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系統識別號 U0026-0812200915063615
論文名稱(中文) 縣市別死亡率排序比較相關問題方法學探討-比什麼?如何比?
論文名稱(英文) Problems Related to Cause-Specific Mortality League Table in City/County Level :What to and How to Compare?
校院名稱 成功大學
系所名稱(中) 公共衛生研究所
系所名稱(英) Graduate Institute of Public Health
學年度 97
學期 1
出版年 98
研究生(中文) 曾頌雅
研究生(英文) Song-ya Tseng
電子信箱 t8695104@mail.ncku.edu.tw
學號 t8695104
學位類別 碩士
語文別 中文
論文頁數 109頁
口試委員 口試委員-楊俊毓
指導教授-呂宗學
口試委員-黃旭明
中文關鍵字 流行病學方法  衛生統計指標  死亡率  統計資料詮釋  人口監測 
英文關鍵字 Statistical data interpretation  Population survelliance  Mortality  Health status indicators  Epidemiology Method 
學科別分類
中文摘要 研究背景:縣市別死亡率排名是大眾媒體與衛生行政機關發現地區健康問題與評價執行績效經常使用的統計方法。但是究竟應該比較什麼死因,至今還沒有定論。此外,忽略縣市別人口數大小造成的死亡率計算的統計不穩定,也會造成錯誤的排名解釋。
研究目的:找出適合於台灣縣市別死亡率排序的可避免死因有哪些,比較傳統排名與考慮95%信賴區間排名對於決定健康問題大小解釋的差異。
材料與方法:以文獻引用率及台灣實際死亡數兩個條件來篩選適合於台灣縣市別死亡率排序的可避免死因。針對這些死因再計算1998-2007與1988-1997兩時期縣市別不同年齡條件(0-75歲和0-69歲)之年齡標準化死亡率、改變率及其95%信賴區間,並以名次高至低的第25、75分位作為切點來決定問題大小。
研究結果:過去文獻曾經使用過的可避免死因超過80種,經過兩條件篩選後本研究選出十種適合台灣縣市別比較的可避免死因。整體而言,以傳統排名方法決定出來的最高五名與最低五名縣市,若考慮了95%信賴區間,約有二至三個縣市未達統計顯著差異。被排除的縣市主要是人口數較少的縣市,譬如澎湖縣、基隆市、新竹市與嘉義市等。本研究也發現1998-2007年縣市別排名與1988-1997年至1998-2007年改變率排名有相當大差異。
結論:要正確解釋縣市死亡率排名結果用於發現地區健康問題與評價執行績效,本研究建議應該侷限於死亡人數達到某程度的可避免死因,最好有年齡限制,也要考慮95%信賴區間與改變率。
英文摘要 Background: League table by city/county is a commonly used statistics by mass media and health authorities to identify health problems and assess the performance. However, it is controversial in choosing which cause of death (COD) for comparisons. In addition, the interpretation of league table might be incorrect if we did not consider the statistical unstabability due to population size.
Objective: To identify avoidable cause of death suitable for league table by city/county in Taiwan and to compare the conclusions derived from traditional ranking method with those considering the 95% confidence intervals (95% CI).
Materials and methods: The criteria used in identifying suitable avoidable COD are the frequence of use by previous studies and number of deaths in Taiwan. We then calculated the age-adjusted mortality rate of each city/county for different age-group ranges (0-75 and 0-69 years) for 1998-2007 and 1988-1997, percentage of chages between the two periods and 95% CI. The 25th and 75th percentile were used as the cutpoint in identifying the size of problem.
Results: Of more than 80 avoidable COD, we identify 10 COD suitable for city/county level comparisons. Of the top and lower five city/counties identified according to traditional ranking method; on avearge two to three of them would be excluded if we considered the 95% CI. Most of the city/counties been excluded were those with small population such as Penghu County, Keelung City, Hsing-Chu City and Chiayi City .We also found that the ranks of mortality for the years 1998-2007 differed greatly from the ranks of changes of mortality from 1988-1997 to 1998-2007.
Conclusions: To have a proper interpretation of league table in identifying important health problems and assessing performace, we should confine to those avoidable COD with significant number of deaths in certain age-group range and taking into account the 95% CI and percentage of changes.
論文目次 考試合格證明書 I
中文摘要 II
ENGLISH ABSTRACT III
致謝 IV
目 次 V
表 目 錄 VI
圖 目 錄 VII
第一章 前言 8
第二章 文獻探討 12
第一節 排名表綜述 12
第二節 排名表的優點與爭議 15
第三節 排名表存在的問題及解決方法 18
第四節 可避免死因指標 25
第三章 研究方法與材料 29
第一節 研究流程 29
第二節 縣市別排名比較的方法 31
第三節 死亡率分析之研究材料 33
第四章 研究結果 36
第一節 可避免死因指標 36
第二節 不同方法下縣市別比較的結果 38
第五章 討論 45
第一節 比什麼-以可避免死因進行縣市別死亡率和死亡率改變率比較 45
第二節 如何比-以區間估計比較縣市別死亡率高低之方法 47
第三節 研究限制和爭議 49
第四節 結論 50
參考文獻 51
英文部分 51
中文部份 54
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