台灣2020年末期腎臟病透析人數預測

Abstract

世界各國末期腎臟病患數均不斷上升，估計至2010年全世界末期腎臟病人口將超過200萬人。美國腎臟資料系統2010年度報告顯示，台灣末期腎臟病發生率與盛行率皆為世界第一，而不斷增加的罹病人口將對醫療支出造成壓力。中央健康保險局2010年統計資料指出，透析醫療費用佔總醫療支出的7.88%，接受透析治療的患者人數卻只佔總人口的0.27%，平均一位接受透析治療患者的醫療費用為全國每人平均的26.4倍，醫療資源的耗用不可謂不大。因此，本研究嘗試以歷史資料分析發生率、盛行率的變化趨勢，進而預測未來至2020年之新發生人數與盛行人數，期予衛生醫療政策擬定者於預算、資源擬定分配之參考依據，減少資源錯置，達到最大利用，促使末期腎臟病的蔓延得以妥善預防與控制。 使用全民健康保險學術研究資料庫1997年至2009年之資料，篩選共114966位末期腎臟病連續四個月以上透析患者。以自我迴歸整合移動平均模型預測發生率，並記錄各年死亡人數以逐年推估盛行人數至2020年。 ARIMA(0,3,3)模式與ARIMA(p,d,q)較適組合模式之2020年預測發生人數分別為17032人與16289人，較2008年實際發生人數增加83%與75%。自2009年至2020年兩組預測模式之平均年增率分別為4.79%、4.67%。ARIMA(0,3,3)+死亡率1模式與ARIMA(較適組合)+死亡率1模式之2020年預測盛行人數分別為102145人、99688人，為2008年的1.7倍之多，平均年增率為4.85%與4.68%。 末期腎臟病患人數的增加主要來自於糖尿病腎病變患者，估計至2020年新發生病例中將有超過八成來自糖尿病患，而盛行人數中糖尿病性腎病變患者人數也將逼近六成。因此，若能針對糖尿病患，積極控制慢性腎臟病的發展，避免進入接受透析治療的最終階段，應可有效降低末期腎臟病接受透析治療的人口數。

The worldwide patients with end-stage renal disease are increasing and are estimated that there will be over two million patients in 2020. According to the United States Renal Data System 2010 Annual Report, Taiwan ranks first in the world in the incidence and the prevalence of end-stage renal disease. Moreover, the medical expenses will be under pressure by the increasing patients in Taiwan. Statistics from Bureau of National Health Insurance, Department of Health, Executive Yuan in 2010 indicated that the expenses of dialysis therapy contributed 7.88% of the total medical expenditure, but the patients on dialysis only accounted for 0.27% of the total population in Taiwan. Indeed, spending of the medical expenditure was at great expense of that the average expenses for one patient on dialysis is 26.4-fold than for any other person. Thus, the purpose of the present research is to use the historical data of the incidence and the prevalence to project the number of dialysis patients with end-stage renal disease in the year 2020, and then to help the Department of Health to optimize the budget and resource allocation and the prevention and control of the spread of end-stage renal disease. In the present study, 114,996 patients with end-stage renal disease who were on dialysis for over continuous four months were chosen from National Health Insurance Research Database of 1997 to 2009. The prediction of incidence was estimated using autoregressive integrated moving average model (ARIMA), and the mortality was recorded by year to speculate the prevalence until 2020. The projecting number of patients with end-stage renal disease in 2020 using ARIMA (0, 3, 3) and ARIMA (p, d, q)better in 2008, respectively. The average year increase rate from 2009 to 2020 estimated by ARIMA (0, 3, 3) and ARIMA (p, d, q)better were 4.79% and 4.67%, respectively. The predicted prevalence in 2020 were 102,145 and 99,688 people speculated by ARIMA (0, 3, 3) + mortality and ARIMA (p, d, q)better + mortality, respectively, which were 1.7-fold than in 2008, and the year increase rate of prevalence were 4.85% and 4.68%. Patients with diabetic nephropathy are the major contributors to the increase of the number of patients with end-stage renal disease. Based on the present prediction in 2020, there will be over 80% of patients on dialysis come from the patients with diabetes, and the patients with diabetic nephropathy will take almost 60% in the prevalence. Thus, efficiently lowering the number of patients with end-stage renal disease could depend on preventing course of disease into the end-stage by controlling actively the development of chronic kidney disease (CKD) which runs in the patients with diabetes.