探索臺灣鄉鎮市區死亡率與環境脈絡的關係

Abstract

本篇論文探討環境脈絡與死亡率 (mortality) 的關係，包含死亡率的空間分布差異、死亡率變遷的空間異質性、環境脈絡因素的空間鄰近效應等。本研究以2001年至2012年的標準化死亡率作為研究對象，以臺灣本島349個鄉鎮作為研究空間單元，以探究環境脈絡與死亡率的關係。 首先，透過文獻回顧瞭解與死亡率相關的環境脈絡因素；接著，繪製死亡地圖來瞭解臺灣死亡率的空間不平等現象；並且，以多層次分析模型 (Multilevel Analysis Model) 之線性成長模式 (Linear Growth Model) 分析臺灣的死亡率變化，也就是死亡率於研究起點的空間差異以及研究期間死亡率的變遷率；繼而，探究與死亡率起點值與變遷率相關的環境脈絡因素；最後，檢驗環境脈絡因素的空間鄰近效應。 2001年至2012年間，歷年的死亡率是東部高於西部，山地鄉高於非山地鄉，南部最高而北部最低，偏遠鄉鎮最高而高度都市化市鎮最低；然而，在研究起點的2001年，山地鄉的死亡率顯著高於非山地鄉，且死亡率的下降速度也較非山地鄉來得慢，可見臺灣的死亡率在起點值與變遷率具空間不平等現象，山地鄉的生存環境最為苛刻。剝奪指數，也就是貧窮程度，是解釋死亡率起點值與變遷率空間差異的主要因素，而生活壓力因素其次。在鄰近效應部分，鄰鄉的剝奪指數、壓力指數、醫療指數具有空間鄰近效應，若能改善這些環境脈絡因素，則毗鄰的鄉鎮能共同受惠，死亡率應能整體下降。

This study aims to explore the relationship between geographical environment and mortality, examining how the environment context influences initial value and rate of change of mortality from 2001 to 2012. This study uses standardized mortality rates (SMRs) as a variable to profile the distribution pattern and the trajectory of death in Taiwan in order to distinguish the spatial heterogeneity of death. On the other hand, much of current literature focuses on the relationship between environment context and mortality but ignores the spatial lag effect. In this study, variables related to the the spatial lag effect are examined to see how they would account for the variation of mortality. The main analysis method of the study is linear gwoth model in multilevel analysis. In addition, mortality and relevant factors are visualized in maps for furtehr discussion. The finding suggest that, first of all, SMRs are in decline during the period of 2001 to 2012, and the average SMRs were different from region to region. Second, the SMRs of indigenous area are high and decline much slower than those non-indigenous areas. Third, deprivation index has most impact on the initial values and change rate of SMRs, and deprivation index of neighborhood could account for the variation of initial value and rate of change of SMRs.