社會經濟與知能在氣候變遷對呼吸道健康衝擊之調適作用

Abstract

氣候變遷已是國際共識，而氣候變遷對人類健康的潛在影響也有許多評估報告。然而，氣候對人類健康的影響仍有許多社會上、制度上、技術上及行為上的調適策略可減低其衝擊，有關公共衛生建設的方案、服務及調查系統也廣為需要。其中的慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)是全球近10年來盛行率逐漸升高的肺部疾病，其成因複雜，與個人健康狀態及外在環境因子有關，如氣候及空氣污染。本研究評估氣候變化對慢性阻塞性肺疾病發生在台灣地區的相關。主要以二手資料做完整分析。分析的基本資料為民國90 年行政院衛生署國民健康局「國民健康促進知識態度與行為調查」（National Health Interview Survey, NHIS)的資料，及同意串檔受訪個案在2000-2002年之全民健康保險資料串連資料檔，並以空氣污染和氣象監測資料分析可能相關。研究地區為台灣本島，串連調查訪問18,177人中有10,092人曾因呼吸道疾病就醫，1306人曾因COPD就醫。研究個人特徵、社會經濟、健康知識、健康行為對應氣象和慢性阻塞性肺疾病的相關，探討極端溫度發生對慢性阻塞性肺疾病發生的相對危險。以多變項Poisson迴歸分析結果發現慢性阻塞性肺病的危險族群是12-19歲和65歲以上的人口，尤其是男性和抽菸人口。控制年齡、性別、氣溫、空氣污染物與時間長期趨勢情況下，相較於BMI為18-24 Kg/m2的人，BMI為18 Kg/m2以下的相對危險性為2.07（95％CI 1.80-2.38）、BMI為25-32 Kg/m2之相對危險性為1.09（95％CI 1.02-1.17）。家中有燒香拜拜習慣個案之相對危險性為0.69。沒有工作的個案之相對危險性為1.15。收入越高相對危險性也越高。有抽菸習慣個案相對危險性為2.42。有嚼檳榔習慣個案之相對危險性為1.50。沒有施打流行性感冒疫苗個案之相對危險性為0.71。曾罹患肺部疾病個案之相對危險性為2.33。曾罹患高血壓個案之相對危險性為1.08。曾中風的個案之相對危險性為1.5。但是在控制各項變因的影響下，極端溫度對於慢性阻塞性肺疾病發生的相對危險性均未有統計上的顯著差異，雖然夏季的COPD就醫較少。本研究顯示，生活型態和慢性阻塞性肺疾病的相關顯著，特別是老年人和12-19歲的少年，慢性阻塞性肺疾病患者也有較高的其他共病勝算比，和氣溫的相關並不顯著。

The climatic change is an international recognized environmental, social and economical threat facing the humans. Many studies have assessed the impact of climate change on human health. Humans need to reduce the impact through social, systematic, technological and behavior adaptation. The related public health establishment, service and investigation are extensively needed. The chronic obstructive pulmonary disease (COPD) is one of the respiratory illnesses with the global concern of its increasing prevalence in the recent years. The etiology of the disease is complicated and may have association with individual health status and environmental conditions such as weather condition and air pollution. The present study investigated the association between weather, and COPD and all respiratory illnesses in Taiwan by comprehensively analyzing the second-hand data. We used the data of 2001 National Health Interview Survey, on the “Population Health Promotion Knowledge, Attitude, Practice,” conducted by the National Health Bureau, Executive Yuan Department of Health. With consents, the data was combined with the 2000-2002 medical records of national health insurance. We identified all types of care for respiratory illnesses and conducted comprehensive analyses for COPD, associated with socio-demographic characteristics, lifestyle, diet, air pollution and the meteorology status. Among 18,177 participants of the survey, 10,092 persons received cares for respiratory illnesses, and 1306 persons received cares for COPD. The results multivariable Poisson regression analyses showed that, children in 12-19 years of age and the elderly in 65 years of age and above were at higher risk of COPD, particularly men and those who smoked. After controlling for age, sex, temperature, and air pollution, this study also found that, compared with participants with the body mass index (BMI) of 18-24 kg/m2, those with the BMI of <18 kg/m2 had the relative risk (RR) of 2.07 (95% confidence interval (CI) 1.80, 2.38) for COPD and those with the BMI of 25-32 kg/m2 had the RR of 1.09 (95%CI 1.02, 1.17) for COPD. The risk of COPD was also associated with higher income, those who did not have jobs, smoking and areca chewing. However, participants who used incense burning at home or did not have a flu shot were at lower risk of COPD. The risk of COPD was also associated with co-morbidities such as hypertension, stroke and other types of pulmonary diseases. This study did not found a significant association between COPD and temperature in the multivariable analyses although the disease is less prevalent in summers. In conclusion, life style instead of weather is an important factor associated with the risk of COPD in the participants.