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系統識別號 U0026-2008201319372200
論文名稱(中文) 接種流感疫苗對預防住院及死亡的效果:非機構之低收入戶與一般老人的比較
論文名稱(英文) Effectiveness of Influenza Vaccination in Preventing Hospitalizations and Deaths : Comparison between Low-income and General Non-institutionalized Elderly
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 101
學期 2
出版年 102
研究生(中文) 林小靖
研究生(英文) Hsiao-Ching Lin
學號 T86001081
學位類別 碩士
語文別 中文
論文頁數 72頁
口試委員 指導教授-王亮懿
口試委員-江東亮
口試委員-呂宗學
中文關鍵字 老人  低社經地位  流感疫苗效果  健康平等政策 
英文關鍵字 elderly  low socioeconomic status  effectiveness of influenza vaccine  health equality policy 
學科別分類
中文摘要 研究背景與研究目的:
過去研究證明該疫苗對慢性病等高危險族群具有較好的效益,但對同為健康弱勢的低社經老人的效果,卻少有研究探討。本研究目的為探討台灣65歲以上老人在2001年全面接種公費流感疫苗後,流感疫苗對低社經老人的效果,以及流感疫苗政策是否為我國有效的健康平等政策。
研究方法︰
本研究透過2001至2010年間的全民健保資料庫及死因檔,65歲以上老人的全死因死亡、全病因住院、肺炎及流感住院三種結果,定義我國法定低收入戶為低社經族群,利用邏輯斯迴歸估算低收入戶老人與一般老人的流感疫苗效果並以敏感性分析估算不同疫苗接種率下,低收入戶老人與一般老人間全死因死亡率的差異,來探討低收入戶與一般65歲以上社區老年人的流感疫苗效果。
研究結果:
本研究發現2002-2009流感年間的疫苗接種率,一般老人約在42-58%之間,低收入的老人只有約36-48%的人接種流感疫苗,且歷流感年低收入戶老人的疫苗接種率皆顯著低於一般老人。流感疫苗對全死因死亡具有保護效果,但對低收入戶老人(OR=0.917)較一般老人(OR=0.848)的效果差。低收入戶老人的疫苗接種率超過一般老人的疫苗接種率之後,兩社經階層老人死亡率差開始逐漸縮小,若未能提高低收入戶老人的疫苗接種率,則會使兩社經階層老人的死亡率差更擴大。
結論:
本研究認為,流感疫苗的確在低收入戶老人身上有保護效果,但可能受其他物質環境或疾病等風險影響而降低,所以效果較一般老人差,雖然不同社經階層的老人的健康不平等情形,不會因接種流感疫苗而完全消失,但是若未能提高低收入戶老人的疫苗接種率,會使兩社經階層的老人健康不平等情形更擴大,為了避免健康不平等的加劇,我們應該優先對於低收入戶老人來施打流感疫苗。
英文摘要 Background and Objectives:
A growing body of research investigated the benefit of vaccination to the high-risk population; however, the correlation between protective effect of vaccine and elderly population in the low socioeconomic (low-SES) status was rarely discussed. This study aimed to investigate the effectiveness of influenza vaccine on the low socioeconomic status elderly after the publicly influenza vaccination program was issued in Taiwan in 2001. And to exam the suitability of the publicly influenza vaccination program as a health equality policy.
Method:
Data were extracted from the National Health Insurance Research Database and Death Registry Dataset from 2001 to 2010. Death of all causes, hospitalization of all causes and hospitalization caused by pneumonia and influenza of elderly were measured as outcome variables. We compared the effectiveness of influenza vaccination to low-SES elderly(LS) with general elderly population(GE). Low-SES was defined as low-income households with official recognition.
Result:
We found that the vaccination rates between 2002 to 2009 are 42~ 58% of GE and 36-48% of LS. Significantly, the vaccination rate of LS is lower than GE in each influenza season. Second, the vaccine has protective effect on death of all cause but the inequality effect was suggested (Odds Ratio: LS:0.917, GE:0.848). As the vaccination rates increased in LS, the variance of mortality rate between two socioeconomic group decreased. Therefore, a relatively lower vaccination rate in LS group could cause a wider variance of mortality rate between LS and GE groups.
Conclusions:
Evidence suggested that influenza vaccination has protective effect on the LS group. However, the effect is weaker on the LS group than it on the GE group which might be a result of other risk factors. Although, the health inequality in different socioeconomic status can not be balanced by influenza vaccination along. Fail to increase the vaccination rate on LS group could aggravate the inequality health status. As a result, LS group should be vaccinated prior to the GE group.
論文目次 第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第三節 研究問題 3
第四節 研究假設 4
第二章 文獻探討 5
第一節 低社經老人的健康弱勢 5
第二節 疫苗對低社經地位的效果 5
第三節 流行性感冒與疫苗 7
第四節 流行性感冒疫苗的效果 9
第五節 探討流感疫苗效果的方法學 12
第六節 小結 14
第三章 材料方法 15
第一節 資料來源 15
第二節 研究對象 16
第三節 研究設計 16
第四節 相關變項定義 19
第五節 統計軟體 23
第四章 研究結果 24
第一節 樣本特性及各社經階層的流感疫苗接種趨勢 24
第二節 各社經階層不同疫苗接種狀態下,全死因死亡率、全病因住院率、肺炎或流感住院率分析 27
第三節 各社經階層的疫苗效果分析 28
第四節 流感疫苗對兩社經階層死亡率差距降低的效果 30
第五章 討論 32
第六章 結論與建議 40
第七章 參考文獻 42
表 48
圖 66
附錄 68
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