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系統識別號 U0026-1602202000355000
論文名稱(中文) 直接觀察治療短程(DOTS)結核病對台灣患者病情的影響
論文名稱(英文) The Impact of Directly Observed Treatment Short-Course (DOTS) for Tuberculosis on Patients’ Profile 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 108
學期 1
出版年 109
研究生(中文) 蘇納沙
研究生(英文) Natasha Sergeant
學號 S76067018
學位類別 碩士
語文別 英文
論文頁數 72頁
口試委員 指導教授-吳政龍
共同指導教授-郭浩然
召集委員-簡順添
口試委員- 郭耀昌
中文關鍵字 直接觀察治療計畫(DOTS)  結核病  台灣 
英文關鍵字 Directly Observed Treatment Short-Course (DOTS)  tuberculosis  Taiwan 
學科別分類
中文摘要 摘要
背景:本研究透過比較實施前與實施後患者的差異,來評估直接觀察治療計畫(DOTS)對肺結核(PTB)發生率的影響。普遍而言,結核病是一種可預防且可治癒的空氣傳播性致命傳染病。而在台灣,結核病幾十年來一直是最為盛行且最重要的傳染病,並且仍然是一種常見的公共衛生威脅,年發病率超過10,000例。世界衛生組織推薦DOTS為一種從人群中消除TB的高效且具有成本效益的策略。根據台灣先前的研究顯示,DOTS確實是一種可用於遏制結核病的方法。然而,DOTS的有效性仍然是具有爭議性的問題。
方法:本研究是採用回顧性世代研究方法,分析1996年至2013年台灣國家健康保險研究資料庫的所有結核病患者的數據,來檢驗我們的研究問題。我們檢查了PRE-DOTS(2000-2006, 引入DOTS之前)和POST-DOTS(2007-2010, 引入DOTS之後)兩個區間以對比引入DOTS前後的差異。我們假設所有肺結核病例都參加了DOTS,並使用統計SAS 9.4版(SAS Inc.,Raleigh,NC,USA) 分析數據。
結果:在17,760例的PTB病例中,發於PRE-DOTS 和POST-DOTS期間的病例分別為77.7% 和22.3%。大部分的PTB病例為男性,共佔62.2%。其中的60%為45歲及以上的年齡组,而最常被感染的則是低收入的工人(佔45.4%)。東部地區的結核病患者增加了約3%。約80%的病例居住在非山區。在PRE-DOTS 和POST-DOTS這兩個時期,年發病率下降為每10,000人-年10.4。糖尿病、過度緊張和營養不良是與PTB相關的危險因素。此外,2000-2010年間,PTB患者使用抗結核藥物的頻率有所下降。
結論:我們的結果顯示結核病DOTS的引入影響了患者的特徵,並降低了台灣結核病的發病率。
關鍵字:直接觀察治療計畫(DOTS)、結核病、台灣
英文摘要 ABSTRACT

Background: The purpose of this study is to evaluate the impact of Directly Observed Treatment Short-Course (DOTS) on the rate of Pulmonary Tuberculosis (PTB) through differences in the patients’ profile before and after its implementation. Globally, tuberculosis (TB) is an airborne, deadly infectious disease that is preventable and curable. In Taiwan, TB has been the most prevalent, significant communicable disease for decades and remains a prevailing public health threat with an annual incidence rate of over 10,000 cases. The World Health Organization recommends DOTS as an efficient and cost-effective strategy for eliminating TB. Previous studies in Taiwan have shown that DOTS is a viable way to stop TB. However, the effectiveness of DOTS remains controversial.
Methods: This study uses retrospective research methods and data from all national TB patients retrieved from Taiwan’s National Health Insurance Research Database from 1996 to 2013 to test our research questions. We examined the differences between groups, PRE-DOTS (2000-2006) and POST-DOTS (2007-2010). We hypothesized that all PTB cases participated in DOTS and analyzed the data using Statistical Analysis Software version 9.4 (SAS Inc., Raleigh, NC, USA).
Results: Of the 17,760 PTB cases, PRE-DOTS and POST-DOTS periods were 77.7% and 22.3% respectively. The majority of the PTB cases 62.2% were male. Over 60%, were in the age groups above 45 years old, whereas patients classified as low-income workers were most affected (45.4%). In the eastern area, revealed an increase of 3% of TB patients. Overall, about 80% live in non-mountainous regions. There was a decrease in the annual incidence rate of 10.4 per 10,000 person-years between both periods. Diabetes mellitus, hypertension and malnutrition were found as risk factors associated with PTB. Also, from 2000 to 2010 the frequency of anti-TB drug usage decreased among PTB patients.
Conclusion: Our results show that the introduction of DOTS for TB has affected the patients' profile and caused a decreased in the rate of TB in Taiwan.

Keywords: Directly Observed Treatment Short-Course (DOTS), tuberculosis, Taiwan
論文目次 TABLE OF CONTENTS

摘要………………………………………………………………………………………………...…….III
Abstract…………………………………………………………………………………………IV
Acknowledgements……………………………………………………………………………..VI
Table of Contents VII
List of Tables…………………………………………………………………………………....IX
List of Figures…………………………………………………………………………………..XI
Abbreviations…………………………………………………………………………………..XII

Chapter I- Introduction 1 - 6
1.1- Background 1
1.2- Study Hypothesis 4
1.3- Aim and Objectives 4
1.4- The Importance of the Research Study 5

Chapter II-Literature Review ………….7 - 18
2.1- History of Tuberculosis ……………………………………………………………………7
2.2- Descriptive Epidemiology of TB in Taiwan 8
2.3- Risk factors for TB ………………...……………………………………………………..11
2.4- Development of DOTS Strategy 14
2.5- Implications of the Implementation of DOTS 16

Chapter III- Methodology 19 - 32
3.1.1- Study Design …………………………………………………………………………...19
3.1.2- Data Source and Study Participants…………………………………………………….19
3.1.3- Data Collection and DOTS 24
3.1.4- Anti-TB Drugs ………………………………………………………………………… 25
3.1.5- Study Period 28
3.1.6- Study Area 28
3.1.7- Comorbidities 29
3.1.8- Outcome Measures 31
3.2- Statistical Analysis 31

Chapter IV- Research Results 33 - 57
4.1- Demographic Characteristics of the Study Participants………………………………….33
4.2- Trends in Pulmonary TB……......……...………………………………………………...37
4.3- Comorbidities of Pulmonary TB...……………………………………………………….42
4.4- Subgroup Analyses……………………………………………………………………….45
4.4.1- Difference-in-Differences Analysis………………………………………………….45
4.4.2- Stratified Analysis of Taiwan’s Counties……………………………………………50
4.5- Anti-TB Drugs……………………………………………………………………………54

Chapter V- Discussion …………………………………………………………………………………………………………… 57 - 62
5.1- Summary of Key Findings ………………………………………………………………57
5.2- Key Findings by Research Question….………………………………………………… 57
5.3- Strengths of the Study……………...…..…………………………………………………61
5.4- Limitations of the Study…………….....…………………………………………………62


Chapter VI- Conclusion 63 - 64
6.1- Conclusion ………………………………………………………………………………63
6.2- Recommendations ………………………………………………………………………63

VII- References…………………………………………………………………………… 65 - 68

Appendix.………………………………………………………………………………….69 - 72
S1- Incidence Rate by Address and Age Group, Taiwan Pulmonary TB Cases, 2000 – 2010
……………………………………………………………………………………….…...69
S2- Incidence Rate by Address and Sex, Taiwan Pulmonary TB Cases, 2000 – 2010……...71
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