科技部專題研究計畫主持人
NSC 102-2410-H-039-006-SS2
以存活分析及集群分析探索台灣地區夫妻共同罹患疾病暨父母子女共同罹患疾病
Your Illness, My Illness? Concordance of Diseases among Married Couples and Parent-child in Taiwan Using Survival Analysis and Cluster Analysis
科技部
Ministry of Science and Technology
中國醫藥大學醫務管理學系(所)
Department of Health Service Administration, China medical University
王中儀
JONG-YI WANG
中國醫藥大學醫務管理學系(所)
Department of Health Service Administration, China medical University
王中儀
副教授
04-22053366 轉6313
ericwang@mail.cmu.edu.tw
計畫執行期間起:2013-08-01
計畫執行期間迄:2015-07-31
2014-11-01
2015-05-28
研究對象為台灣北中南四家醫院之家醫科門診就診之患者
2
001
01,02
相同疾病;家庭群聚;夫妻;父母子女
concordant diseases;family cluster;disease prevention;couple;parent-child
背景:文獻顯示家庭成員若一方罹病,其他成員亦患病之機率將提高。因重大與慢性疾病衝擊著大眾健康及健保財政,以家庭群聚角度進行共同疾病之檢視與預防顯得格外重要。目前台灣此類全國性研究闕如,應可增進疾病理論及照護實務應用。 目的:相同疾病可能出現於家庭成員間。以關切家庭成員罹患相同疾病之健康風險差距為出發點,本研究欲達目的如下:分析夫妻暨父母子女間罹患相同疾病之種類及相關因素;探索家庭成員罹患相同疾病之群聚。 方法:設計採回溯性世代研究,擷取健保資料庫2002-2013年承保抽樣歸人檔中夫妻5,643對及父母-子女20,165對為研究組;另加入Case-Control設計,以相同性別及年齡配對產生相同組數之非家人對照組。初級資料為以結構式問卷進行橫斷式調查,獲取北中南三區共四家教學醫院家醫科門診患者963份(家庭)。主要分析方法包括以SAS 9.3進行McNemar檢定、二項式與多項式邏輯斯迴歸分析、存活分析及集群分析。 結果:夫妻易罹患相同疾病種類包括代謝、精神、神經、循環、呼吸、消化、皮膚及骨骼,其整體共同罹患率89.74%,罹患相同疾病之相關因素主要為年齡、投保身分別、投保金額、投保區域、都市化程度、共病。配對結果發現夫妻較非夫妻顯著易罹患相同疾病。父母-子女易罹患相同疾病種類主要為代謝、精神、神經、循環、呼吸、泌尿,整體共同罹患率98.26%,罹患相同疾病之相關因素主要為年齡、投保身分別、投保金額、投保區域、都市化程度、疾病嚴重度。配對結果顯示,父母-子女較非父母-子女顯著易罹患相同疾病。問卷調查顯示,大於等於三位家庭成員共同罹患疾病之家庭比例最高前四項為肥胖(13.29%)、過敏性鼻炎(4.57%)、高血壓(3.12%)以及高膽固醇(1.77%)。相同健康行為易導致相同疾病。 結論:本研究證實健康行為與包含癌症等疾病皆存在家庭群聚現象。家庭群聚符合家庭生態系統等各理論。時值衛生福利部推動論人計酬制度,醫療機構宜針對易共同罹患之疾病及高風險家庭成員特性,進行即時有效介入規劃,以「以家庭為單位」嘗試預防疾病發生。
Objectives: If one family member suffers from illness, the odds of other member for illness might be escalating. However, there is a dearth of nationally-representative study on this domain in Taiwan. This study seeks to: 1. Analyze the complete category of concordant diseases and associated factors; 2. Explore the underlying and undiscovered clusters of concordant diseases among family members. Methods: 3,344 couples and 11,242 pairs of parent-child were identified from 2002-2013 Taiwan National Health Insurance Research Databases with a case-control design. In a cross-sectional design, primary data of 963 valid family samples were collected using structured questionnaires at the family medicine outpatient clinics in four teaching hospitals of northern, central, and southern Taiwan. Major analysis methods included McNemar test, dichotomous as well as multinomial logistic regressions, survival analysis, and cluster analysis performed in SAS 9.3. Results: Concordant systemic diseases among married couples included metabolism, psychiatry, neurology, circulation, respiration, digestion, dermatology, and orthopedics, with the overall prevalence rate 89.74%. The results of matching showed that couples were more likely to suffer from concordant diseases than non-couples did. Concordant systemic diseases among parent-child included metabolism, psychiatry, neurology, circulation, respiration, and uropathy, with the overall prevalence rate 98.26%. The matching results indicated that parent-child pairs were more likely to suffer from concordant diseases than non parent-child counterparts did. According to the survey results, the highest top three ranked familial proportions of concordant diseases with at least three members suffering were obesity (13.29%), followed by allergic rhinitis (4.57%), and hypertension (3.12%). Concordant health behaviors might lead to concordant diseases. Conclusion: The current study identified the family clustering phenomena in both health behaviors and diseases notably including cancer. The authorities and healthcare organizations should target the concordant diseases and persons of high risk, in the attempt to deliberate upon the effective family-based medical interventions for preventing concordant diseases.
否,無直接識別資料
除檢查有無可識別個人身份資料外,另檢查個案編號是否重複、變項及選項數值說明是否與問卷一致或未被定義,發現前述狀況時,將於確認後協助修改。
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