- 學位論文
利用失能調整人年估算2005年至2017年台灣癌症疾病負擔
Using disability-adjusted life years (DALYs) to estimate 2005-2017 disease burden of cancer in Taiwan
摘要
本研究目的為利用失能調整人年 (Disability- Adjusted Life Years, DALYs) 估算2005年至2017年台灣癌症疾病負擔。藉由台灣癌症登記系統資料庫，使用DALYs工具量化目前有實施癌症篩檢的四個癌症 (口腔癌、大腸癌、乳癌及和子宮頸癌) 之長期疾病負擔，採用癌症三階段疾病自然史模型考慮癌症在各疾病階段所對應的失能期間、失能權重等相關參數，綜合分析各年齡層族群之死亡數、發生數、治療率、治癒率及癌症期別等參數對台灣癌症的影響。 研究結果顯示在第二期及第三期國家癌症防治計畫期間 (2010 - 2017)，四癌平均每年造成疾病負擔損失較大的為乳癌 (每十萬人673人年)，其次為大腸癌 (每十萬人510人年)、口腔癌 (每十萬人353人年) 和子宮頸癌 (每十萬人155人年)，且生命損失人年 (Year of life lost due to premature, YLL) 是造成國人疾病負擔最主要貢獻來源，有68% - 82%的疾病負擔都是來自死亡，且40-69歲為主要死亡貢獻族群。另一方面，各癌症期別對於失能損失人年 (Years of life lost due to disability, YLD) 的影響，分別在四癌有所不同，造成口腔癌失能損失較大的期別是stage IV、而大腸癌及子宮頸癌都是stage 0，最後乳癌則是stage I，大部分的發生數都在40-69歲的族群，但子宮頸癌與其他三者發生數相比有年輕化的趨勢。 總體而言，乳癌疾病負擔的增加主要是從 2005 年到 2017 年上升了 75%，其次是大腸癌 (增加64%) 和口腔癌 (增加 40%)。然而，子宮頸癌的DALYs卻下降了13%，這可能與台灣早期篩檢政策有關。本研究為台灣提供四癌 (口腔癌、大腸癌、乳癌及和子宮頸癌) 疾病負擔對國人健康影響的量化結果，也期許未來應持續進行疾病負擔相關研究，納入全部癌症之疾病負擔，以利估算出更符合本國現況的疾病負擔結果，提供政府機關在政策上有更多元且準確性的參考價值。
並列摘要
The purpose of this study is to use disability-adjusted life years (DALYs) to estimate the burden of cancer in Taiwan from 2005 to 2017. Based on the Nationwide Cancer Registration System in Taiwan, this study tends to quantify the long-term burden of four types of cancers, including oral cancer, colorectal cancer, breast cancer and cervical cancer. There are screening policies for these four cancers. Besides, three-stage natural history model of cancer is used and examined the disability duration and disability weight for different stages of cancer progress. It also combined the incidence cases, mortality cases, proportion treated and proportion cured for different cancer stages. Results of this study show that the disease burden of breast cancer is the predominant cancer than other cancers. The total DALYs due to breast cancer, colorectal cancer, oral cancer, and cervical cancer were 673, 510, 353 and 155 DALYs per 100,000 people, respectively, from 2010 to 2017. Overall, the year of life lost due to premature (YLL) accounted for 68%-82% of DALYs in these four cancers and the age groups of 40-69 years were predominant. On the other hand, there are different patterns between the years of life lost due to disability (YLD) with cancer stages. The largest contribution of YLD is Stage IV in oral cancer; Stage 0 in colorectal and cervical cancer; and Stage I in breast cancer. Overall, the increasing breast cancer burden is mainly observed with 75% raised from 2005 to 2017. This is followed by colorectal cancer (64% increase), and oral cancer (40% increase). However, the DALYs of cervical cancer showed a decrease of 13%, which may be caused by the early screening policy in Taiwan.Finally, our study provides the long-term disease burden of cancer in Taiwan from 2005 to 2017 and varied with different stage of cancers. Further research is needed to identify the overall cancers in Taiwan and provided recommendations for disease control and health policies.