處方藥之非醫療使用與自陳生活品質：台灣2014年全國物質使用調查結果

Abstract

目的：儘管健康相關生活品質在許多不同疾病的族群中越來越常被使用，卻少有研究探討處方藥之非醫療使用者及醫療使用者的健康相關生活品質是否有所不同。本研究探討了在台灣全人口中，不同社會人口學特徵及處方藥之非醫療使用或醫療使用，與自陳健康相關生活品質的關係。 方法：在2014年全國物質使用調查中，共有17,837位受訪者完成了問卷，內容包含了受訪者社會人口學特徵、鎮靜安眠藥及止痛藥的使用經驗，以及生活品質量表EQ-5D等資訊。依據鎮靜安眠藥及止痛藥使用的情形，受訪者被區分為：未使用、醫療使用、前非醫療使用及目前非醫療使用。本研究比較了在不同社會人口學特徵，及不同處方藥使用模式下的EQ-5D中的5個面向及EQ-VAS分數，並使用分量迴歸來分析社會人口學特徵、處方藥使用與EQ-VAS的關聯。 結果：在所有的受訪者中，鎮靜安眠藥有8.31%為醫療使用、0.89%為前非醫療使用、0.71%為目前非醫療使用；止痛藥則有6.91%為醫療使用、1,93%為前非醫療使用、3.02%為目前非醫療使用。全體受訪者的平均EQ-VAS為78.8分(標準誤 = 0.3)。多變項分量迴歸分析結果顯示，男性、25-34歲、單身、擁有大學以上教育程度、居住在都市地區、鎮靜安眠藥或止痛藥之醫療使用及目前非醫療使用，與其他人相比，特別在低分量時會有較低的EQ-VAS分數。其中年齡、教育程度與鎮靜安眠藥的使用，是較差EQ-VAS分數的最強相關因子。而就鎮靜安眠藥的使用而言，目前非醫療使用對健康相關生活品質的負面影響，與醫療使用相比更大；然而就止痛藥的使用而言，兩者並沒有顯著的差異。 結論：在台灣全人口中，我們發現擁有高學歷的年輕成人，有著出乎預期較差的健康相關生活品質。同時，處方藥的目前非醫療使用，特別是鎮靜安眠藥，也與較差健康相關生活品質有關。 關鍵字：健康相關生活品質、EQ-5D、非醫療原因使用處方藥、鎮靜安眠藥、止痛藥、分量迴歸

Aim: Despite increasing application of health-related quality of life (HRQoL) on various diseased populations, few existing studies have examined the difference in HRQoL between people with non-medical use (NMU) and those with medical use (MU) of prescription drugs. This study aims to examine the relationships among socio-demographic characteristics, NMU or MU of prescription drugs, and self-reported HRQoL among the general population in Taiwan. Methods: Participants (N = 17,837) of 2014 National Survey of Substance Use completed a computer-assisted self-interview questionnaire with information on their socio-demographic characteristics, use of sedatives/hypnotics and analgesics, as well as the EuroQOL five dimensions questionnaire (EQ-5D), among others. Participants’ use of sedatives/hypnotics or analgesics were classified into non-use, medical-use (MU), ex-NMU, or current NMU. Individual dimensions and the visual analogue scale (VAS) in EQ-5D were compared among subgroups of different socio-demographic characteristics and prescription drug use. Quantile regressions of VAS were conducted on socio-demographic characteristics and prescription drug uses. Results: Among the participants, prevalence of MU, ex-NMU and current NMU of sedatives/hypnotics were 8.31%, 0.89%, and 0.71%, respectively, and the counterparts for analgesics were 6.91%, 1.93%, and 3.02%. The mean EQ-VAS among the participants was 78.8 (S.E. = 0.3). Results from multi-variable quantile regressions showed that participants who were male, 25-34 years old, having an educational attainment of college or above, single, living in urban areas, having MU or NMU of sedatives/hypnotics or analgesics were more likely to report lower EQ-VAS, especially in the lower quantiles. Age, education, and use of sedatives/hypnotics were the strongest correlates of poor EQ-VAS. For sedatives/hypnotics, people with current NMU had greater negative effects than those with MU, while there were no significant differences between MU and current NMU for analgesics. Conclusions: In Taiwanese general population, unexpected poor HRQoL for young adults with college degree was observed. Meanwhile, current NMU of prescription drugs, especially sedatives/hypnotics, were also associated with poor HRQoL. Keywords: Health related quality of life, EQ-5D, non-medical use of prescription drugs, sedatives, analgesics, quantile regression