推估國內主要傳染性疾病之疾病負擔

Abstract

背景：近幾年，因為新興傳染病及再發傳染病的爆發，使得傳染病的發生率大幅度的增加，這嚴重地造成全民健康的威脅。因此，若要有效的分配醫療資源及促進健康政策的制定，對於傳染病的疾病負擔發展出一套全面性的綜合比較分析是必要的。該研究的目的在於依據全球疾病負擔計畫中，疾病負擔推估模式，對全國主要六大傳染病（結核病、愛滋病、B型肝炎、C型肝炎、登革熱、流感）進行失能調整人年(Disability-Adjusted Life Year, DALY)估算。 方法：本研究利用2006至2013年間，臺灣疾病管制署之通報資料庫、健保資料庫、癌症登記資料庫以及全國死因統計檔，推估各目標傳染病之疾病負擔。採用GBD 2010計畫的疾病架構、生命表及失能權重。各疾病的盛行率是由發生率乘上疾病病程推估而來，其中，發生率的推估是來自於修正過低估之後的通報數據。此外，為了有效的計算各傳染病完整的疾病負擔，本研究在計算負擔的時候，亦同時納入了各疾病的急性及慢性併發症。 結果：在2013年，病毒性肝炎在臺灣地區所造成的疾病負擔最高：B型肝炎為每十萬人口758.78 (95% uncertainty interval (UI) 709.17-809.28) DALYs，C型肝炎為每十萬人口296.00 (95%UI 272.96-319.49) DALYs。接著則是慢性傳染病：愛滋病(每十萬人口68.07 DALYs, 95%UI: 63.05-73.98)以及結核病(每十萬人口49.27 DALYs, 95%UI: 48.88-49.65)。急性傳染病是負擔相對較低的疾病：流感為每十萬人口22.74 (95%UI 20.43-29.66) DALYs，登革熱為每十萬人口0.39 (95%UI 0.38-0.41) DALYs。其中，超過98%的病毒性肝炎疾病負擔是來自於慢性併發症(肝硬化及肝癌)。此外，在2006到2013年間，除了目前尚無法治癒的愛滋病之外，慢性傳染病(B型肝炎、C型肝炎及結核病)之疾病負擔逐年下降，而急性傳染病(流感及登革熱)之疾病負擔則是會依據各年度偶發性的流行而起起伏伏。 結論：病毒性肝炎(B型肝炎及C型肝炎)為國內疾病負擔最高之傳染性疾病，其中，絕大部分是來自於它的慢性併發症。因此對於病毒性肝炎的病人而言，長期的照護是很重要的。本篇研究是國內第一篇以一致性方法推估多個傳染病疾病負擔的研究。雖然目前只有以國內六大傳染病為例，但建立了一個推估疾病負擔的範例及基準，可供後續研究者參考，以期將國內各疾病之負擔推估做得更完整。 中文關鍵詞：疾病負擔、傳染病、失能調整人年(DALY)、臺灣

Background: Estimating the burden of infectious diseases is necessary for evidence-based health policy making and prioritization of limited resources. The current study focused on tuberculosis (TB), human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS), hepatitis B virus (HBV) infection, hepatitis C virus (HCV) infection, dengue fever, and influenza. Methods: The annual disease burden was estimated for the period 2006-2013 for selected infectious diseases in Taiwan using the disability-adjusted life years (DALY) metric. The definition of sequelae and corresponding disability weights for the diseases of interest and the residual life expectancy were obtained from the GBD2010 project. Prevalence estimates were calculated as the incidence multiplied by the duration of disease, whereas the incidence estimates were based on surveillance data corrected for underestimation. We combined both short-term (acute) and long-term (chronic) impacts of diseases in our estimations in order to gain a comprehensive insight into true burden of infectious diseases. Results: Among the six infectious diseases under investigation, viral hepatitis accounted for the largest disease burden in Taiwan in 2013: 758.78 (95% uncertainty interval (UI) 709.17-809.28) DALYs/100,000 population for HBV and 296.00 (95%UI 272.96-319.49) DALYs/100,000 population for HCV respectively. They were followed by HIV/AIDS (68.07 DALYs/100,000 population, 95%UI: 63.05-73.98) and TB (49.27 DALYs/100,000 population, 95%UI: 48.88-49.65). Acute infections of influenza and dengue fever accounted for 22.74 (95%UI 20.43-29.66) and 0.39 (95%UI 0.38-0.41) DALYs/100,000 population in 2013 respectively. The majority (>98%) of the disease burden of viral hepatitis was due to the health loss from chronic complications of cirrhosis and liver cancer, rather than the health loss during acute infection. Moreover, except for lifelong infectious disease of HIV/AIDS, the burden of chronic infectious diseases (HBV, HCV and TB) was declining from 2006 to 2013, while the burden of acute infectious diseases (influenza and dengue fever) were fluctuating. Conclusion: Viral hepatitis (HBV and HCV) are the most burdensome infectious diseases in our estimations, and most of the burden are contributed by their chronic outcomes. As a result, the medical care is important for HBV and HCV patients to reduce long-term complications. Although we only included six major infectious diseases in current research, we established a framework for future assessing the burden of infectious diseases, non-communicable diseases and injuries in Taiwan. Keywords: disease burden; infectious disease; disability adjusted life year (DALY); Taiwan