以空間分析決定結核病主動篩檢高危險群之政策分析：以花東地區為例

Abstract

背景：結核病一直以來是全球重要的傳染病議題，隨著各國的努力及國際間的共同合作，結核病的發生率、死亡率均有下降，但其下降幅度卻有逐漸趨緩的趨勢。「發現病人」及「治癒病人」為防治結核病兩大主要介入重點。臺灣自1952年開始利用胸部X光巡迴篩檢來主動發現結核病患之政策已執行超過60年，雖然高危險族群確實有較高的發生率，但仍有高達95%的病患是因症就醫，且病患多分布在非高危險區域之非山地鄉社區中。研究目的：本研究藉由進行胸部X光主動發現巡迴篩檢政策成效評值，期望研究結果可提供未來國內X光巡檢政策規劃及擬定之參考。研究方法：利用空間分析及空間自相關分析檢定結核病分布的小區域（small area）異質性，及胸部X光主動發現巡迴篩檢在不同結核病發生率區域之成本效果經濟評估。研究結果：本研究對象包含2009至2013年期間居住在花東地區（324村里）的2065名結核病患。結核病發生率在「村里」的空間分布較「鄉鎮」容易呈現小區域（small area）的異質性，此外，隨著巡檢區域的發生率越低，付出的增量成本效果比值越高。結論：本研究結果建議以村里為單位的結核病胸部X光主動發現巡檢比以鄉鎮單位更適合，同時，建議將「非山地鄉高發生率村里」做為X光巡檢區域篩選的參考項目之一。

Background: Tuberculosis has been an important issue in infectious diseases control worldwide. The incidence and mortality rate have declined after the efforts of every countries and the international cooperation, but the decline trend is slowing down. 'Find TB' and 'Cure TB' are the 2 main strategies of TB control. Taiwan has been implemented chest X-ray screening for active case finding, especially for mountainous townships, since 1952. Although high-risk groups have a higher incidence, more than 95% of the patients are found in non-high-risk areas, e.g. non-mountainous communities by passive case finding. Objective: The purpose of this study is to evaluate the chest X-ray screening policy for active case finding in Taiwan. Method: We used spatial analysis and spatial autocorrelation analysis to examine where there was small area heterogeneity in TB distribution. This study also conducted cost-effectiveness analysis for chest X-ray screening in different TB incidence areas. Results: A total of 2,065 TB cases from 324 villages in Hualien and Taitung during 2009-2013 were included in this analysis. The heterogeneity of tuberculosis incidence was much easier to be detected by spatial analysis using village as the unit than using township as unit of analysis. The analysis also revealed that screening for lower TB incidence villages tended to have higher incremental cost-effectiveness ratio. Conclusion: This study suggests that using village as the unit for TB chest X-ray screening for active case finding is more appropriate than township. Moreover, this study recommends that villages with high TB incidence in non-mountainous area should be included in chest X-ray screening.