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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
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dc.contributor.advisor | 季瑋珠(Wei-Chu Chie),李永凌(Yungling Leo Lee) | |
dc.contributor.author | Yi-Fan Wu | en |
dc.contributor.author | 吳逸帆 | zh_TW |
dc.date.accessioned | 2021-06-15T05:17:58Z | - |
dc.date.available | 2010-09-09 | |
dc.date.copyright | 2010-09-09 | |
dc.date.issued | 2010 | |
dc.date.submitted | 2010-07-21 | |
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/46599 | - |
dc.description.abstract | 背景:氣喘是一個慢性呼吸道發炎的疾病,近一二十年來在台灣乃至於全世界,都發現其盛行率有不斷攀升的趨勢,並造成全世界相當大的負擔。Global Initiative for Asthma (GINA)在2004年提出全球為減少氣喘負擔常面臨的障礙,裡面除了包含菸害、空氣污染、職業暴露等因素外,也列入了貧窮、低教育程度等社經地位因子;顯見社經地位對健康的影響,除了心血管疾病、糖尿病等慢性疾病的範疇外,在氣喘等呼吸道疾病也扮有重要的角色。社經地位對氣喘的影響,不只侷限在個人層面,區域層級的社經地位也會透過社會結構、心理等多方面對個人疾患造成影響。過去研究兩者關聯性的文獻,常無法得到一致的結果,主因是氣喘診斷可能受個人社經地位的干擾,因此以客觀的肺功能檢查將能更精確的探索兩者之間的關聯性。
研究方法:本研究採橫斷性研究的設計,在全台灣十四個不同縣市中各隨機挑選一個社區,以該社區國中一年級的學生為研究對象。我們以問卷的方式收集個人層級的社經地位指標 (父母最高教育程度、家庭年收入)、生產前後重大事件、個人健康習慣、居家環境是否有二手菸暴露等環境因素及家族過敏史。肺功能的測量則根據American Thoracic Society (ATC)在2005年針對肺功能測量所更新的建議,建立一套標準的作業程序,以減少不同社區、學童間測量的誤差;最後我們共選取了吸飽氣後用力吐氣第一秒內的總吐氣量(FEV1,單位:ml)、吐氣至最終的總吐氣量 (FVC,單位:ml)、吐氣過程中段的平均呼氣流速 (MMF,單位:ml/sec)及吐氣過程中瞬間最高呼氣流速 (PEF,單位:ml/sec)等四個結果變項。區域性的社經地位指標來源為台灣行政院主計處,我們共選取了人口、職業、教育及收入等四個面向七個指標,以防止因為社經地位定義不同所造成結果上的偏差,並以過去五年的平均值來處理社經地位對肺功能影響慢性的效應。和過去相關文獻不同的是,本研究也收集了各社區中環保署所設立空氣品質監測站所測到的空氣污染指標,並將其放入統計模型中校正,減少空氣污染對兩者關聯性可能存在的干擾作用。最後我們以Hierarchical linear model (HLM,階層式回歸分析) 同時處理個人及區域層級因子對學童肺功能可能產生的效應。 研究結果:我們的研究總共在2007年10月至11月回收了5091份有效問卷,扣除掉當天有急性疾患、缺席及無法達到ATC所建議肺功能檢驗標準者,共有3994位學童進入後續的分析。我們先以線性回歸的方式在個人層級變項裡,挑選出對肺功能結果存在顯著相關的因子 (是否早產、是否有運動習慣、家中是否有飼養寵物及父母過敏史),連同研究預設的個人層級社經地位指標及二手菸的暴露,一起放入階層式回歸分析的模型中。結果發現在校正過空氣污染指標後,平均每人賦稅的指標項,在我們對其取對數以符合常態分布的假設後,在階層式回歸分析中四個結果變項的回歸係數及95%信賴區間分別是:FEV1: -47.8 (95% CI: -80.9 to -14.8)、FVC: -43.8 (95%CI: -75.2 to -12.5)、MMF: -93.4 (95%CI: -179.3 to -7.5)和PEF: -203.2 (95% CI: -349.1 to -57.2),都達到統計上的顯著。其他的各個社經地位指標,儘管並非在每一個結果變項上都有顯著相關的發現,但其關聯性的方向都是一致的:居住在區域性社經地位越差地區的學童,肺功能是比較好的;且該效應在男性學童身上更為顯著。除此之外,上述平均每人賦稅指標在取對數放入階層式回歸模型中,與父母教育程度在PEF的結果變項上,存在有顯著的交互作用 (回歸係數-314.6,95%信賴區間-467.8 至 -161.4),顯示兩層級社經地位對學童肺功能的影響,存在有協同作用。 | zh_TW |
dc.description.abstract | Objective:Our study was carried out to investigate the association of area socio- economic status (SES) with lung function, as measured by forced expiratory volume in 1 second (FEV1, ml), forced vital capacity (FVC, ml), Maximal mid-expiratory flow (MMF, ml/sec) and peak expiratory flow (PEF, ml/sec).
Method:Participants were from Taiwan Children Health Study (TCHS): 3,994 7th grade students were recruited from 14 different communities in Taiwan. SES predictors, all collected from Taiwan Directorate-General of Budget, Accounting and Statistics, were divided into four dimensions: population, occupation, education and income. Multi- level modeling techniques (Hierarchical linear model, HLM) examined the effects of area SES on lung function, after accounting for area air pollution index and individual SES (parents’ educational level and family income). Results:High area tax per person was independently associated with decreased lung function. The coefficients (β) and 95% confidence interval (CI) for log transformation of area tax per person in HLM were -47.8 (95% CI: -80.9 to -14.8) in FEV1, -43.8 (95%CI: -75.2 to -12.5) in FVC, -93.4 (95%CI: -179.3 to -7.5) in MMF and -203.2 (95% CI: -349.1 to -57.2) in PEF. Though some predictors’ effects were not statistically significant, all the other SES predictors’ influences were in the same direction and showed greater effects in male gender. In addition, the interaction of area tax per person with individual parental educational level was significant on PEF, which meant that children with high parental educational level were more susceptible (β and 95% CI for log transformation of area tax per person in HLM: -314.6 and -467.8 to -161.4). Conclusion:The results of our study provided evidence of inverse association between high area SES and lung function in Taiwanese children. | en |
dc.description.provenance | Made available in DSpace on 2021-06-15T05:17:58Z (GMT). No. of bitstreams: 1 ntu-99-R97846006-1.pdf: 3866225 bytes, checksum: 705f2421e32c4e580d76313d3364445a (MD5) Previous issue date: 2010 | en |
dc.description.tableofcontents | 口試委員會審定書………………………………………………………i
誌謝……………………………………………………………………ii 中文摘要………………………………………………………………iii 英文摘要…………………………………………………………………v 目錄……………………………………………………………………vii 圖目錄…………………………………………………………………ix 表目錄……………………………………………………………………x 第一章 研究背景………………………………………………………1 第一節 氣喘盛行率及所造成的健康危害……………………………1 第二節 社經地位指標影響氣喘發生的機轉…………………………1 第二章 文獻回顧………………………………………………………9 第一節 個人層級社經地位指標與氣喘之關聯性……………………9 第二節 區域層級社經地位指標與氣喘之關聯性……………………12 第三節 個人/區域層級社經地位指標與肺功能之關聯性…………15 第三章 研究目的與假說……………………………………………21 第一節 研究目的………………………………………………………21 第二節 研究假說………………………………………………………21 第四章 研究方法……………………………………………………22 第一節 研究架構………………………………………………………22 第二節 研究對象及選取………………………………………………22 第三節 研究資料內容及收集方式……………………………………22 4.3.1 台灣兒童健康研究個人資料變項定義………………………22 4.3.2 學童肺功能測量………………………………………………24 4.3.3 區域性社經地位指標…………………………………………25 4.3.4 空氣污染指標…………………………………………………27 第四節 統計方法………………………………………………………27 第五章 研究結果……………………………………………………32 第一節 研究對象基本資料分析………………………………………32 第二節 研究地區基本資料分析………………………………………33 第三節 個人變項與肺功能相關性分析………………………………33 第四節 區域性社經地位指標與肺功能的相關性分析………………34 第五節 區域/個人指標交互作用與肺功能的相關性分析…………36 第六章 討論…………………………………………………………46 第一節 整體結果概述…………………………………………………46 第二節 研究結果與過去文獻之比較…………………………………47 第三節 研究優點及限制………………………………………………51 第四節 未來方向及應用………………………………………………53 第五節 結論……………………………………………………………53 參考文獻………………………………………………………………55 附錄1 台灣兒童健康研究問卷………………………………………63 附錄2 台灣各縣市2002年至2006年社經地位指標詳表……………71 附錄3 研究社區2004年10月至2007年9月空氣污染指標及副指標值詳表………………………………………………………………………78 附錄4 區域性社經地位指標對肺功能結果變項區域間變異影響之檢定結果…………………………………………………………………92 附錄5 區域性社經地位指標與肺功能相關性敏感度分析………………………………………………………………………93 | |
dc.language.iso | zh-TW | |
dc.title | 區域性社經地位指標與台灣學童肺功能的關聯性 | zh_TW |
dc.title | Association of Area Socioeconomic Status with Lung Function in Taiwanese Children | en |
dc.type | Thesis | |
dc.date.schoolyear | 98-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 陳端容,莊?智 | |
dc.subject.keyword | 社經地位,肺功能,階層式回歸分析, | zh_TW |
dc.subject.keyword | socioeconomic status,lung function,multi-level, | en |
dc.relation.page | 96 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2010-07-21 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 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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ntu-99-1.pdf 目前未授權公開取用 | 3.78 MB | Adobe PDF |
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