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系統識別號 U0026-1108201411041900
論文名稱(中文) 臺灣地區長期細懸浮微粒暴露與發生第2型糖尿病之研究
論文名稱(英文) Association Between Long-term Exposures of Fine Particulate Matter and Type 2 Diabetes 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 102
學期 2
出版年 103
研究生(中文) 林柏秀
研究生(英文) Po-Hsiu Lin
學號 s76014023
學位類別 碩士
語文別 中文
論文頁數 62頁
口試委員 召集委員-辛錫璋
口試委員-郭浩然
口試委員-郭炤裕
指導教授-蘇慧貞
中文關鍵字 細懸浮微粒  發生率  第2型糖尿病 
英文關鍵字 Fine particulate matter  Incidence  Type 2 diabetes 
學科別分類
中文摘要 部分動物試驗與流行病學研究發現,長期暴露於較高細懸浮微粒濃度下可能導致糖尿病之發生。然而,現階段實證研究證據仍相當匱乏,並且僅於歐美地區有所探討。因此,研究希望藉由台灣地區資料為例,瞭解亞洲地區長期細懸浮微粒 (fine particulate matter 2.5, PM2.5) 之暴露量與發生第2型糖尿病之關聯性。
研究利用全民健康保險2000年百萬承保抽樣歸人檔 (Longitudinal Health Insurance Database 2000, LHID 2000) 之世代追蹤研究資料,選取2007年至2011年間罹患糖尿病者的新病例、排除20歲以下患者,利用國際病例碼第九版篩選第2型糖尿病者 (ICD-9: 250)。暴露資料則以疾病發生前12個月、24個月與36個月之細懸浮微粒資料取自2006至2011年空氣品質監測網之PM2.5自動監測資料,並以克力金模型 (Ordinary Kriging) 將每小時之PM2.5監測資料模擬至研究對象就醫地點所在之鄉鎮,做為受試者之暴露代表。再以Cox比例風險模型 (Cox proportional hazard model) 估計PM2.5暴露濃度與發生糖尿病之危險比 (hazard ratios, HRs),以及其95%信賴區間 (confidence intervals, CIs)。
於2007年至2011年追蹤期間,共發現16,270位糖尿病新病例。若僅考慮罹病前12個月之PM2.5暴露,每增加10 μg/m3將顯著增加8%罹患風險 (HR=1.08, 95% CIs: 1.06–1.10),若加以控制個人疾病風險因子、暴露地區與共病症後,則顯著增加2%罹患風險 (HR=1.02, 95% CIs: 0.98–1.07)。同理,罹病前24個月之PM2.5暴露每增加10 μg/m3之危險比 (HR) 為0.86 (95% CIs: 0.80–0.93),加以控制個人疾病風險因子、暴露地區與共病症後,則增加16%罹患風險 (HR=1.16, 95% CIs: 1.01–1.35)。拉長至36個月之PM2.5暴露,每增加10 μg/m3之危險比為0.83 (95% CIs: 0.74–0.92),加以控制個人疾病風險因子、暴露地區與共病症後,則顯著增加20%罹患風險 (HR=1.20, 95% CIs: 0.94–1.53)。
結果顯示,台灣地區長期細懸浮微粒之暴露,可能提高第2型糖尿病發生風險。
英文摘要 Animal and few epidemiological studies found that long-term exposures to higher fine particulate matter (PM2.5) may contribute to the development of type 2 diabetes. However, empirical research evidence relating PM2.5 and diabetes is scarce and lack of evidence in the Asian country. The study assesses the association between long-term exposure to PM2.5 and incident diabetes in Taiwan.
The subjects’ health information was retrieved from Longitudinal Health Insurance Database 2000 (LHID 2000), and incident diabetes cases were defined as participants who were 20-year-old or more in 2007-2011 and without diabetic history. PM2.5 automatic monitoring data from 2006 to 2011 were acquired from the Taiwan Air Quality Monitoring Network (Taiwan AQMN). Personal exposures to PM2.5 were based on the levels estimated by the Ordinary Kriging model levels that extrapolated PM2.5 levels measured at monitor sites to each individual. The Cox proportional hazards model was utilized to assess the association between incident type 2 diabetes and long-term exposure to PM2.5.
There were 16,270 incident cases of type 2 diabetes from 2007 to 2011. For every 10 μg/m3 increase of PM2.5 averaged over the 12 months prior to diabetes diagnosis, the crude hazard ratio (HR) for incident diabetes was 1.08 (95% confidence intervals [CIs], 1.06–1.10). Further controlling for individual-level covariates, neighborhood-level covariates and comorbidities, the risk was significantly increased by 2% (HR=1.02, 95% CIs: 0.98–1.07) for every 10 μg/m3 increase on PM2.5. In sensitivity analyses that assessed the effect of every 10 μg/m3 increase in PM2.5 24-month and 36-month prior to disease diagnosis on diabetes, the adjusted HRs was 1.16 (95% CIs: 1.01–1.35) and 1.20 (95% CIs: 0.94–1.53), respectively.
This study suggests that long-term exposure to PM2.5 may increase the risk of type 2 diabetes.
論文目次 摘要 I
EXTENDED ABSTRACT II
致謝 VIII
目錄 IX
表目錄 VI
圖目錄 VII
第一章 研究背景 1
第二章 文獻回顧 3
第一節 國內外懸浮微粒趨勢變化 3
第二節 國內外糖尿病之近況 5
第三節 細懸浮微粒 (PM2.5) 與第2型糖尿病之間的流行病學證據 7
第2型糖尿病是PM2.5所影響之健康不良效應的易感性因子 8
糖尿病與懸浮微粒中間機制之實驗證據 9
第三章 材料與方法 12
第一節 資料來源 12
細懸浮微粒 (PM2.5) 12
第2型糖尿病 14
共變數定義 17
第二節 統計分析 18
第四章 研究結果 19
第一節 描述性統計 19
細懸浮微粒 (PM2.5) 狀態 19
第2型糖尿病狀態 19
第二節 統計分析成果 20
單位PM2.5改變量對第2型糖尿病之影響 21
多重因子對第2型糖尿病之影響 21
分層分析成果 22
第五章 討論與結論 24
第一節 相關文獻與本研究之比較 24
細懸浮微粒 (PM2.5) 暴露時間 27
細懸浮微粒 (PM2.5) 來源與濃度 28
糖尿病人口統計差異 29
第二節 研究優勢與限制 30
研究優勢 30
研究限制 31
第六章 研究結論與建議 33
第七章 參考文獻 35
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