牙周處置與糖尿病醫療費用之相關性

糖尿病及牙周病都是國人常見之疾病，二者皆屬多因性的慢性疾病，都有免疫調節失能的致病機轉，流行病學顯示糖尿病為牙周病之高危險群，而牙周病亦被認為是糖尿病的第六個併發症；在醫療費用支出方面，2004、2005年度中央健康保險醫療費用支出中，牙齒相關疾病與糖尿病之疾病項目，皆為依門診別統計申報醫療服務點數之排序前20大疾病，國家醫療支出持續成長，社會人口老化，需要更進ㄧ步探討二疾病間之相關性，惟目前台灣並無類此二疾病間之醫療費用關係探討，故有其必要性。本研究之目的為瞭解不同牙周處置對糖尿病醫療費用之相關性，而運用全民健康保險申報之次級資料統計分析。結果顯示年齡對糖尿病之醫療費用有統計學之顯著正相關；非手術性牙周處置亦對糖尿病醫療費用有統計學之顯著正相關；而糖尿病的病人施行手術性牙周處置與糖尿病之醫療費用並無統計學之顯著相關。依本研究之發現，爰提出下列建議：1.由全人醫療之角度思考，促使內科及牙科有良好溝通機制之病人為中心治療，才能早期預防或治療糖尿病及牙周病，以撙節健保資源；2.應做流行病學調查，以利了解實際醫療需求情況。本研究係以次級資料分析，尚有無法排除之干擾因子限制，爰日後宜再以大型之隨機對照試驗RCT(random control test)研究支持。

關鍵字

牙周處置；糖尿病；醫療費用

並列摘要

Diabetes and periodontal disease are general diseases in Taiwan, both are multiple etiology of chronic diseases and disorders of the immune pathogenesis.Epidemiology showed that diabetes is a high-risk group of periodontal disease, in the other hand, periodontal disease have been considered the sixth complication of diabetes.The out-patient medical services expenditure of dental or diabetes related disease are the top 20 diseases from the National Health Insurance. Not only National health service expenditure growth, but also the aging population, it is necessary to further explore the relationship,especially medical costs between diabetes and periodontal disease , there is no similar study currently in Taiwan. This study analysed the claim data of National Health Insurance, so that to the purpose to know that the impact of different periodontal disposal to diabetes medical expenses . The results showed that the age of the medical costs of diabetes were statistically significant positive correlation; it also were statistically significant positive correlation between the non-surgical periodontal treatment and medical costs of diabetes, but there is no statistically significant correlation between periodontal surgical treatment and the medical costs of diabetes. According to this study found, the following recommendations were: 1. From the perspective of holistic health care, medical and dental doctors need a good communication mechanism of patient-centered treatment, to early prevention or treatment of diabetes and periodontal disease in order to preserve health-care re -sources. 2. Epidemiological investigation should be done to facilitate understanding of the actual medical needs of the situation. However, This study was limited to secondary data analysis, therefore, can not be ruled out confunding factor, in futher study ,it need more large randomized controlled trials(RCT) for more objective and credible.