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系統識別號 U0026-2908201913391700
論文名稱(中文) 台灣地區飲用水之砷暴露與失智症之相關性
論文名稱(英文) The Associations between Arsenic in Drinking Water and Dementia 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 107
學期 2
出版年 108
研究生(中文) 蔡馥宇
研究生(英文) Rodger Tsai
電子信箱 ricxeor@gmail.com
學號 S76057013
學位類別 碩士
語文別 英文
論文頁數 5頁
口試委員 指導教授-郭浩然
召集委員-鄭天浚
口試委員-黃建程
口試委員-簡玉雯
中文關鍵字 無機砷  飲用水  相關性  失智症 
英文關鍵字 Inorganic arsenic  drinking water  associations  dementia 
學科別分類
中文摘要 研究目的:
調查飲用水中的砷曝露與失智症之相關性。
研究方法:
本研究利用臺灣的全民健康保險資料庫2000 年歸人檔與先前政府飲用水含砷量普查數據,以年齡等於或高於40 歲的成員為對象,納入了在1998 年1 月1 日至2010 年 12 月31 日期間新診斷出的失智症患者為病例組和無失智症者為對照組,年齡分為40-65 歲之間及大於65 歲兩組,分析飲用水中的砷暴露與失智症之相關性。
研究結果:
在資料庫中1998 年有196,958 名成員符合納入條件,1998 年1 月1 日至2010 年12月31 日期間新診斷出的失智症患者有8,836 例(病例組),對照組有188,122 人。研究族群的平均年齡為54.0±10.9 歲,失智症患者平均年齡顯著高於對照組(67.4±10.1歲比53.3±10.5 歲,p<0.01),超過一半的失智症病例是女性(55%)。單變項分析顯示失智症與飲水砷暴露、性別、和都市化程度之間存在顯著的相關性(p<0.01),多變項邏輯回歸分析顯示大於65 歲者砷暴露的失智症之勝算比(OR)=1.25(95%CI=1.05-1.48,p<0.05)。
結論:
本研究顯示飲水含砷暴露為大於65 歲者患失智症的危險因子。性別及都市化程度則與40-65 歲者之失智症存在顯著的相關性。
英文摘要 Objective:
The purpose of this study was to investigate the associations of arsenic in drinking water and dementia.
Methods:
This study analyzed the National Health Insurance Database and arsenic exposure data in Taiwan, where a cohort of 196,958 members with age of 40 or above in 1998 was followed. Individuals under 40 years of age in 1998 were excluded because they were unlikely to drink water from wells as the tap water system had been constructed widely throughout Taiwan in the 1970s. Arsenic exposures were divided into endemic (Chia-Yi, Tainan, and Yi-Lan Counties) and nonendemic areas (other cities/counties). We identified 8,836 cases with dementia they were newly diagnosed between January 1, 1998 and December 31, 2010. In further analyses, we divided the study cohort into two major groups: 40-65 years old and over 65 years old. We used chi-square tests to evaluate differences in the distributions of categorical variables between cases and the rest of 188,122 cohort members. Multivariate logistic regression analyses were then applied to assess the associations between arsenic exposure and dementia.
Results:
The average age of study population was 54.0 years (SD=10.9). For those with dementia the average age was 67.4 years (SD=10.1, p<0.01), and those without dementia was 53.3
years (SD=10.5, p<0.01). More than half of the dementia patients were female (55%). Univariate analyses showed that dementia was associated with arsenic exposure, gender,
and urbanization level of cities (p<0.01). Multivariate logistic regression analyses revealed an odds ratio (OR) of 1.25 for dementia from arsenic exposure (95% confidence interval [CI]=1.05-1.48, p<0.05) in those above 65 years old only. For those 40-65 years old, logistic regression analyses of dementia status showed significant OR of 1.16
(95%CI=1.15-1.17, p<0.01) and 1.09 (95%CI=1.07-1.12, p<0.01) respectively for age and urbanization level of cities. The entire study population in addition revealed significant OR
of 1.14 for gender (95%CI=1.09-1.19, p<0.01). No significant odds ratios for arsenic exposure and dementia status were observed in ages 40-65 and for the entire study population.
Conclusions:
The current study showed that arsenic exposure may be a risk factor for dementia in Taiwanese older than 65 years. Age and the urbanization level of the city/county of residence were also significant predictors for dementia in Taiwan in those who were 40-65 years old.
論文目次 中文摘要................ 2
Abstract ................ 4
Acknowledgements .............. 6
Chapter 1 Introduction ............. 9
Background .............. 9
Objective .............. 10
Chapter 2 Literature review ........... 11
Arsenic characteristics ........... 11
Arsenic exposure and its impact .......... 11
Biological mechanisms of arsenic and dementia ....... 13
Dementia background and epidemiology ........ 14
The etiology of dementia ........... 16
Clinical diagnostic criteria of dementia ......... 17
The treatment of dementia ........... 18
Chapter 3 Materials and Methods .......... 19
Study data source and structure ........... 19
Definition of dementia cases .......... 20
Study population and area ............ 20
Statistical analysis ............ 22
Chapter 4 Results ............. 23
Demographical characteristics of entire study ....... 23
Demographical characteristics of endemic vs. non-endemic areas ..... 23
Univariate analyses ............ 24
Multivariable logistic regression analyses ......... 25
Summary of associations between arsenic exposure in drinking water and dementia 26
Chapter 5 Discussions ............ 28
Associations between arsenic exposure in drinking water and dementia .... 28
Strengths and limitations ............ 33
Chapter 6 Conclusions ............. 35
References .............. 36
Table 1. Basic characteristics of the participants by the dementia disease status. . 47
Table 2. Basic characteristics of the participants by the water arsenic exposure and
dementia status. ............ 48
Table 3. T-test for age vs. dementia status. ........ 49
Table 4. Study population characteristics with chi-square analyses. ... 50
Table 5. Study population measures of association (2x2 table analyses). ... 51
Table 6. Multivariable logistic regression analysis of dementia status for endemic vs.
non-endemic areas. ............ 52
Table 7. Study distribution of cases and controls in Taiwan. ..... 53
Figure 1. Study design and the flow chart of the selection of the subjects. ... 54
Figure 2. Map of southwestern and northeastern water arsenic exposed areas in
Taiwan. ............... 55
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