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應用空間資訊技術以探討環境綠蔽度與肺癌發生之關聯:以大台北及大嘉義地區為例

Association between Surrounding Greenness and Lung Cancer Incidence using Geospatial Information Technologies: A Case Study of Taipei and Chiayi areas

摘要


肺癌為國內癌症死因前三位,由於早期診斷不易,大部分患者預後不佳,故為重要之癌症疾病。與此同時,現今已有許多研究指出,植物所組成之環境綠蔽度對人體身心健康具有正面影響功效,因此了解環境綠蔽度對於肺癌發生之影響,對預防醫學之發展實為一重要議題。本研究結合地理資訊系統、遙感探測等空間資訊技術,以2003至2012年全民健康保險資料庫抽樣歸人檔為材料,選擇大台北及大嘉義地區為研究試區,首先利用全域型Moran's I指標以了解肺癌之發生是否具有空間群聚之效應;其中在校正可取得之肺癌風險因子的情況下,利用廣義加乘混合模型,以探討環境綠蔽度及地區肺癌發生之關聯性。空間群聚分析之結果指出,研究期間肺癌之發生確實具有空間群聚的現象;並且由模型分析結果可知,當常態化差異植生指標(Normalized Difference Vegetation Index, NDVI)增加1個單位之四分位距(NDVI Interquartile Range (IQR) = 0.27))時,將使得該地區肺癌發生風險減少32%(相對風險:0.68;95%信賴區間:0.66 - 0.70;P < 0.01),此統計結果於生活環境差異頗大的大嘉義地區及大台北地區,均達到顯著水準。由此可知環境綠蔽度對於肺癌之發生具有統計上的保護效力。

並列摘要


Lung cancer was ranked as the top-3 leading cause of cancer-related deaths in Taiwan in the last decade. Signs and symptoms of lung cancer typically occur only when the disease is advanced, therefore elevating the difficulties in early-stage diagnosis. Moreover, the prognosis is usually poor for most patients. Recently, studies have suggested that exposure to areas with higher amounts of distributed community vegetation has health benefits. To understand the cardiovascular health effects related to greenness exposures is important in developing the lung cancer preventive medicine. In this study, township level lung cancer incidence from 2000 to 2010 for Taipei and Chiayi areas were obtained from the Longitudinal Health Insurance Database (LHID). The MODIS Normalized Difference Vegetation Index (NDVI) database was used to identify the long-term exposure to greenness of the study population. A global Moran's I was used to examine the spatial clustering effects of lung cancer incidence during the study period. Then, a Generalized Additive Mixed Model (GAMM) was applied to assess the association between surrounding greenness and lung cancer incidence. While all the calculated Moran's I achieved statistical significance (p < 0.01), lung cancer represented a spatial clustering trend regardless the season or study year. The results of GAMM indicates that, greenness exposures showed a negative association with lung cancer. The adjusted relative risk for NDVI was 0.68 (95% confidence interval [CI] = 0.66 to 0.70; p < 0.01) per NDVI interquartile range (IQR) increment (0.27) exposure. Consistently negative association was found regardless the study cities. The results demonstrated long-term greenness exposure decreased the risk for lung cancer.

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