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系統識別號 U0026-0812200915173809
論文名稱(中文) 癲癇死亡率趨勢及癲癇病人死亡率分析
論文名稱(英文) Trends in epilepsy mortality and mortality in patients with epilepsy
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 2
出版年 98
研究生(中文) 張雅惠
研究生(英文) Ya-hui Chang
電子信箱 t8696407@mail.ncku.edu.tw
學號 t8696407
學位類別 碩士
語文別 中文
論文頁數 112頁
口試委員 口試委員-李中一
指導教授-呂宗學
指導教授-蔡景仁
中文關鍵字 死因  年度變化百分比  標準化死亡比  癲癇  年齡、時期、出生世代模型 
英文關鍵字 age-period-cohort  annual percentage change  epilepsy  standard mortality ratio  cause of death 
學科別分類
中文摘要 背景:過去台灣沒有看到使用全人口為分母的癲癇死亡率研究,且過去在探討死亡率趨勢時,往往無法檢定證明趨勢下降或上升的變化轉折點是否有意義。此外,出生世代同時也可能會影響趨勢的變化。同時,過去研究也指出癲癇患者的死亡風險高於一般人口,但是不同研究對於死因別死亡風險的數值估計仍有相當大差異,台灣至今尚無死因別死亡風險相關的研究。
目的:分析台灣和美國的癲癇死亡率時間趨勢改變以及年齡、時期、出生世代效應對癲癇死亡率的影響。同時瞭解南台灣癲癇患者之性別、年齡別、癲癇病因別與死因別死亡風險是否顯著高於一般人口,是否有某些死因別死亡風險數值顯著高於或低於其他國家。
材料與方法:利用 1971-2008 年之台灣衛生署死因統計資料與1981-2005 年之美國死因統計資料來分析年度變化百分比(Annual percentage change)以及年齡、時期、出生世代模型(Age、Period、Cohort model)。而癲癇患者的資料來源則為1988至2008年持續於南部某醫學中心癲癇特別門診就診之患者共2,237位,以身份證字號連結1988-2008年衛生署死因資料庫,共獲得26,701人年。分別計算性別、年齡別、癲癇病因別與死因別之標準化死亡比與95%信賴區間。
結果:台灣癲癇死亡率趨勢自1971年下降直至1993,94年開始上升,除了老人逐年上升外,其餘年齡層皆下降;美國癲癇死亡率趨勢則逐年下降,與台灣不同。主要是出生世代效應影響癲癇死亡率的趨勢。2,237位癲癇病人中共有240位癲癇病人死亡,其中男性175位,女性65位死亡。癲癇病人總體標準化死亡比為1.6 (95%信賴區間為1.3-1.7)。年齡10-19歲之年輕人死亡風險最高(標準化死亡比為9.7,95%信賴區間為5.6-13.7)。不同死因別標準化死亡比差異相當大,最高是腦瘤(標準化死亡比為14.5,95%信賴區間為3.8-25.2),其次是溺水(標準化死亡比為6.0,95%信賴區間為1.19-10.7)。
討論:台灣癲癇死亡率趨勢自1971,72年至1993,94年是下降的趨勢,而後又逐年上升,可能的解釋為1994年後開辦全民健康保險。開辦保險之前老年族群的癲癇患者沒有機會死於癲癇,而是死於其它競爭死因,直到健保開辦後,增加癲癇死亡的診斷,分子的增加,造成死亡率的提高。另外,出生世代是最主要影響癲癇死亡率的原因,且愈晚期出生的癲癇世代死亡率愈高,可能的解釋同樣是因為競爭死因的減少,死於癲癇的機會增加,使得癲癇死亡率升高。癲癇患者除了與癲癇有關的死因-腦瘤,有較高的死亡風險外,與癲癇間接相關的死因-溺水,也是患者死亡風險較高的死因之一。
結論與建議:本研究建議未來除了積極治療癲癇以及癲癇相關的併發症外,也應該注意癲癇患者事故傷害之預防與關懷,且近年來可預防死因的觀念逐漸引起重視,台灣對癲癇患者可預防死因之事故傷害防治需加以注意。
英文摘要 Background:Study the trends in mortality have often proved unable to test the trend of decrease or increase the turning point of the change whether it is meaningful before. In addition, the cohort effect may affect the trend, but no Taiwan study to prove the result. At the same time, past studies have pointed out that the risk of death in patients with epilepsy than the general population, but different studies the risk of death for the cause-specific estimates of the numerical differences are still considerable. Taiwan has no cause-specific mortality risk related research.
Objective: To analyze time trends in epilepsy mortality in Taiwan between 1971 to 2005 and the United States between 1981 to 2005. To compare the difference between Taiwan and other country in sex, age, causes of cause-specific mortality in patients with epilepsy.
Methods:Calculate age- and sex-specific epilepsy mortality rates. Mortality rates were modeled as a function of age, period of death, and cohort of birth by using Poisson regression techniques. Outpatients with diagnosis of epilepsy (ICD-9-CM, 345) from a special clinical in 1988-2008 were included in this study. The demographic characteristics and clinical manifestations of the cases were recorded by chart review. Besides, the data were linked to the Mortality Database of the Department of Health to confirm the cause of death. Cause-specific standard mortality ratio (SMR) was calculated.
Results:Trends in epilepsy mortality in Taiwan was declined since 1971 until 1993,94, and then the beginning of the year rose. In addition to the elderly have been increasing in each of the other age groups are declining; epilepsy mortality trends in the United States is declining year after year, with Taiwan different. The main effect is the cohort effect in epilepsy mortality trend. There are 240 deaths in the study periods among 2237 patients with epilepsy, 175 men, 65 women. The mortality of patients of epilepsy of prevalence cohort is significantly higher than that of general population (SMR = 1.6, 95% CI= 1.3-1.7). Those aged 10-19 years have the highest mortality (SMR=9.7; 95% CI= 5.6-13.7). The most common cause of death in patients with epilepsy is brain tumor (SMR=14.5; 95% CI =3.75-25.2), followed by drowning (SMR=6.0; 95% CI= 1.19-10.7).
Discusion:Epilepsy mortality trends in Taiwan from 1971,72 to 1993,94 was a downward trend, and then increased each year, may be interpreted as the start-up in 1994 after the National Health Insurance. Insurance prior to start-up of epilepsy in elderly people died of epilepsy in patients with no chance, but the cause of death from other competition until after the Health Insurance to increase the diagnosis of epilepsy deaths, an increase in elements, resulting in the improvement of mortality. In addition, the cohort effect in the impact of epilepsy is the most important causes of mortality. The possible explanation is that the reduction of the competition of cause of death died of epilepsy the opportunity to increase, making epilepsy mortality increase. In addition to patients with epilepsy and epilepsy-related cause of death - brain tumor, the indirect and epilepsy-related cause of death – drowning is a higher risk of death than general population.
Conclusions: This study suggest that the future treatment of epilepsy and epilepsy-related complications, but also in patients with epilepsy should be noted that the accident injury prevention and care, and preventable cause of death in recent years the concept of growing importance to Taiwan's cause of death in patients with epilepsy of preventable injuries prevention and treatment need to be addressed.
論文目次 摘要 i
Abstract iii
致謝 v
目錄 vi
表目錄 viii
圖目錄 x
壹、前言 1
1.1 研究背景 1
1.1.1 全人口為分母之癲癇死亡率 1
1.1.2 癲癇患者為分母之癲癇死亡率 2
1.2、研究目的 4
貳、文獻探討 5
2.1 分母為全人口之癲癇死亡率研究 5
2.1.1 小結 6
2.2分母為癲癇患者之癲癇死亡率研究 6
2.2.1 美國的研究 7
2.2.2 英國的研究 8
2.2.3 瑞典的研究 8
2.2.4 冰島的研究 10
2.2.5 荷蘭的研究 10
2.2.6 蘇格蘭的研究 10
2.2.7 中國的研究 11
2.2.8 台灣的研究 11
2.2.9 小結 12
2.3 癲癇死亡率方法學 13
2.3.1 標準化死亡率的計算 13
2.3.2 死亡率研究:發生世代和盛行世代 14
2.3.3 資料來源 15
2.3.4 世代影響 15
2.3.5 競爭危險 16
2.3.6 小結 17
參、研究方法 18
3.1 資料來源 18
3.2 死因分類 19
3.3 資料分析 19
3.3.1 死亡率時間趨勢改變分析(Joinpoint) 20
3.3.2 年齡-時期-世代模型分析(Age、period、cohort) 22
3.3.3 標準化死亡比計算(SMR) 23
3.4 研究倫理 24
肆、研究結果 26
4.1 死亡率時間趨勢改變分析(Joinpoint) 26
4.1.1 台灣時間趨勢改變 26
4.1.1.1 性別 26
4.1.1.2. 年齡別 27
4.1.1.3. 城鄉別 27
4.1.2 美國時間趨勢改變 27
4.1.2.1 性別 27
4.1.2.2 年齡別 28
4.2 年齡-時期-出生世代模型分析 (Age、period、cohort) 28
4.2.1 年齡影響 29
4.2.2 時期影響 29
4.2.3 出生世代影響 29
4.2.4 年齡-時期-出生世代影響 29
4.3 癲癇患者之癲癇死亡率(SMR) 30
4.3.1 性別 30
4.3.2 年齡別 31
4.3.3 癲癇病因別 31
4.3.4 特定死因別死亡率 32
伍、研究討論 33
5.1主要研究結果 33
5.2 本研究結果的重要性 33
5.3 與過去研究結果比較 35
5.3.1全人口之癲癇死亡率(Joinpoint) 35
5.3.2全人口之癲癇死亡率(Age、period、cohort) 36
5.3.3 癲癇患者之癲癇死亡率 36
5.4 研究限制 39
陸、結論與建議 40
參考文獻 41
表 46
圖 82
附錄 112
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