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題名 以健保資料庫探討臺灣高齡人口第二型糖尿病與其併發症
Using National Health Insurance Database to Explore Taiwan Elderly’s Type II Diabetes and its Complications作者 許育嘉
Shiu, Yu-Jia貢獻者 楊曉文<br>余清祥
Yang, Sheau-Wen<br>Yue, Ching-Syang
許育嘉
Shiu, Yu-Jia關鍵詞 人口老化
第二型糖尿病
併發症
醫療利用
全民健保資料
Population Aging
Type 2 Diabetes
Complications
Health Care Utilization
National Health Insurance日期 2021 上傳時間 2-九月-2021 16:01:58 (UTC+8) 摘要 由於生活飲食習慣的改變，加上缺乏足夠的定期運動，國人罹患糖尿病的比例有越來越高的趨勢，尤其是佔比超過九成的第二型糖尿病，隨著年齡增加，罹病機率愈大。糖尿病患者屬於代謝症候群的一員，可視為健康的危險訊號，糖尿病患者通常容易罹患心血管疾病，死亡率也高於一般國民，近年我國代謝症候群相關死亡率甚至超過癌症，可謂可怕的隱形殺手，對國家發展、個人生活造成重大威脅。台灣糖尿病盛行率高於世界平均，尤其是高齡者情況更加嚴重，由於糖尿病屬於慢性疾病，需要長期治療及觀察，預計相關醫療支出及影響將隨著人口老化而加劇。有鑑於此，本文以第二型糖尿病為研究目標，推估第二型糖尿病病患及醫療利用的變化趨勢，提供政府及保險公司因應的參考。本文以台灣高齡人口為研究對象，探討第二型糖尿病罹病趨勢與其併發症，並分析患者的門診、住院等醫療利用，使用全民健保資料庫的2005年百萬老年人抽樣資料，資料期間為2005～2013年。由於糖尿病至今仍無一致的認定標準，基於慢性病有持續就醫的需求，本文採用門診與住院紀錄作為判斷是否罹患糖尿病的標準。資料分析顯示第二型糖尿病高齡患者的盛行率與發生率皆逐年上升，而死亡率則呈現下降的趨勢；無論是門診或住院的醫療利用，糖尿病患者明顯高於非糖尿病患者，且糖尿病高齡患者的門診醫療使用在近年有上升趨勢。另外，本文亦探討第二型糖尿病併發症帶來的影響，發現心血管病變、洗腎、神經病變、眼部病變會增加第二型糖尿病高齡患者的門診次數，且患有洗腎需求的第二型糖尿病高齡患者其平均門診金額會大幅上升。
Due to the changes in dietary habits and the absence of sufficient physical activity, an increasing proportion of the population has become susceptible to diabetes, particularly type 2 diabetes, which accounts for over 90% of the disease, with increasing incidence with age. Diabetes is a member of the Metabolic Syndrome Family, regarded as a health risk signal. Patients with diabetes are commonly predisposed to cardiovascular diseases. They have a higher mortality rate when compared to the general population, which has even surpassed cancer in recent years, making it a formidable covert killer that poses a significant threat to national development and personal life. In Taiwan, the prevalence of diabetes exceeds the world average, particularly among the elderly. Furthermore, as diabetes is a chronic disease requiring long-term treatment and observation, it is expected that the related medical expenses and impacts would intensify as the population ages. In consideration of these factors, this study addresses type 2 diabetes to estimate the trend of the changing number of diabetic patients and their medical utilization in order to provide a reference for the government and insurance companies.In this study, we analyzed the trend of type 2 diabetes and its complications among the Taiwanese elderly population, as well as the outpatient and inpatient medical utilization based on the National Health Insurance Database`s 2005 population-based sample records of one million elderly people, covering the period between 2005 and 2013. Due to the fact that there are no consensus criteria for diabetes, this study considers outpatient records and inpatient records as a criterion for determining diabetes in view of the demand for continuous medical care for chronic diseases. The prevalence and incidence of type 2 diabetes in elderly patients have been increasing year after year, while mortality rates have been decreasing; the use of outpatient and inpatient medical care for diabetic patients were significantly higher than that for non-diabetic patients, while the utilization of outpatient medical care for diabetic elderly patients has been on the rise in recent years. In addition, this study also examined the impact of type 2 diabetes complications and found that cardiovascular diseases, renal and neuropathy, as well as ophthalmic pathologies increased the number of outpatient visits for elderly patients with type 2 diabetes, whereas the average amount of outpatient visits and costs for elderly patients with type 2 diabetes who require renal dialysis increased significantly.參考文獻 一、中文部分王乙涵（2019）。「以全民健保資料庫探討臺灣高齡人口第二型糖尿病現況」。國立政治大學風險管理與保險學系研究所碩士論文。王培東（2006）。「疾病發生的測量:發生率(Incidence)和盛行率(Prevalence)」。《台灣醫界》，49卷4期，頁29-33。古鯉榕、廖翊涵、李中一、李昱逵（2018）。「臺灣各縣市中高齡糖尿病病人眼底檢查率與失明率之相關性研究」，《健康科技期刊》，2018專刊，頁93-101。杜思德（2019)。「臺灣糖尿病年鑑2019第2型糖尿病」。社團法人中華民國糖尿病衛教學會。吳文權（2001）。「糖尿病之眼部疾病」。《高醫醫訊月刊》，20卷12期，檢自：http://www.kmuh.org.tw/www/kmcj/data/9005/4717.htm。李天行、黃婷萱、呂奇傑（2016）。「以資料探勘技術進行糖尿病與乳癌關聯性分析之研究」。《數據分析》，11卷5期，頁77-96。林信成（2005）。「應用全民健保資料庫分析台灣地區糖尿病患者之醫療服務利用」。國立交通大學管理學碩士在職專班經營管理組碩士論文。林渤越（2014）。「以全民健保資料庫探討國人慢性疾病的現況」。國立政治大學統計學系研究所碩士論文。連珮誼（2016）。「以高齡健保資料庫分析高齡人口醫療之需求」。國立政治大學風險管理與保險研究所碩士論文。郭俊宏（2006）。「糖尿病患者醫療資源利用情形及其相關因素之探討」。中臺科技大學醫護管理研究所碩士論文。許惠恒、王治元、王署君、朱志勳、李奕德、杜思德、孫維仁、張鳴宏、郭清輝、陳榮福、黃禹堯（2017）。「台灣糖尿病周邊神經病變臨床指引」。社團法人中華民國糖尿病學會。許筱翎（2019）。「以全民健保資料庫評估高齡人口的醫療利用」。《人口學刊》，58期，頁89-120。陳鴻鈞（2001）。「糖尿病之腎臟病變」。《高醫醫訊月刊》，20卷12期，檢自：http://www.kmuh.org.tw/www/kmcj/data/9005/4716.htm。葉柏劭（2016）。「以健保資料庫建構的2型糖尿病患者確診後轉化為大腸直腸癌之預測模型」。臺北醫學大學醫學資訊研究所碩士論文。鄭明旭（2016）。「以健保資料庫探討第二型糖尿病人使用Acarbose與失智症之相關性」。國立陽明大學醫務管理研究所碩士論文。魏榮男、莊立民、林瑞雄、趙嘉玲、宋鴻樟（2000）。「1996~2000年台灣地區糖尿病盛行率與住院率」。《台灣公共衛生雜誌》，21卷3期，頁173-180。顧芳萍（2021）。「糖尿病國際疾病分類編碼準確度研究：不同個案審定程序之比較」。國立成功大學醫學院公共衛生研究所碩士論文。二、英文部分American Diabetes Association (2018). Economic costs of diabetes in the U.S. in 2017. Diabetes Care, 41(5):917-928.Du, Y.F., Huang, Y.P., Hung, H.C., Lin, C.H., Cheng, K.P., Wu, H.T., Hu, C.Y., Wu, C.L., and Ou, H.Y. (2020). Time trend analysis of the prevalence and incidence of type 2 diabetes among patients with autosomal dominant polycystic kidney disease. Formosan Journal of Endocrinology and Metabolism, 1-9.International Diabetes Federation (2019). IDF diabetes atlas, 9th ed. Brussels, Belgium: International Diabetes Federation, 2019.Kennedy, B.L., Berger, S.L., Brunet, A., Campisi, J., Cuervo, A.M., Epel, E.S., Franceschi, C., Lithgow, G.J., Morimoto, R.I., Pessin, J.E., Rando, T.A., Richardson, A., Schadt, E.E., Wyss-Coray, T., and Sierra, F. (2014). Aging: a common driver of chronic diseases and a target for novel interventions. Cell., 159(4):709-713.King, H., Aubert, R.E., and Herman, W.H. (1998). Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabetes Care, 21(9):1414-1431.Lee, C.J., Yeh, Y.C., Liang, C.Y., and Chen, Y.Y. (2017). Risk of Parkinson’s disease in patients with type 2 diabetes mellitus and other comorbidities: a 5-year population-based cohort study in Taiwan. The Changhua Journal of Medicine, 15(3):128-137.Lee, R.D. and Carter, L.R. (1992). Modeling and forecasting U.S. mortality. Journal of the American Statistical Association 87, 659-671.Lin, C.C., Li, C.I., Hsiao, C.Y., Liu, C.S., Yang, S.Y., Lee, C.C., and Li, T.C. (2013). Time trend analysis of the prevalence and incidence of diagnosed type 2 diabetes among adults in Taiwan from 2000 to 2007: a population-based study. BMC Public Health, 13(1):318.Lindgren, B. (2016). The rise in life expectancy, health trends among the elderly, and the demand for care - a selected literature review. NBER Working Paper, No. 22521.Mulnier, H.E., Seaman, H.E., Raleigh, V.S., Soedamah-Muthu, S.S., Colhoun, H.M., and Lawrenson, R.A. (2006). Mortality in people with type 2 diabetes in the UK. Diabetic Medicine, 23(5):516-521.Omodei, D. and Fontana, L. (2011). Calorie restriction and prevention of age-associated chronic disease. FEBS Letter, 585(11):1537-1542. 描述 碩士
國立政治大學
風險管理與保險學系
106358013資料來源 http://thesis.lib.nccu.edu.tw/record/#G0106358013 資料類型 thesis dc.contributor.advisor 楊曉文<br>余清祥 zh_TW dc.contributor.advisor Yang, Sheau-Wen<br>Yue, Ching-Syang en_US dc.contributor.author (作者) 許育嘉 zh_TW dc.contributor.author (作者) Shiu, Yu-Jia en_US dc.creator (作者) 許育嘉 zh_TW dc.creator (作者) Shiu, Yu-Jia en_US dc.date (日期) 2021 en_US dc.date.accessioned 2-九月-2021 16:01:58 (UTC+8) - dc.date.available 2-九月-2021 16:01:58 (UTC+8) - dc.date.issued (上傳時間) 2-九月-2021 16:01:58 (UTC+8) - dc.identifier (其他 識別碼) G0106358013 en_US dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/136857 - dc.description (描述) 碩士 zh_TW dc.description (描述) 國立政治大學 zh_TW dc.description (描述) 風險管理與保險學系 zh_TW dc.description (描述) 106358013 zh_TW dc.description.abstract (摘要) 由於生活飲食習慣的改變，加上缺乏足夠的定期運動，國人罹患糖尿病的比例有越來越高的趨勢，尤其是佔比超過九成的第二型糖尿病，隨著年齡增加，罹病機率愈大。糖尿病患者屬於代謝症候群的一員，可視為健康的危險訊號，糖尿病患者通常容易罹患心血管疾病，死亡率也高於一般國民，近年我國代謝症候群相關死亡率甚至超過癌症，可謂可怕的隱形殺手，對國家發展、個人生活造成重大威脅。台灣糖尿病盛行率高於世界平均，尤其是高齡者情況更加嚴重，由於糖尿病屬於慢性疾病，需要長期治療及觀察，預計相關醫療支出及影響將隨著人口老化而加劇。有鑑於此，本文以第二型糖尿病為研究目標，推估第二型糖尿病病患及醫療利用的變化趨勢，提供政府及保險公司因應的參考。本文以台灣高齡人口為研究對象，探討第二型糖尿病罹病趨勢與其併發症，並分析患者的門診、住院等醫療利用，使用全民健保資料庫的2005年百萬老年人抽樣資料，資料期間為2005～2013年。由於糖尿病至今仍無一致的認定標準，基於慢性病有持續就醫的需求，本文採用門診與住院紀錄作為判斷是否罹患糖尿病的標準。資料分析顯示第二型糖尿病高齡患者的盛行率與發生率皆逐年上升，而死亡率則呈現下降的趨勢；無論是門診或住院的醫療利用，糖尿病患者明顯高於非糖尿病患者，且糖尿病高齡患者的門診醫療使用在近年有上升趨勢。另外，本文亦探討第二型糖尿病併發症帶來的影響，發現心血管病變、洗腎、神經病變、眼部病變會增加第二型糖尿病高齡患者的門診次數，且患有洗腎需求的第二型糖尿病高齡患者其平均門診金額會大幅上升。 zh_TW dc.description.abstract (摘要) Due to the changes in dietary habits and the absence of sufficient physical activity, an increasing proportion of the population has become susceptible to diabetes, particularly type 2 diabetes, which accounts for over 90% of the disease, with increasing incidence with age. Diabetes is a member of the Metabolic Syndrome Family, regarded as a health risk signal. Patients with diabetes are commonly predisposed to cardiovascular diseases. They have a higher mortality rate when compared to the general population, which has even surpassed cancer in recent years, making it a formidable covert killer that poses a significant threat to national development and personal life. In Taiwan, the prevalence of diabetes exceeds the world average, particularly among the elderly. Furthermore, as diabetes is a chronic disease requiring long-term treatment and observation, it is expected that the related medical expenses and impacts would intensify as the population ages. In consideration of these factors, this study addresses type 2 diabetes to estimate the trend of the changing number of diabetic patients and their medical utilization in order to provide a reference for the government and insurance companies.In this study, we analyzed the trend of type 2 diabetes and its complications among the Taiwanese elderly population, as well as the outpatient and inpatient medical utilization based on the National Health Insurance Database`s 2005 population-based sample records of one million elderly people, covering the period between 2005 and 2013. Due to the fact that there are no consensus criteria for diabetes, this study considers outpatient records and inpatient records as a criterion for determining diabetes in view of the demand for continuous medical care for chronic diseases. The prevalence and incidence of type 2 diabetes in elderly patients have been increasing year after year, while mortality rates have been decreasing; the use of outpatient and inpatient medical care for diabetic patients were significantly higher than that for non-diabetic patients, while the utilization of outpatient medical care for diabetic elderly patients has been on the rise in recent years. In addition, this study also examined the impact of type 2 diabetes complications and found that cardiovascular diseases, renal and neuropathy, as well as ophthalmic pathologies increased the number of outpatient visits for elderly patients with type 2 diabetes, whereas the average amount of outpatient visits and costs for elderly patients with type 2 diabetes who require renal dialysis increased significantly. en_US dc.description.tableofcontents 第一章 緒論 1第一節 研究動機 1第二節 研究目的 4第二章 文獻探討 6第一節 糖尿病種類與判斷標準 6第二節 糖尿病文獻回顧 7第三章 資料與研究方法 9第一節 全民健保資料庫介紹及資料處理 9第二節 研究方法 13第四章 第二型糖尿病發生率、死亡率、盛行率分析 15第一節 第二型糖尿病之發生率 15第二節 第二型糖尿病之死亡率 20第三節 第二型糖尿病之盛行率 26第五章 第二型糖尿病之醫療使用分析 28第一節 第二型糖尿病門診醫療使用概況 28第二節 第二型糖尿病住院醫療使用概況 35第六章 第二型糖尿病併發症之門診醫療使用分析 42第一節 第二型糖尿病併發症門診醫療使用概況 42第二節 第二型糖尿病及其併發症與商業保險應用 56第七章 建議與結論 58第一節 結論 58第二節 建議與研究限制 59參考文獻 61 zh_TW dc.format.extent 6930003 bytes - dc.format.mimetype application/pdf - dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0106358013 en_US dc.subject (關鍵詞) 人口老化 zh_TW dc.subject (關鍵詞) 第二型糖尿病 zh_TW dc.subject (關鍵詞) 併發症 zh_TW dc.subject (關鍵詞) 醫療利用 zh_TW dc.subject (關鍵詞) 全民健保資料 zh_TW dc.subject (關鍵詞) Population Aging en_US dc.subject (關鍵詞) Type 2 Diabetes en_US dc.subject (關鍵詞) Complications en_US dc.subject (關鍵詞) Health Care Utilization en_US dc.subject (關鍵詞) National Health Insurance en_US dc.title (題名) 以健保資料庫探討臺灣高齡人口第二型糖尿病與其併發症 zh_TW dc.title (題名) Using National Health Insurance Database to Explore Taiwan Elderly’s Type II Diabetes and its Complications en_US dc.type (資料類型) thesis en_US dc.relation.reference (參考文獻) 一、中文部分王乙涵（2019）。「以全民健保資料庫探討臺灣高齡人口第二型糖尿病現況」。國立政治大學風險管理與保險學系研究所碩士論文。王培東（2006）。「疾病發生的測量:發生率(Incidence)和盛行率(Prevalence)」。《台灣醫界》，49卷4期，頁29-33。古鯉榕、廖翊涵、李中一、李昱逵（2018）。「臺灣各縣市中高齡糖尿病病人眼底檢查率與失明率之相關性研究」，《健康科技期刊》，2018專刊，頁93-101。杜思德（2019)。「臺灣糖尿病年鑑2019第2型糖尿病」。社團法人中華民國糖尿病衛教學會。吳文權（2001）。「糖尿病之眼部疾病」。《高醫醫訊月刊》，20卷12期，檢自：http://www.kmuh.org.tw/www/kmcj/data/9005/4717.htm。李天行、黃婷萱、呂奇傑（2016）。「以資料探勘技術進行糖尿病與乳癌關聯性分析之研究」。《數據分析》，11卷5期，頁77-96。林信成（2005）。「應用全民健保資料庫分析台灣地區糖尿病患者之醫療服務利用」。國立交通大學管理學碩士在職專班經營管理組碩士論文。林渤越（2014）。「以全民健保資料庫探討國人慢性疾病的現況」。國立政治大學統計學系研究所碩士論文。連珮誼（2016）。「以高齡健保資料庫分析高齡人口醫療之需求」。國立政治大學風險管理與保險研究所碩士論文。郭俊宏（2006）。「糖尿病患者醫療資源利用情形及其相關因素之探討」。中臺科技大學醫護管理研究所碩士論文。許惠恒、王治元、王署君、朱志勳、李奕德、杜思德、孫維仁、張鳴宏、郭清輝、陳榮福、黃禹堯（2017）。「台灣糖尿病周邊神經病變臨床指引」。社團法人中華民國糖尿病學會。許筱翎（2019）。「以全民健保資料庫評估高齡人口的醫療利用」。《人口學刊》，58期，頁89-120。陳鴻鈞（2001）。「糖尿病之腎臟病變」。《高醫醫訊月刊》，20卷12期，檢自：http://www.kmuh.org.tw/www/kmcj/data/9005/4716.htm。葉柏劭（2016）。「以健保資料庫建構的2型糖尿病患者確診後轉化為大腸直腸癌之預測模型」。臺北醫學大學醫學資訊研究所碩士論文。鄭明旭（2016）。「以健保資料庫探討第二型糖尿病人使用Acarbose與失智症之相關性」。國立陽明大學醫務管理研究所碩士論文。魏榮男、莊立民、林瑞雄、趙嘉玲、宋鴻樟（2000）。「1996~2000年台灣地區糖尿病盛行率與住院率」。《台灣公共衛生雜誌》，21卷3期，頁173-180。顧芳萍（2021）。「糖尿病國際疾病分類編碼準確度研究：不同個案審定程序之比較」。國立成功大學醫學院公共衛生研究所碩士論文。二、英文部分American Diabetes Association (2018). 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