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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 賴美淑 | |
dc.contributor.author | Chi-Shin Wu | en |
dc.contributor.author | 吳其炘 | zh_TW |
dc.date.accessioned | 2021-06-07T23:44:33Z | - |
dc.date.copyright | 2014-10-20 | |
dc.date.issued | 2014 | |
dc.date.submitted | 2014-07-08 | |
dc.identifier.citation | I. References
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/16728 | - |
dc.description.abstract | 背景與目的:抗鬱藥為常用的藥物之一。過去的研究發現抗鬱藥的使用,有逐年增加的趨勢,其增加的原因可能為新一代抗鬱藥物上市,以及增加新的治療適應症。雖然新一代的藥物有較少的副作用,但臨床上服用抗鬱藥之持續性偏低,成為憂鬱症治療成效的影響因素。此外,抗鬱藥的長期安全性,尤其是代謝方面的副作用,仍然未有定論。本研究目的:為探討台灣新一代抗鬱藥之治療持續性與糖尿病之風險。本研究主要內容是利用健保資料庫的資料,針對下列三個議題加以研究:一、探討新一代抗鬱藥之盛行率與發生率之趨勢。二、憂鬱症病患使用新一代抗鬱藥之治療持續性,以及相關影響因素。三、長期使用新一代抗鬱藥與糖尿病之關連。
方法:本研究將以健保資料庫2005年百萬人抽樣檔,分析台灣使用抗鬱藥的盛行率與發生率之趨勢。 憂鬱症患者使用抗鬱藥之治療持續性,將以回溯性世代研究,進行新一代抗鬱藥與傳統藥物之比較分析,並探討可能相關的因素。 評估長期使用新一代抗鬱藥是否增加第二型糖尿病之風險,本研究將以新診斷之第二型糖尿病的患者,進行巢狀病例對照研究,選出2倍的對照個案。統計分析將以條件式羅吉斯迴歸來估算使用長期使用新一代抗鬱藥之糖尿病風險,並控制相關的干擾因素。 結果:台灣使用抗鬱藥的盛行率從2000年的37.6‰ 增加到2011年的54.0‰。而抗鬱藥的發生率則是從2000年的20.2‰,逐年增加到2004年23.7‰,但之後又始逐年下降至2011年18.7‰。 憂鬱症患者使用抗鬱藥之藥物持續性的研究發現,只有17.4%的憂鬱症患者,持續使用抗鬱藥治療超過180天。新一代抗鬱藥之使用者,有較佳之治療持續性。此外,男性、年長者、有焦慮症或睡眠疾患共病之患者,亦有較佳之治療持續性。 使用新一代抗鬱藥之選擇性血清抑制劑超過兩年以上者,會增加41%的糖尿病風險。而使用傳統三環抗鬱藥兩年以上者,其糖尿病風險並無顯著增加。 結論:台灣抗鬱藥之使用盛行率逐年增加,但其發生率逐年下降。整體而言,台灣使用抗鬱藥之盛行率略低於其他國家。新一代抗鬱藥之使用者,有較佳之治療持續性。然而累積使用新一代抗鬱藥超過兩年,將會增加之糖尿病風險。本研究使用台灣健保資料庫,其資料樣本數大,且有全國代表性,因此研究結果有高度的可類推性。臨床上,使用新一代抗鬱藥時,需仔細評估其可能之利弊,如治療持續性與代謝副作用。 | zh_TW |
dc.description.abstract | Background
Antidepressants are one of the most frequently prescribed medications. Studies have shown that antidepressant use has increased over time. The introduction of new-generation antidepressants, and an expansion of the conditions they treat, might be responsible for the increased trend in antidepressant use. Although new-generation antidepressants have fewer adverse effects, the medication persistence is still low and affects the treatment outcome. In addition, the long-term safety and metabolic effects of new-generation antidepressants remains unclear. Therefore, the aim of this study is to explore the treatment persistence and diabetes risk of new-generation antidepressants in Taiwan. We used the National Health Insurance Research Database to examine the following three issues: 1) the prevalence and incidence of antidepressant use in Taiwan; 2) the treatment persistence of new-generation antidepressants among patients with depressive disorders and potential determinants; and 3) the association between long-term new-generation antidepressant use and diabetes risk. Methods To address these issues, we conducted several studies. First, we used the Longitudinal Health Insurance Database 2005, a subset of National Health Insurance Research Database, to explore the prevalence and incidence of antidepressant use. Next, we conducted a retrospective cohort study to compare the treatment persistence of new-generation antidepressants with that of tricyclic antidepressants and explored the potential determinants. Finally, to investigate the relationship between long-term antidepressant use and diabetes risk, we conducted a nested case-control study with newly-diagnosed patients with type 2 diabetes mellitus and used a conditional logistic regression model to estimate the effect of new-generation antidepressants on diabetes risk with adjustment for potential confounders. Results Overall, the prevalence of antidepressant use increased from 37.6‰ in 2000 to 54.0‰ in 2011; however, the age-adjusted incidence increased from 20.2‰ in 2000 to 23.7‰ in 2004, but then declined to 18.7‰ in 2011. In terms of the persistence of antidepressant treatment among patients with depressive disorder, only 17.4% of patients continued antidepressant treatment over 180 days. Depressive patients treated with new-generation antidepressants showed better treatment persistence. Male gender, older age, comorbidity with anxiety or sleep disorders, and concomitant use of sedatives/hypnotics were associated with better treatment persistence. Patients treated with new-generation antidepressants more than 2 years had an increased risk of diabetes (adjusted odds ratio 1.41, 95% CI 1.03–1.93). However, use of tricyclic antidepressants more than 2 years was not associated with diabetes risk. Conclusion We found the prevalence of antidepressant use in Taiwan increased; however, the incidence declined. Patients taking new-generation antidepressants were associated with better treatment persistence. However, cumulative use of new-generation antidepressants for more than 2 years increased the risk of diabetes. Because this study used the National Health Insurance Research Database, which has a large sample size that is representative of the national population, its results have good generalizability. In clinical implications, use of a new-generation antidepressant should be considered against its risk and benefits, such as medication persistence and adverse effects. | en |
dc.description.provenance | Made available in DSpace on 2021-06-07T23:44:33Z (GMT). No. of bitstreams: 1 ntu-103-D00849014-1.pdf: 8106587 bytes, checksum: f22c9a1a98b881daddd999abe4afa5da (MD5) Previous issue date: 2014 | en |
dc.description.tableofcontents | 中文摘要 1
Abstract 3 I. Background 15 II. Literature Review 18 1. Global Trends of Antidepressant Utilization 18 2. Medication persistence and compliance in antidepressant treatment among patients with depressive disorder 21 3. Antidepressant use and Potential Metabolic Adverse Effects 25 4. Summary 29 5. Unsolved Issues Regarding Antidepressant Use in Taiwan 31 6. Thesis Aims 32 III. Material and Methods 34 1. Study Framework 34 2. Data Source 36 2.1 National Health Insurance Research Database 36 2.1.1 Longitudinal Health Insurance Database 2005 36 2.1.2 Longitudinal Health Insurance Database 2010 37 2.2 Validation of Clinical Diagnosis in the NHIRD 38 2.3 A Preliminary Validation study of NHIRD Using National Health Interview Survey 38 3. Classification of Antidepressants 40 4. Study I: The prevalence and incidence of antidepressant use in Taiwan 42 4.1 Definition of study population 42 4.2 Classification of Antidepressants 42 4.3 Conditions treated with antidepressants 42 4.4 Prevalence and incidence 43 4.5 Statistical analysis 44 5. Study II: The treatment persistence of new-generation antidepressants among patients with depressive disorder and potential determinants 47 5.1 Definition of Study Population: antidepressant-treated patients with depressive disorder 47 5.2 Definition of medication persistence and compliance 47 5.3 Potential determinants of medication persistence and compliance 48 5.4 Statistical analysis 49 6 Study III: The association between long-term new-generation antidepressant use and diabetes risk 52 6.1 Definition of Study Population 52 6.2 Cases of Type 2 Diabetes Mellitus 52 6.3 Comparison Subjects 53 6.4 Antidepressant Exposure 53 6.5 Statistical Analysis 54 IV. Results 56 1. The prevalence and incidence of antidepressant use in Taiwan 56 2. Treatment persistence of new-generation antidepressants among patients with depressive disorder and potential determinants 59 3. The association between long-term new-generation antidepressant use and diabetes risk 61 V. Discussion 63 1. The trend of prevalence and incidence of antidepressant use in Taiwan 63 2. The treatment persistence of new-generation antidepressant among patients with depressive disorder and potential determinants 67 3. The association between long-term new-generation antidepressant use and diabetes risk 73 4. Quality Control for Studies Using Claims Database 77 VI. Conclusions 78 VII. References 80 VII. Figure. 99 VIII. Tables 125 Table of Figures Figure 1. Study Framework of Pharmacoepidemiological Study of Antidepressant use in Taiwan. 99 Figure 2. The Ratio of LHID2005 to Statistics of Interior, by Age Groups, 2000-20011 100 Figure 3. The effect of different algorithm for indentifying clinical diagnoses in claims records 101 Figure 4. Flow chart of identifying the prevalent antidepressant users 102 Figure 5. Flow chart of identifying the incident antidepressant users 103 Figure 6. The Flow Chart of Selection of Study Subjects 104 Figure 7. Flow Chart of Selection of Patients with Incident Type 2 Diabetes Mellitus and Comparison Subjects in Taiwan’s National Health Insurance Research Database 105 Figure 8. The Weighted Prevalence and Incidence of Antidepressant Use and Annual Percent Change 106 Figure 9. Comparison between Crude and Weighted Prevalence and Incidence, 2000-2011 107 Figure 10. Standardized Prevalence & Incidence of Antidepressant Use and Annual Percent Change, 2000-2011 108 Figure 11. The Weighted Prevalence of Antidepressant Use and Annual Percent Change, by Age Groups, 2000-2011 109 Figure 12. The Weighted Prevalence of Antidepressant Use and Annual Percent Change, by Gender, 2000-2011 110 Figure 13. The Weighted Incidence of Antidepressant Use and Annual Percent Change, by Age Groups, 2000-2011 111 Figure 14. The Weighted Incidence of Antidepressant Use and Annual Percent Change, by Gender, 2000-2011 112 Figure 15. The Weighted Prevalence of Antidepressant Use and Annual Percent Change, by Drug Classes, 2000-2011 113 Figure 16. The Weighted Incidence of Antidepressant Use and Annual Percent Change, by Drug Classes, 2000-2011 114 Figure 17. The Weighted Prevalence of Antidepressant Use and Annual Percent Change, by Psychiatric Treated Conditions 115 Figure 18. The Weighted Prevalence of Antidepressant Use and Annual Percent Change, by Somatic Treated Conditions 116 Figure 19. The Weighted Incidence of Antidepressant Use and Annual Percent Change, by Psychiatric Treated Conditions 117 Figure 20. The Weighted Incidence of Antidepressant Use and Annual Percent Change, by Somatic Treated Conditions 118 Figure 21. Comparison the Estimated Prevalence of Antidepressant Use Using LHID2005 and LHID2010 119 Figure 22. Kaplan-Meier estimates of treatment persistence for overall treatment and initial monotherapy 120 Figure 23. Cumulative incidence of modification of initial antidepressant monotherapy 121 Figure 24.Trend of Antidepressant Non-Persistence Treatment, 1998-2009 122 Figure 25. Trend of Noncompliance (Medication possession ratio < 0.8) of antidepressant treatment, 1998-2009 123 Figure 26. Diabetes Risk for Long-Term Antidepressant Use, Stratification Analysis by Patients Characteristics 124 Table of Tables Table 1. Antidepressants reimbursed by the National Health Insurance Program 125 Table 2. The change of prevalence of antidepressant use in the worlds 126 Table 3. Summary of medication persistence and compliance of antidepressant use in the worlds 127 Table 4. Adverse Effect of Antidepressant Drug 130 Table 5. Observational studies of diabetes risk and exposure to antidepressant 131 Table 6. The age distribution of general population according to the Statics of Interior, 2000-2011 (%)* 133 Table 7. The age distribution of selected sample in the LHID2005, 2000-2011 (%)* 134 Table 8. Characteristics of study subjects in the validation study of NHIRD 135 Table 9. Claims records for clinical diagnosis and medication use in the NHIRD 136 Table 10. Concordance between self-report and claims record, by diseases, medication use, and health system utilization 138 Table 11. Treated conditions of antidepressant use, based ICD-9-CM 140 Table 12. The WHO World Standard Population Distribution (%) 141 Table 13. Baseline Characteristics and Treated Conditions of Prevalent Antidepressant use, by Drug Class 142 Table 14. Baseline Characteristics and Treated Conditions of Incident Antidepressant use, by Drug Class 143 Table 15. Baseline Characteristics of incident antidepressant users with depressive disorders, by antidepressant class* 144 Table 16. Factors of non-persistence and poor compliance of antidepressant treatment 146 Table 17. Factors of discontinuation, switching, and combining of antidepressant treatment 148 Table 18. Demographic and clinical characteristics of patients with diabetes and comparison subjects between 2000 and 2009 150 Table 19. Diabetes Risk Associated with Antidepressant Use, by Duration, Dose, and Classes 152 Table 20. Diabetes Risk Associated with Individual SSRI Use 154 Table 21. Diabetes Risk Associated with Antidepressant Use, by Age Groups 155 Table 22. Diabetes Risk With Antidepressant Use, by Mood Disorders 156 Table 23. Sensitivity Analysis for Diabetes Risk with Antidepressant Use, by Latent Periods and Analytic Methods 158 Table 24. Demographic and clinical characteristics of study population, by antidepressant usea 160 Table 25. Demographic and clinical characteristics of case with diabetes and comparison subjects between 2000 and 2009 162 Table 26. Antidepressant exposure status of propensity-score matched diabetes cases and controls 164 Table 27. Diabetes Risk with Antidepressant Use, by Propensity Score-Matching Methods 165 Table 28. A Checklist for Retrospective Database Studies 166 | |
dc.language.iso | en | |
dc.title | 台灣抗鬱藥之藥物流行病學研究:新一代抗鬱藥之治療持續性與糖尿病風險 | zh_TW |
dc.title | Pharmacoepidemiological Study of Antidepressants in Taiwan: The Treatment Persistence and the Diabetes Risk of New-Generation Antidepressants | en |
dc.type | Thesis | |
dc.date.schoolyear | 102-2 | |
dc.description.degree | 博士 | |
dc.contributor.coadvisor | 高淑芬 | |
dc.contributor.oralexamcommittee | 簡國龍,劉仁沛,簡以嘉,李信謙 | |
dc.subject.keyword | 抗鬱藥,憂鬱症,持續性,遵囑性,糖尿病,健保資料庫,藥物流行病學, | zh_TW |
dc.subject.keyword | antidepressant,depressive disorder,persistence,compliance,diabetes mellitus,National Health Insurance Research Database,Pharmacoepidemiology, | en |
dc.relation.page | 167 | |
dc.rights.note | 未授權 | |
dc.date.accepted | 2014-07-08 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 流行病學與預防醫學研究所 | zh_TW |
顯示於系所單位: | 流行病學與預防醫學研究所 |
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