921震災對中老年人死亡風險的影響

Abstract

地震及颱風等天災往往在非常短時間內，對生命與健康造成全面性的傷害與破壞，即便是倖存者也必須面對災害造成的身心苦痛，因而增加了死亡風險。其中，中高齡人口由於生理機能退化，容易因為天災及氣候環境變化罹患疾病，後續醫療救護需求往往高於其他年齡層。過去文獻大多論及重大天災對死亡率立即的衝擊，較少探討後續災民死亡風險的變化，亦即災民死亡風險回復至與震災前的水準的恢復期間，本文利用全民健保資料庫分析921地震所屬的南投縣和臺中縣，與相鄰非災區彰化縣比較，估計震災前後的死亡風險的變化，衡量震災對災民的影響。研究發現：震災在短時間內造成災區嚴重的死傷，在震災中倖存之災民後續仍必須承受震災傷害的死亡風險，震災後災區領有震災卡之災民在震災後第一季的死亡風險顯著高過非災區1.27倍，震災後一年仍顯著高過非災民1.16倍，此結果顯示震災對於在震災中倖存但受創嚴重之災民的影響效果不會在短時間內消失，而是會持續一段時間。本研究對中老年人死亡風險的估計結果，可提供政府評估未來中高齡人口的緊急醫療，以及長期的照護需求之政策參考依據。

Earthquakes, typhoons and many natural disasters often cause comprehensive damage and destruction to human life and health in a very short time. The survivors of natural disasters bear physical and mental damage, which increases the risk of death. Particularly, the middle-aged and elderly are most vulnerable after natural disasters, due to their weakened physiological conditions. Their demand for medical care is also higher than that of other age groups. Most past work addressed the immediate impact of disasters on the morality risk of survivors, while little literature has focused on the aftermath of natural disasters to the morality risk of survivors. In this study, we use the National Health Insurance database and explore the mortality risk of the 921 Chi-Chi Earthquake`s survivors. Specifically, we study the mortality risk of earthquake survivors aged 50 and beyond in Nanto and Taichung counties (the disaster area), and compare them with those in Changhua county (a non-disaster area). The major findings include the face that the earthquake caused severe casualties within a short period of time, yet the survivors still had higher a mortality risk, which was about 1.27 times higher than that of the people of the non-disaster area for the first 3 months after the earthquake, and 1.16 times higher one year later. This suggests that the earthquake`s effect on the mortality risk did not disappear immediately after the disaster and, in fact, lasts almost one year. Our results can provide the government with some policy implications regarding the assessment of emergency medical care and long-term care for the elderly.