Relative Factors between Diabetes Mellitus and Tuberculosis

鄭清方(Ching-Fang Cheng)

指導教授 ： 龔佩珍 ； 蔡文正

亞洲大學/健康學院/健康產業管理學系健康管理組/碩士(2012年)

摘要

研究背景與目的：糖尿病與結核病關係密切，兩者互為危險因子，常互相影響，糖尿病病患合併感染結核病(DMTB)時，糖尿病疾病嚴重程度與結核病完治率會比單純得到糖尿病或結核病要來得更嚴重。
研究方法：本研究使用次級資料，採縱斷性研究方法，取自1997-2007年國衛院健保資料庫之糖尿病特定主題檔、行政院主計處之「中華民國家庭收支報告」、內政部統計處資訊服務網及行政院衛生署統計資料網「醫療機構現況及醫療服務量統計摘要」等資料進行統計分析。首先利用健保資料庫，分析糖尿病盛行率、發生率，糖尿病結核之發生率及相對於一般民眾之危險性，另外利用邏輯斯迴歸分析，探討影響糖尿病患罹患結核病之相關因素。
研究結果：糖尿病盛行率由1997年的3.49%上升至2007年的5.43%，每萬人口糖尿病發生率由1998年164.94人下降至2007年82.12人，每萬人口糖尿病結核發生率在1998年為36.03人，至2007年間則下降至19.63人，追蹤1-9年發現糖尿病患併發結核病相對於一般民眾之危險性(OR)為1.34-4.74倍；影響糖尿病患罹患結核病之相關因素如下：男性為女性的3.52倍，隨著年齡增加會增加1.02倍，居住地農業人口比例高區域為較低區域的1.13倍，有重大傷病者為無重大傷病者的1.36倍，而隨著疾病嚴重度增加會多1.03倍，第2型糖尿病是第1型的1.46倍，但隨著糖尿病併發症增加卻會減少0.77倍。
結論：本研究發現糖尿病盛行率逐年上升，但糖尿病及糖尿病結核發生率皆逐年下降；追蹤1-9年發現糖尿病患併發結核病相對於一般民眾之危險性(OR)，其第一年罹患結核病的相對危險性最高；影響糖尿病患罹患結核病之重要相關因素為性別、年齡、重大傷病、疾病嚴重度、糖尿病類型等。
建議：除了糖尿病本身的血糖控制外，加強一般民眾對於糖尿病的自我照護衛教、飲食指導、鼓勵養成運動習慣等相關介入性措施，與定期的血糖篩檢來降低糖尿病的盛行率。針對疾病篩檢與預防時，可專門針對糖尿病患高危險群篩檢及健康促進，與加強其結核病篩檢，當有病灶時，可早期發現早期治療。

關鍵字

糖尿病 ； 結核病 ； 糖尿病結核 ； 盛行率 ； 發生率 ； 相對危險性 ； 勝算比

並列摘要

Background and Objective: Diabetes and tuberculosis are closely related to each other between the two risk factors, often inter-related, when diabetes patients comes with TB (DMTB) the case mix and complete treatment rate will be more serious than only have TB or diabetes.
Methods: This research used secondary material, belonging to longitudinal study. We used the National Health Insurance database by National Health Research Institutes, Surveys of Family Income and Expenditure (SFIE), Ministry of the Interior of Department of Statistics, Current Situation of Medical Facilities, Medical Personnel, and Medical Services of Taiwan Public Health Report for statistical analysis from 1997 to 2007. That used national health insurance dataset of diabetes which including all nationwide diabetes claim data to analyze the prevalence, incidence, and the relative risk of diabetes patients to general population to suffer from tuberculosis.
Results: The results showed that the prevalence of diabetes was increased from 3.49% in 1997 to 5.43% in 2007. The study found that the prevalence of DM and DMTB increased year by year, the incidence of DM was decreased from 164.94 per ten thousand population in 1998 to 82.12 per ten thousand population in 2007. For DMTB, the highest incidence was 36.03 per ten thousand population in 1998, and it was decreased from 32.21 per ten thousand persons in 1999 to 19.63 per ten thousand persons in 2007.The new diabetics were followed from one year to nine years, and we found that the relative risk of diabetics combined TB compared to general population was 1.34 to 4.74, the OR of the first year of suffering from TB was highest. After controlling for other variables, the analysis results of logistic regression influence the related factors of DM patients contract TB as follows: male have more possibility than female, the OR of male to have TB is 3.52 times higher than female, and for each first-year diabetics the possibility to have TB is 1.02 times higher than those who only have diabetes. The higher proportion of agricultural population in medical regions has 1.13 times possibility than lower regions. Catastrophic illness Outpatient having TB is 1.36 times than without catastrophic illness Outpatient, and for each additional CCI the possibility to have TB 1.03 times than those who only have diabetes. But for each additional Complications the possibility to have TB reduced 0.77 times than those who only have diabetes. The OR of type 2 to have TB is 1.46 times higher than type 1.
Conclusion: This study found that prevalence of DM increased year by year, but the diabetes and the incidence of diabetes tuberculosis are declining year after year; 1-9 year follow-up found that tuberculosis complicated by diabetes in relation to the risk of the general population (OR), its first year of suffering from tuberculosis is the highest relative risk; the impact of diabetes-related risk factors of TB for the importance of gender, age, major injuries, severity of illness, such as type of diabetes.
Recommendations: In addition to diabetes control their blood sugar, strengthen the general population for diabetes by self-education, dietary guidance, developing a campaign to encourage the involvement of customs-related measures, and regular screening to reduce the blood sugar of diabetes prevalence. For disease screening and prevention, it can be specifically targeted high-risk diabetes screening and health promotion, and to strengthen its tuberculosis screening, when a lesion may be the early detection of early treatment.

並列關鍵字

Diabetes ； Tuberculosis ； AND ； Tuberculosis in Diabetes ； Prevalence ； Incidence ； Relative Risk ； Odds Ratio

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