性別、社經地位對急性心肌梗塞患者醫療資源使用與預後狀況之影響

Abstract

研究背景： 冠心病乃是現代人主要死因之一。文獻證實醫療介入可大幅提升冠心病的預後，但許多國外研究發現，女性及社經地位較低者的醫療使用率較低，冠心病預後情況也較差。 研究目的： 本研究針對台灣急性心肌梗塞患者，且以教育程度作為社經地位之指標，探討性別、教育程度對其醫療資源使用與預後狀況的影響。 研究方法： 針對2001年8月至2003年5月之台南地區兩大醫學中心505名急性心肌梗塞初發病患（387名男性及118名女性），分析其病歷登記資料，及以問卷訪談方式進行個案追蹤研究。 研究結果： 急性心肌梗塞女性患者有較少的醫療資源使用，尤其是血管支架置入部分；65歲及以下女性患者之追蹤期間致死率明顯高於男性。由於女性樣本教育程度變異性小，故探討教育程度影響之研究僅限於男性族群，研究發現，教育程度為高中職以上男性患者之血栓溶解劑及血管支架使用率皆顯著高於教育程度為國中小以下者；不同教育地位族群間的存活狀況並未發現有所差異。 結論： 急性心肌梗塞患者之醫療利用及存活情況存在性別差異。社經地位雖會影響患者醫療利用情形，但與存活之間並無統計上之關係，可能是由於本研究樣本小且教育程度的變異性小有關。

Background： Coronary heart diseases（CHD）is one of major causes of death today. Evidence shows that advances in medical treatment lead to better prognosis of CHD, however, women and low socioeconomic status（SES）groups have been found to have less medical utilization and worse prognosis. Objective： The purpose of the present study was to examine the influence of gender and education as a proxy of SES on the medical utilization and prognosis among patients with acute myocardial infarction（AMI）in Taiwan. Methods： A total of 505 first AMI cases（387 men and 118 women）diagnosed at two hospitals in Tainan during the period between August 2001 and May 2003 were studied. Medical charts were reviewed and interviews were carried out using a standardized questionnaire. Results： Our findings show that women were less likely to receive medical treatment than men, especially for stenting. Among patients below 65 years of age, women had a higher fatality than men during the follow-up period. The analyses on education restricted to men because of the small variation of education among women. Our findings show men with higer education levels were more likely to undergo thrombolysis and stenting, than those who had lower education level. However, after controlling age, there was no significant association between education and survival. Conclusions： There were gender differences on medical utilization and survival after AMI. Lower education level was associated with decreased medical utilization, but there was no association with survival. The small sample size lack in variation in education might be the reason for negative findings of this study.