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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 季瑋珠(Chie,Wei Chu) | |
dc.contributor.author | Cheng-Chang Lin | en |
dc.contributor.author | 林承昌 | zh_TW |
dc.date.accessioned | 2021-05-20T20:15:51Z | - |
dc.date.available | 2014-09-16 | |
dc.date.available | 2021-05-20T20:15:51Z | - |
dc.date.copyright | 2009-09-16 | |
dc.date.issued | 2009 | |
dc.date.submitted | 2009-07-09 | |
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NHIRD. Representative of subsets of LHID2000. 2009; Available from: http://w3.nhri.org.tw/nhird//file_talk/r_sing.pdf. 37. Chen, C.Y., et al., Factors associated with the diagnosis of neurodevelopmental disorders: a population-based longitudinal study. Pediatrics, 2007. 119(2): p. e435-43. 38. Elixhauser, A., et al., Comorbidity measures for use with administrative data. Med Care, 1998. 36(1): p. 8-27. 39. Schneeweiss, S. and M. Maclure, Use of comorbidity scores for control of confounding in studies using administrative databases. Int J Epidemiol, 2000. 29(5): p. 891-8. 40. 周碧瑟, 健保資料既有疾病(comorbidity)之驗證─以北部某醫學中心為例, in 中央健康保險局委託研究. 2003, 中央健康保險局. 41. 朱育增, 探討共病測量方法於健保次級資料之應用, in 衛生福利研究所. 2007, 國立陽明大學 台北. p. 160. 42. Hak, E., et al., Confounding by indication in non-experimental evaluation of vaccine effectiveness: the example of prevention of influenza complications. J Epidemiol Community Health, 2002. 56(12): p. 951-5. 43. Fisher, L.D. and D.Y. Lin, Time-dependent covariates in the Cox proportional-hazards regression model. Annu Rev Public Health, 1999. 20: p. 145-57. 44. Dupont, W.D. and W.D. Plummer, Jr., Power and sample size calculations. A review and computer program. Control Clin Trials, 1990. 11(2): p. 116-28. 45. Frame, P.S. and S.J. Carlson, A critical review of periodic health screening using specific screening criteria. Part 1: Selected diseases of respiratory, cardiovascular, and central nervous systems. J Fam Pract, 1975. 2(1): p. 29-36. 46. BHP. Prevalence survey of hypertension, diabetes and dyslipidemia. 2002; Available from: http://www.bhp.doh.gov.tw/health91/study-2.htm. 47. Bonithon-Kopp, C., Menopause-related changes in lipoproteins and some other cardiovascular risk factors. International Journal of Epidemiology, 1990. 19(1): p. 42. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/9282 | - |
dc.description.abstract | 背景:
疾病預防的觀念自二十世紀初期開始蓬勃發展,同時也促成了各類型週期性健康檢查計畫的實行。我國全民健康保險自從民國85年開始全面支付成人預防保健服務,服務內容包含生活型態及病史調查、物理檢查及實驗室檢查,其檢查項目涵蓋大部分我國國民主要死因的疾病篩檢,每年約有三成民眾接受此項服務。然而至今少有足夠之證據和文獻有效的評估成人預防保健服務的效用,尤其是在臨床上結果的分析。目的:本研究的目的在探討對於高血壓、糖尿病及高血脂疾病病程,接受成人預防保健服務可以達成早期治療和降低全死因死亡率的效果。材料與方法:本研究為回溯性世代研究,採用具有全國代表性的全民健康保險研究資料庫20萬人抽樣歸人檔進行次級資料分析,研究材料採用抽樣歸人檔資料中第一及第二組資料,以民國89年為基準,擷取年齡40到100歲的保險對象做為追蹤世代,追蹤時間自民國90年1月1日至96年12月31日。由次級資料庫中擷取目標族群於87至89年間接受預防保健服務的資料,及其追蹤期間所有門、住、急診及治療記錄。本研究使用multiple logistic regression 及Cox proportional hazard regression 分析曾接受此項服務對於新發生高血壓、糖尿病、高血脂治療及全死因死亡事件的勝算比(odds ratio)及風險比(hazard ratio),本研究亦採用時間相依Cox模型進行分析。結果:本研究世代樣本共包含16,080位男性 (50.2%) 及15,959位女性(49.8%) ,平均年齡分別是55.6±11.9歲和56.0±11.9歲。在7年追蹤期間,原先沒有高血壓、糖尿病及高血脂的族群,各有32.1%, 9.1%和14.5%的比例發生目標疾病的治療。 研究結果發現,每次接受成人預防保健服務後1年,在40-54歲、55-64歲和65-100歲的族群,其發生高血壓治療之風險比(hazard ratio)為1.80(95% confidence interval, CI: 1.64-1.97)、1.67(95%CI: 1.50-1.85) 和1.56 (95%CI: 1.43-1.72);發生糖尿病治療的風險比為1.59(95%CI: 1.19-2.13)、2.21(95%CI: 1.87-2.61) 和1.76(95%CI: 1.50-2.05) ;發生高血脂治療的風險比則是3.97 (95%CI: 3.59-4.38)、3.21(2.85-3.63)和2.82(95%CI: 2.49-3.20)。這些估計值都具統計上顯著意義 (p< 0.001)。 每次接受成人預防保健服務後1年內及7年內,其發生全死因死亡的風險比僅在65至100歲的族群達到統計上顯著(p<0.001),其風險比分別0.74(95%CI: 0.67-0.84) 及0.80(95% CI: 0.72-0.89)。結論:本研究有效證實成人預防保健服務對於健康結果的影響。研究結果顯示使用成人預防保健服務,對於高血壓、糖尿病和高血脂三種影響國人健康的主要慢性病,能達到早期治療的效果, 且在65至100歲的族群,有降低全死因死亡風險的保護效果。 | zh_TW |
dc.description.abstract | Introduction:Chronic diseases prevention became more important in the first decades of the 20th century, which stimulated the implementation of screening programs. The National Health Insurance (NHI) reimbursed the adult preventive care service package for beneficiaries aged 40 and older in Taiwan since 1996. About one-third of its target population utilized this service periodically. However, there has been little evidence for the effectiveness of the service, particular in clinical outcomes. Purpose:The purpose of this study is to assess effectiveness of the adult preventive service on early treatment of chronic disease and the reduction of mortality. Material and methods:A total of 32,039 subjects aged 40-100 years by the year 2000 were identified from the representative 200,000-person sample in the reimbursement database of the National Health Insurance in Taiwan. Uptakes of preventive service during 1998-2000 were retrieved, and subjects were followed from Jan 1, 2001 to Dec 31, 2007, information about ambulatory visits and inpatient care during this period was also collected. Multiple logistic regression and Cox proportional hazard regression were applied to estimate the odds ratio and hazard ratio on newly treated hypertension, diabetes, hyperlipidemia and all-cause mortality for those who ever utilize the service. Extended Cox model with counting process was implemented to treat the time-dependent covariate and assess the effectiveness of each uptake. Results:There were 16,080 male (50.2%) and 15,959 female(49.8%) in the study population and the average age of each group were 55.6±11.9 years and 56.0±11.9 years. During the seven years follow-up, 32.1%, 9.1% and 14.5% of each defined cohort developed newly treated hypertension, diabetes and hyperlipidemia. The hazard ratios (HR) of each uptake on newly treated hypertension within one year were 1.80(95% confidence interval, CI: 1.64-1.97), 1.67(95%CI: 1.50-1.85) and 1.56 (95%CI: 1.43-1.72) among subjects aged 40-54, 55-64 and 65-100. For newly treated diabetes, the hazard ratios were 1.59(95%CI: 1.19-2.13), 2.21(95%CI: 1.87-2.61) and 1.76(95%CI: 1.50-2.05) among subjects aged 40-54, 55-64 and 65-100. For newly treated hyperlipidemia, the hazard ratios were 3.97(95%CI: 3.59-4.38), 3.21(2.85-3.63) and 2.82(95%CI: 2.49-3.20) among subjects aged 40-54, 55-64 and 65-100. All of these estimates were statistically significant (p< 0.001).
The hazard ratio of each uptake on all-cause mortality within one and within seven years were statistically significant only among subjects aged 65-100 (HR: 0.74, 95%CI: 0.67-0.84; HR: 0.80, 95% CI: 0.72-0.89, p<0.001). Conclusion:This study provides strong evidence for impact of adult preventive care service on major health outcomes. The results indicated the effectiveness of the service on early treatment of hypertension, diabetes and hyperlipidemia, and finally, reduction of all-cause mortality, especially in subjects aged 65-100. | en |
dc.description.provenance | Made available in DSpace on 2021-05-20T20:15:51Z (GMT). No. of bitstreams: 1 ntu-98-R96846015-1.pdf: 1264710 bytes, checksum: c5feebd76e233799b99ec6eb19395738 (MD5) Previous issue date: 2009 | en |
dc.description.tableofcontents | Acknowledgement i
English bstract ii Chinese abstract v Tale of contents vii List of Tables ix List of Figure xii List of appendices xiii Chapter 1. Introduction 1 1.1 Background 1 1.2 Specific objectives 5 Chapter 2. Literature review 6 2.1 Randomized controlled trials for effectiveness of periodic health examination(PHE) 6 2.2 Observational studies for effectiveness of PHE 11 2.3 Systematic review for effectiveness of PHE 14 2.4 Summary of the effectiveness of PHE 15 2.5 Factors related to PHE utilization 16 2.6 Adult preventive care service program in Taiwan 17 2.7 Hypothesis proposed 19 Chapter 3. Materials and methods 45 3.1 Data sources 45 3.2 Study design 46 3.3 Study subjects 50 3.4 Data retrieving and definition of variables 51 3.5 Statistical analysis 59 3.6 Sample size calculation 61 Chapter 4. Results 62 4.1 Descriptive results 62 4.2.1 Effectiveness on new disease treatment in subjects aged 40-54 years 63 4.2.2 Effectiveness on new disease treatment in subjects aged 55-64 years 65 4.2.3 Effectiveness on new disease treatment in subjects aged 65-100 years 66 4.3 Effectiveness on death prevention 67 4.4 Brief summary of esults 68 Chapter 5. Discussion 99 5.1 Major findings and discussions 99 5.2 Comparison with previous studies 103 5.3 Possible mechanisms 105 5.4 Strengths of this study 106 5.5 Limitations of this study 107 5.6 Conclusion and future perspectives 108 Chapter 6. References 109 | |
dc.language.iso | en | |
dc.title | 全民健保成人預防保健服務對於疾病早期治療及降低全死因死亡的效果分析 | zh_TW |
dc.title | The effectiveness of Adult Preventive Care Service under National Health Insurance on early disease treatment and reduction of all-cause mortality | en |
dc.type | Thesis | |
dc.date.schoolyear | 97-2 | |
dc.description.degree | 碩士 | |
dc.contributor.coadvisor | 李永凌(Lee, Yung-Ling) | |
dc.contributor.oralexamcommittee | 簡國龍(Chien,Kuo-Liong),劉仁沛(Liu, Jen-Pei) | |
dc.subject.keyword | 成人預防保健服務,週期性健康檢查, | zh_TW |
dc.subject.keyword | adult preventive care service,periodic health examination, | en |
dc.relation.page | 127 | |
dc.rights.note | 同意授權(全球公開) | |
dc.date.accepted | 2009-07-09 | |
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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