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系統識別號 U0026-0907201915544500
論文名稱(中文) 探討社區整合性篩檢利用情形與中老年人腎功能變化結果之相關性
論文名稱(英文) The association between the utilization of community-based integrated screening and outcomes of renal function in middle-aged and elderly recipients
校院名稱 成功大學
系所名稱(中) 公共衛生研究所碩士在職專班
系所名稱(英) Graduate Institute of Public Health(on the job class)
學年度 107
學期 2
出版年 108
研究生(中文) 王琦瑩
研究生(英文) Chi-Ying Wang
學號 SB7041015
學位類別 碩士
語文別 中文
論文頁數 109頁
口試委員 指導教授-劉立凡
共同指導教授-王榮德
口試委員-李柏蒼
中文關鍵字 社區整合性篩檢  利用  成效  慢性腎臟病 
英文關鍵字 community-based integrated screening  utilization  effectiveness  chronic kidney disease 
學科別分類
中文摘要 中文摘要
背景:在台灣,社區整合性篩檢是由縣市衛生局提供給40歲以上民眾免費的週期性健康檢查,目的是早期發現慢性病及危險因子、早期介入治療以維護群體健康。這項公共衛生政策已執行20年之久,然而,關於健康結果成效評估之研究很少,尤其是減少慢性病的罹病率,如腎臟病。
目的:探討偏遠地區中老年人社區整合性篩檢的利用情形與腎功能變化結果之間的相關性。
方法:本研究回溯收集2003年至2017年間參加台南市龍崎區社區整合性篩檢的40歲以上成人健康檢查資料,研究對象為重複利用整合性篩檢且基線無慢性腎臟病的個案,自變項為整合性篩檢利用次數(連續變項)及分組(兩次組vs≧3次組,類別變項),依變項包含腎功能年變化率、腎功能快速下降、以及新發生慢性腎臟病,分別以線性迴歸、邏輯斯迴歸、以及Cox迴歸進行多變量分析。
結果:本研究樣本包含935位基線無慢性腎臟病的個案,平均年齡為57歲,其中男性占52%,在平均7.4年的追蹤期間,分別有177人(18.9%)呈現腎功能快速下降及128人(13.7%)新發生慢性腎臟病。整合性篩檢利用次數≥三次組相較於兩次組,腎功能快速下降風險減少42%(OR 0.58,95%CI 0.35-0.96)、新發生慢性腎臟病風險減少71%(HR 0.29,95%CI 0.18-0.44),達統計上的顯著差異。
結論:在符合國家政策所規範的受檢年齡及頻率之前提下,定期且持續利用社區整合性篩檢與中老年人腎功能衰退之延緩可能有關,建議未來在政策宣導上應鼓勵民眾持續規則參與篩檢。
英文摘要 SUMMARY
Although community-based integrated screening has been implemented for 20 years as a national periodic health examination program in Taiwan, evidence about the effectiveness of morbidity reduction is sparse. Effectiveness of similar nationwide program in other countries has mainly reported on cardiovascular disease related outcomes. The aim of this study is to test the hypothesis of higher utilization of community-based integrated screening associated with better renal outcomes. We conducted a retrospective cohort study which enrolled participants aged ≥ 40 years old without baseline kidney disease who attended community-based integrated screening repeatedly in Longci District Tainan City during 2003-2017. In a subgroup analysis, participants with baseline hypertension, diabetes or cardiovascular diseases were further excluded. Screening utilization was either presented as numbers or utilization groups in separate models. Three renal health outcomes included annual change in kidney function, rapid decline in kidney function and incident chronic kidney disease were analyzed in corresponding statistical methods. A total of 935 participants without kidney disease at baseline were followed for 7.4 years. Results showed individuals who used screening more than three times had a 42%(OR 0.58,95%CI 0.35-0.96) lower risk of rapid decline in kidney function and 71%(HR 0.29,95%CI 0.18-0.44) lower risk of developing incident chronic kidney disease comparing with individuals who used screening twice only. In a subgroup analysis, higher screening utilization was associated with more risk reduction in renal health outcomes. Government should advise middle-aged and elderly to participate screening regularly and consecutively because of possible benefit of kidney function preservation.
論文目次 目錄
第一章 前言 1
第一節 研究背景與動機 1
第二節 研究重要性 3
第三節 研究目的 4
第四節 研究問題 4
第二章 文獻探討 5
第一節 社區整合性篩檢之介紹 5
第二節 週期性健康檢查之成效 7
第三節 腎功能變化之介紹 12
第四節 不同族群的腎功能變化及相關影響因子 15
第五節 週期性健康檢查與腎功能變化結果相關的研究 27
第三章 研究方法 28
第一節 研究設計與研究架構 28
第二節 資料來源與研究對象 30
第三節 研究變項之操作型定義 33
第四節 資料統計與分析方法 38
第四章 研究結果 40
第一節 社區整合性篩檢全部樣本之描述 40
第二節 單次篩檢組與重複篩檢組基本特性之雙變項與迴歸分析 45
第三節 全部樣本與次族群的腎功能變化情形 51
第四節 基線無慢性腎臟病的樣本之描述 55
第五節 整合性篩檢利用次數多寡分組基本特性之雙變項與迴歸分析 59
第六節 整合性篩檢利用次數與腎功能年變化率之迴歸分析 62
第七節 整合性篩檢利用次數與腎功能快速下降之迴歸分析 65
第八節 整合性篩檢利用次數與新發生慢性腎臟病之迴歸分析 70
第五章 討論 75
第一節 社區整合性篩檢利用情形的相關因素 75
第二節 中老年人在不同共病狀況下腎功能隨時間變化的情形 76
第三節 中老年人腎功能變化相關的影響因子 78
第四節 社區整合性篩檢利用次數與中老年人腎功能變化結果之相關性 81
第六章 結論與建議 83
第一節 結論 83
第二節 研究限制 84
第三節 建議 86
參考文獻 87
英文部分 87
中文部分 95
附件 96
附件一、社區整合性篩檢問卷舊版(2003-2010年) 96
附件二、社區整合性篩檢問卷新版(2011-2017年) 103

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