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系統識別號 U0026-2608201412091400
論文名稱(中文) 失智症患者跌倒與髖部骨折之多重死因分析
論文名稱(英文) Falls & hip fracture among people with dementia: A multiple-cause mortality analysis
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 102
學期 2
出版年 103
研究生(中文) 唐嘉宏
研究生(英文) Chia-Hung Tang
學號 T86011078
學位類別 碩士
語文別 中文
論文頁數 137頁
口試委員 指導教授-呂宗學
口試委員-楊俊毓
口試委員-王亮懿
口試委員-邱靜如
中文關鍵字 失智  跌倒  髖部骨折  頭部外傷  多重死因 
英文關鍵字 dementia  fall  hip fracture  traumatic brain injury  multiple-cause-of-death 
學科別分類
中文摘要 背景:失智症患者會增加跌倒死亡的風險。但是,過去研究大多樣本數較少且觀察時間較短,因此無法進行分層比較或趨勢分析。
目標:探討死亡證明書提及失智症者同時提及跌倒為死因之相關性,及其年代別、性別、年齡別與傷害別差異。
方法:本研究使用美國1981-2010年、臺灣2003-2012年多重死因資料進行分析。首先分析死亡診斷書提及失智症者(ICD-9:290, 331, ICD-10:F01-F03, G30)又提及跌倒(ICD-9:E880-E886, E888, ICD-10:W00-W19)之百分比。接著計算失智症患者不同特徵間提及跌倒之勝算比。再以提及跌倒為病例組,提及他殺為對照組,以多變項邏輯斯迴歸,估計各特徵分層下提及失智症為死因之調整後勝算比。
結果:美國死亡診斷書提及失智症又提及跌倒為死因之百分比,30年之趨勢變化為先下降後上升,男性高於女性,隨年齡增加而增加。臺灣之百分比,也是男性高於女性,但是年齡卻是高齡者較低。失智組相對於各種對照組提及跌倒為死因之調整後勝算比分別為,缺血性心臟病1.13(95%CI 1.12-1.15)、糖尿病1.30(95%CI 1.27-1.32)。跌倒組相對於各種對照組提及失智症為死因之勝算比分別為,交通事故組11.5(95%CI 10.8-12.2)、自殺組19.7(95%CI 17.9-21.6)、哽塞組0.32(95%CI 0.32-0.33)。選定他殺組做為跌倒組的對照時,提及失智症為死因之勝算比為4.4(95%CI 3.9-5.1);男性為7.5(95%CI 5.8-9.6)、女性為3.2(95%CI 2.8-3.8);年齡從65-74歲組的11.1(95%CI 7.5-16.5)降到85歲以上組的2.6(95%CI 2.1-3.1);年代趨勢為先增後減。如果再將跌倒細分為髖部骨折與頭部外傷,勝算比分別為6.9(95%CI 6.0-7.9)與3.1(95%CI 2.7-3.6)。
結論:雖然死亡診斷書同時提及失智症與跌倒為死因之百分比,近十年呈現上升趨勢,但是如果考慮對照組之變化趨勢,同時提及失智症與跌倒為死因之勝算比近十年呈現下降趨勢。未來研究,應進一步探討不同嚴重度失智症患者跌倒風險與機轉之差異,提供跌倒防制更具體之參考資訊。
英文摘要 「英文延伸摘要」Summary
Fatal death risk increase in dementia. However, past literature has too small sample size/observation time to be analyzed for stratification/time trend. To analyse the association of reporting fall and dementia in death certificates, we use multiple-cause-of-death data of U.S.A.(1981-2010) and Taiwan(2003-2012). We calculate the amount of reporting dementia (ICD-9:290, 331, ICD-10:F01-F03, G30) and percentage of reporting fall (ICD-9:E880-E886, E888, ICD-10:W00-W19), then focus on dementia group and calculate the odds ratios of reporting fall between characteristics. We use multivariate logistic regression model to analyse the adjusted odds ratios of reporting dementia fall(vs. assault) group. In U.S.A., percentage of reporting fall in dementia decrease then increase in recent 30 years; increase in men; and increase with age. Percentage in Taiwan is also higher in men, but lower in older group. The adjusted odds ratios of reporting dementia in fall (vs. assault) group are 4.4(95%CI 3.9-5.1); 7.5(95%CI 5.8-9.6) in men, 3.2(95%CI 2.8-3.8) in women; decrease from 11.1(95%CI 7.5-16.5) (65-74 age) to 2.6(95%CI 2.1-3.1)(85+ age); increase then decrease in recent 30 years. The adjusted odds ratios in fall-related hip fracture and fall-related traumatic brain injury are 6.9(95%CI 6.0-7.9) and 3.1(95%CI 2.7-3.6). Although the percentage of reporting fall in dementia group has increased time trend in recent 10 years, the adjusted odds ratio of reporting dementia in fall group(vs. assault group) has decreased time trend in recent 10 years. Future studies should analyse the risk and mechanism in different severity of dementia.
論文目次 摘要 I
誌謝 VII
目錄 VIII
表目錄 XII
圖目錄 XVII
第1章 前 言 1
1.1研究背景 1
1.2 過去研究限制 2
1.3 研究目的 2
1.4 研究問題 3
第2章 文 獻 回 顧 4
2.1 失智症與死亡 4
2.1.1 失智症簡介 4
2.1.2 失智症原死因研究 6
2.1.3 從原死因到多重死因研究 8
2.1.4 用多重死因資料探討兩項死因的相關性 10
2.1.5 失智症多重死因研究 10
2.1.6 小結 11
2.2 失智症與跌倒死亡 12
2.2.1 失智症與跌倒 12
2.2.2 失智症與髖部骨折 15
2.2.3 失智症與髖部骨折死亡 17
2.2.4 跌倒頭部外傷死亡 20
2.2.5 小結 21
2.3 年代趨勢 21
2.3.1 失智症死亡的年代趨勢 21
2.3.2 跌倒死亡的年代趨勢 22
2.3.3 髖部骨折的年代趨勢 23
2.3.4 頭部外傷的年代趨勢 24
2.3.5 小結 25
第3章 研 究 方 法 26
3.1 資料來源 26
3.2 個案界定 26
3.3 統計分析 28
第4章 結 果 30
4.1 美國死診提及失智者當中提及跌倒之比例 30
4.2 美國死診提及失智者不同特徵間提及跌倒之勝算比 31
4.3 美國死診提及跌倒(相對於他殺)當中提及失智之比例 32
4.4 美國死診提及跌倒(相對於他殺)當中提及失智之勝算比 34
4.5 臺灣死診提及失智者當中提及跌倒之比例 36
4.6 臺灣提及失智者不同特徵間提及跌倒之勝算比 36
4.7 失智、跌倒、髖部骨折、頭部外傷之年代趨勢 38
4.8 同平面跌倒、異平面跌倒、未分類型跌倒的分析 41
4.9 死亡診斷書填寫分析 42
4.10 小結 43
第5章 討 論 45
5.1 回答研究問題 45
5.2 本研究長處 46
5.3 與過去研究對話 47
5.4 研究限制 53
5.5 結論 59
第6章 參 考 文 獻 60
圖 表 65
附 錄 124
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