2008年至2023年台灣外因死因對群體健康負擔與經濟損失之評估

Abstract

外因死因在公共衛生、人口健康與經濟損失評估中具有重要意義，相較於多數自然死因主要集中於中高齡階段，外因死亡可能發生於生命的不同階段，進而對平均餘命、生命損失與經濟損失造成不同程度的影響。過去台灣相關研究多以單一外因死因、特定族群或較早期資料為主，較少同時比較不同外因死因在健康與經濟層面的相對負擔。因此，本文以台灣2008年至2023年外因死因為研究對象，整合內政部戶政司、衛生福利部以及行政院主計總處等資料，分析主要外因死因對台灣群體健康與經濟損失的影響。本文先依ICD-10外因死因分類，整理各年度、性別與五歲年齡組之死亡人數及死亡率，以呈現不同外因死因的年齡與性別分布。接著，建置五歲年齡組的簡易生命表，並以刪除死因生命表估計排除特定外因死因後的平均餘命差額，衡量各類死因對整體存活條件的潛在影響。最後，結合生命表剩餘預期壽命、勞動力參與率與平均收入資料，進一步估計生命損失與勞動生產力損失。研究結果顯示，在研究期間，台灣外因死亡主要集中於運輸事故、意外事故的其他外因，以及蓄意自我傷害，且男性死亡人數普遍高於女性。進一步由細分類觀察，蓄意自我傷害、摩托車騎乘者受傷、其他陸路運輸意外事故及摔倒與跌落，為研究期間較具代表性的外因死因類別。蓄意自我傷害為所有外因死因中死亡人數最高者，死亡較多集中於中壯年族群，因此在平均餘命差額、生命損失與勞動生產力損失上皆呈現較明顯負擔。運輸事故的結果反映台灣交通暴露結構的特性，其中摩托車騎乘者受傷與其他陸路運輸意外事故皆為主要負擔來源。摔倒與跌落雖在勞動生產力損失上相對較低，其主要意義在於高齡者脆弱性、失能風險與照護需求。本文透過死亡分布、平均餘命差額、生命損失與勞動生產力損失四項指標，呈現不同外因死因在健康負擔與經濟損失上的差異。研究結果顯示，外因死因的防治排序不應僅依死亡人數或單一指標決定，而應依政策目標與負擔型態加以判斷，本文補足過往研究在近期資料、多外因類別與多指標比較上的不足，並可作為後續外因死因防治策略與公共衛生資源配置之參考。

External causes of death are important for public health, population health burden, and the evaluation of economic loss. Unlike many natural causes of death, which mainly occur in middle-aged and older people, external-cause deaths may occur at different ages. Therefore, they may affect life expectancy, years of life lost, and economic loss in different ways. Previous studies in Taiwan have often focused on one specific external cause, one population group, or earlier data. Fewer studies have compared different external causes from both health and economic perspectives. Therefore, this study analyzes external causes of death in Taiwan from 2008 to 2023, using data from the Department of Household Registration, the Ministry of Health and Welfare, and the Directorate-General of Budget, Accounting and Statistics. This study first uses ICD-10 external-cause categories to organize the number of deaths and mortality rates by year, sex, and five-year age group. This helps show the age and sex patterns of different external causes of death. Next, this study builds an abridged life table based on five-year age groups. Cause-deleted life tables are then used to estimate the change in life expectancy after removing specific external causes of death. Finally, this study combines remaining life expectancy, labor force participation rates, and average income data to estimate years of life lost and labor productivity loss. The results show that external-cause deaths in Taiwan were mainly from transport accidents, other external causes of accidental injury, and intentional self-harm during the study period. The number of deaths was generally higher among males than females. In more detailed categories, intentional self-harm, motorcyclist injuries, other land transport accidents, and falls were the main external causes. Intentional self-harm had the largest number of deaths among all external causes. Since many of these deaths occurred among working-age adults, intentional self-harm caused a larger burden in life expectancy loss, years of life lost, and labor productivity loss. The results for transport accidents reflect Taiwan’s traffic exposure patterns. Motorcyclist injuries and other land transport accidents were both important sources of burden. Falls caused lower labor productivity loss, but they were important because they were closely related to the vulnerability of older adults. By using four indicators, including death distribution, life expectancy difference, years of life lost, and labor productivity loss, this study compares the health burden and economic loss associated with different external causes of death. The conclusion of this study is that prevention priorities for external causes of death should not be determined based on a single indicator alone, but should instead be evaluated according to policy objectives and the type of burden involved. The main contribution of this study is to address gaps in previous research by using recent data, including multiple external-cause categories, and applying a multi-indicator comparison framework. The findings may serve as a reference for future prevention strategies for external causes of death and for the allocation of public health resources.