臺灣縣市層級可歸因危險因子之疾病死亡負擔：比較性風險評估

Abstract

站在公共衛生的角度，如何在有限的資源下制定最有成效的健康介入政策來達到預防與控制疾病的發生、失能與死亡是促進族群健康的關鍵，為了達成這樣的目標，全盤了解族群所面臨的健康問題與其背後的危險因子分布是首要步驟。 臺灣在死因統計的建立與品質的管控是令其他國家所稱羨的，但要如何有效利用這樣的結果來進一步探討成因並提供給各級政府作為政策方針制定的參考依據成為當前的課題，本研究利用全球疾病負擔團隊所發展的比較性風險評估架構來推估臺灣疾病死亡負擔背後可歸因危險因子的分布並利用完善的資料庫將分析解析度推展到縣市層級，主要討論包括血壓過高、血糖過高、血脂過高、肥胖、吸菸、飲酒、嚼食檳榔、缺乏運動、室外空氣汙染、慢性B 型肝炎和C 型肝炎感染的分布。 分析結果顯示血壓過高、肥胖與血糖過高是造成國人死亡負擔最重要的危險因 子，進一步也發現吸菸與肥胖對於青年與中壯年族群的影響更甚於其他危險因子。而在縣市層級中也發現在東部地區有普遍較高的死亡負擔再來依序為中部南部與北部地區。以危險因子來看，環境與行為相關危險因子(如:吸菸、檳榔、飲酒)在中部地區造成一定程度的死亡負擔，而東部地區需格外注意中壯年族群中行為相關危險因子與慢性B 型肝炎感染。 本研究提供危險因子對於國人整體健康影響的量化證據，並依據不同的縣市去評估其所面臨的健康問題與成因，來幫助各級政府制定更針對性的健康政策。在資源有限的前提下，這樣的分析更能有效達成促進健康的目標，也期許未來能納入更全面的危險因子做評估，並做一個長期性的分析與監測更可結合成本效益分析，同時納入更多方資源或政府部會做整合來達成真正的健康促進。

From the perspective of public health, the key to promoting the health of the population is developing the most effective health intervention policy under limited resources to prevent and control the occurrence, disability and death. In order to achieve such a goal, fully understood the health problems and the distribution of potential risk factors is the first step. The establishment and quality control of death cause statistics in Taiwan is praised by other countries. However, how to use such results effectively to further explore the causes and provide them to governments as a reference for policy development becomes the current topic. This study used the comparative risk assessment (CRA) framework developed by the Global Burden of Disease (GBD) program to estimate the distribution of death burden of disease that attributes to risk factors in Taiwan. Use a comprehensive database to extend the analytical resolution to the subnational level, including high blood pressure, high fasting blood glucose, high low-density cholesterol, obesity, smoking, alcohol drinking, chewing betel nut, low physical activity content, outdoor air pollution, chronic hepatitis B and hepatitis C infection. The results of the analysis showed that high blood pressure, obesity and high fasting blood glucose were the most important risk factors for the death burden. We further found that smoking and obesity affected younger and middle-aged groups more than other risk factors. At subnational levels, there is a generally high death burden in the eastern region, followed by the central, southern and northern regions in Taiwan. In terms of risk factors, behavior-related risk factors (for example: smoking, betel nut, and drinking) cause a certain level of death burden in the central region, while the eastern region need pay efforts on young and mid age population for infection and behavior-related risk factors . This study provides quantitative evidence of the impact of risk factors on the health, and evaluates the health problems and causes of them according to subnational level to help governments to develop health policies that adapt to local condition. Under the premise of limited resources, such an analysis can effectively achieve the goal of promoting health, and expect that a more comprehensive risk factors can be included for evaluation in the future. Further, a long-term analysis and monitoring and even combined with cost-effectiveness analysis, incorporating more resources or government departments to integrate to achieve real health promotion.