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系統識別號 U0026-0604201709444600
論文名稱(中文) 臺灣地區肺結核與空氣汙染物及其他環境因素的相關性
論文名稱(英文) Correlations of pulmonary tuberculosis with air pollutants and other environmental factors in Taiwan
校院名稱 成功大學
系所名稱(中) 環境醫學研究所
系所名稱(英) Institute of Environmental and Occupational Health
學年度 105
學期 1
出版年 106
研究生(中文) 呂宗翰
研究生(英文) Chung-Han Lu
學號 S76031122
學位類別 碩士
語文別 英文
論文頁數 52頁
口試委員 指導教授-郭浩然
口試委員-簡玉雯
口試委員-吳致杰
口試委員-郭耀昌
中文關鍵字 肺結核  治療結果  空間分析 
英文關鍵字 Tuberculosis  treatment outcome  Spatial Analysis 
學科別分類
中文摘要 目的:結核病在全球是一項重要的公共衛生議題,估計有三分之一的人口受結核分枝桿菌感染侵入而引起慢性結核病感染。臺灣近年來的發生率及與死亡率雖已逐年下降,但與其他已開發國家相比依然有較高的發生率與死亡率,因此還是一項重要的健康問題。結核病發病情況與居住地區的生活方式、生活習慣、人口密度、人口流動速率以及生活水平等具高度相關,但其治療成效是否也與所在地區之環境特性有關,則尚待研究。因此,本研究擬評估臺灣地區肺結核患者使用肺結核藥物治療的成效與環境的相關性。
方法:本研究使用回溯性世代追蹤設計,採用臺灣健保資料庫中2000年的百萬抽樣歸人檔中2004到2011年的肺結核病患做為追蹤世代,再依據肺結核用藥情形將族群分成一線用藥及二線用藥族群,並選取未被診斷有結核病的人作為對照組。空氣污染的數據則採用行政院環境保護署空氣品質監測網69個測站的資料。
結果與討論:從2004年到2011年的健保資料庫百萬抽樣歸人檔中,總共有6,770名結核病患者,其中一線用藥與二線用藥的病人各占了6,477人及293人,並選取33,346名樣本作為對照組。在共病症方面,三組人不管在糖尿病、氣喘、肺阻塞、愛滋病及塵肺症皆有統計上的顯著差異(P<0.001)。本研究將空氣污染指標依據四分法進行分組,使用logistic regression 評估空氣污染指標PM10,NO2,O3和CO與肺結核治療成效的相關性,在調整了年齡、性別、都市化程度、共病症等干擾因子後,發現空氣污染的濃度指標會影響肺結核患病情形。
關鍵字:肺結核、治療結果、空間分析
英文摘要 Objective: Tuberculosis (TB) is a major infectious disease that causes illness and death worldwide. It has been reported one third of the world’s population is infected with Mycobacterium tuberculosis. The incidence and the mortality of tuberculosis has been decreased recent year in Taiwan. However, compared to other developed countries, the incidence and mortality rates are higher. Its incidence is associated with the region's lifestyle, habits, population density, and social-economic status. However, it is unclear whether the treatment outcome is also related to environmental factors. Therefore, this study evaluated the associations between anti-TB treatment outcome and potential environmental factors.
Methods: We conducted a retrospective cohort study using data from the Longitudinal Health Insurance Database 2000 of Taiwan between 2004 and 2011 to identify pulmonary tuberculosis cases. According to anti-TB treatment, the patients were divided into two groups: first-line treatment and second-line treatment. We estimated individual exposure to air pollution using data from air quality monitoring stations established by the Environmental Protection Administration, Taiwan. We stratified air pollutant concentrations into quartiles and applied logistic regression models to evaluate their association with TB outcome while adjustments were made for age, sex, urbanization, and comorbidity.
Results: There were 6,770 patients diagnosed with tuberculosis between 2004 and 2011; 6,477 received first-line treatment only, and 293 received second-line treatment. A total of 33,346 individuals were selected as the control group. As to comorbidity, diffenences in the prevalence rates of diabetes mellitus, asthma, chronic obstructive pulmonary disease, AIDS and pneumoconiosis between the two patient groups were statistically significant (P<0.001). After adjusting for cofounders, our cohort study provided evidence supporting that fine particle pollution and traffic-related air pollution might be associated with an increased risk of TB.
Keywords: Tuberculosis; treatment outcome; Spatial Analysis
論文目次 目錄
中文摘要 I
英文摘要 II
誌謝 III
目錄 V
表目錄 VII
圖目錄 VIII
Chapter 1 Introduction 1
1.1 Background and motivation 1
1.2 Research question 2
Chapter 2 Literature review 3
2.1 The epidemiology of tuberculosis 3
2.2 The ambient air pollution and tuberculosis 3
2.3 The effectiveness of the anti-tuberculosis treatment 4
Chapter 3 Significance 5
3.1 Objective 5
3.2 Significance 5
Chapter 4 Materials and Methods 6
4.1 Study structure and study design 6
4.2 Study cohort 6
4.3 Outcome of interest 6
4.4 Exposure assessment 7
4.5 Covariates 7
4.6 Statistical analysis 8
Chapter 5 Results 10
5.1 Description of sample 10
5.2 Air pollution 10
5.3 The risk of tuberculosis 11
5.3.1 The 3-month Models 11
5.3.2 The 6-month Models 12
5.3.3 The 12-month Models 14

Chapter 6 Discussion 15
6.1 Past literatures 15
6.2 Tuberculosis and air pollution 15
6.3 Tuberculosis and other risk factor 16
6.4 Strength and limitation 16
Chapter 7 Conclusion 18
Reference 19
Appendixes 23
表目錄
TABLE 1 The frequency distributions among gender in patients with anti-tuberculosis treatment and control group stratified by age. 23
TABLE 2 Distribution of estimated air pollution concentration based on monitoring stations. 25
TABLE 3 Correlations between different pollutants 26
TABLE 4 Crude odds ratios (OR) and associated 95 % confidence intervals (CI) for tuberculosis treatment from univariate model. 27
TABLE 5 Crude and adjusted odds ratios (OR) and associated 95 % confidence intervals (CI) for tuberculosis from quartile air pollutant (3-month) model. 28
TABLE 6 Crude and adjusted odds ratios (OR) and associated 95 % confidence intervals (CI) for tuberculosis from quartile air pollutant (6-month) model. 30
TABLE 7 Crude and adjusted odds ratios (OR) and associated 95 % confidence intervals (CI) for tuberculosis from quartile air pollutant (12-month) model. 32
圖目錄
FIGURE 1. Study flow chart 34
FIGURE 2. The monthly variation of air pollutants level over the study years... 35
FIGURE 3. The Taiwanese town scale concentration of particulate matter less than 10 m in diameter in main Taiwan island 37
FIGURE 4. The Taiwanese town scale concentration of nitrogen dioxide in main Taiwan island 41
FIGURE 5. The Taiwanese town scale concentration of ozone in main Taiwan island 45
FIGURE 6. The Taiwanese town scale concentration of carbon monoxide in main Taiwan island 49
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