推估臺灣2012-2015食媒性疾病負擔

Abstract

背景：根據美國疾病管制與預防中心(U.S. Centers for Disease Control and Prevention, U.S. CDC) 的資料顯示，全美每年有4,800萬人因食媒性疾病而生病，12.8萬人住院，3,000人因此而死亡，若以美國人口3.2億人口來計算，等於每6個人就有一個人受到食媒性疾病的侵害，造成全美每年超過156億美元的經濟損失。但我國衛生福利部食品藥物管理署統計資料顯示，2014年臺灣地區食品中毒患者數為4,504人，死亡數為0人，若以臺灣人口2,300萬人來計算，等於每5,000人才一個人受到食媒性疾病的侵襲，食媒性疾病的發生率明顯地被低估。因此，本研究目的為推估臺灣真正的食媒性疾病負擔。 方法：本研究透過2012-2015年健保資料庫中食媒性疾病相關的ICD診斷代碼、疾管署法定傳染病通報系統與食藥署食品中毒通報資料，推估每年食媒性疾病患者數。本研究更利用我國急性胃腸炎採檢資料推估被診斷為未知病原體的急性胃腸炎感染中已知食媒性疾病感染數，且將未就醫的患者納入估計。再加上世界衛生組織(World Health Organization, WHO)所提出的失能調整生命年(disability-adjusted life years, DALYs)的概念，損失一個DALY代表損失一個健康的生命年，用以量化食媒性疾病負擔。另一方面，也從描述性流行病學的角度分析健保資料庫中食媒性疾病的人口學特徵、流行趨勢與醫療成本花費，且將研究成果與目前臺灣通報資料進行探討。 結果：2012-2015年臺灣平均每年有3,895,914人因食媒性疾病而生病，50人死亡。若以臺灣人口2,300萬人進行換算，等於每6人就有一人受到食媒性疾病的侵襲，造成每年4,974個DALY損失。在健保資料庫中，每年約有344萬人被診斷為病因未明的急性胃腸炎感染，本研究發現其中有141萬人是和食媒性相關；另一方面，因食媒性疾病未就醫的患者則有245萬人。在就醫的患者中，已知食媒性病原體感染以細菌類感染的患者數為最多、其次為病毒類、寄生蟲類病原體。非傷寒性沙門氏菌感染為已知病原體中排行第一名，每年約有18萬人因為不潔的食物受害，6人因此而死亡，造成510個DALY損失，其次為諾羅病毒、腸炎弧菌所造成的腸道感染。非傷寒性的沙門氏菌與諾羅病毒好發於5歲以下的孩童，A肝病毒、弓蟲感染好發於20-64歲的壯年人；腸炎弧菌、霍亂弧菌、李斯特菌、阿米巴蟲、與其他細菌類引起的食物中毒常見於65歲以上的老人身上。在季節分布上，被診斷為未知病原體所造成的腹瀉、急性胃腸炎、大腸炎就醫的分布集中於1-3月，但本研究並無法推估是否為食物所造成；非傷寒性沙門氏菌就醫分布集中於夏季，諾羅病毒集中於冬季。在地理區的分布上，曲狀桿菌、輪狀病毒在北部地區更為常見；諾羅病毒、霍亂弧菌、大腸桿菌所造成的腸道感染的流行發生於中部；李斯特菌、其他病毒性腸炎在南部有較高的發生率；志賀氏桿菌、蛔蟲、弓蟲、腺病毒的感染則常見於東部地區。非傷寒性的沙門氏菌感染則分布於中南部。在醫療花費上，食媒性疾病造成台灣每年至少13億元新台幣的醫療支出，已與每年流感疫苗採購基金相當。 結論：在臺灣，每年每6人就有一人受到食媒性疾病的侵襲，卻長期遭受忽視。本研究是臺灣首次利用健保資料庫結合疾病負擔數量化的估計方法了解臺灣食媒性疾病，並針對被診斷為未知病原體所造成的急性胃腸炎患者進行病原體分布的推估，對未來提升臺灣食品安全的重要性與建立食媒性疾病整合監視與應變機制有重要影響。

Background：According to the U.S. Centers for Disease Control and Prevention (U.S. CDC), approximately 48 million people get sick, 128,000 are hospitalized, and 3,000 die from foodborne illnesses in the United States each year. That is to say, 1 in 6 Americans gets sick from contaminated food. And it cost $15.6 billion in economic burden annually. However, the foodborne outbreak data released by Taiwan Food and Drug Administration (TFDA) shows that only 4,504 people who had suffered from food poisoning in Taiwan in 2014, which means about 1 in 5,000 Taiwanese people experience foodborne illness each year. Comparing with the U.S., foodborne illnesses in Taiwan are highly underestimated. The aim of the study is to estimate the disease burden from foodborne illnesses in Taiwan. Methods：Data were collected from the National Health Insurance Research Database (NHIRD), CDC National Notifiable Diseases Surveillance System, and TFDA Foodborne Illness Outbreak Data covering the years 2012-2015 to estimate foodborne illnesses in Taiwan. The etiology of acute gastroenteritis in Taiwan was used to identify foodborne illnesses among acute gastroenteritis caused by unspecified agents. Patients who not sought medical care had also been estimated in our study. The disease burden was expressed in disability-adjusted life years (DALYs) to quantify the number of healthy life years lost due to morbidity and mortality. Descriptive epidemiology analysis was performed to describe the demographics, geographic, seasonal distribution, and medical cost in NHIRD in Taiwan. Results：Our study showed that each year 3,895,914 people suffered from foodborne illnesses, 50 people died in Taiwan, and results in a total of 4,974 DALYs lost. Namely, each year every 1 in 6 people gets sick from eating contaminated food in Taiwan. 3.44 million people were diagnosed with acute gastroenteritis caused by unspecified agents in NHIRD annually. We used the etiology data of acute gastroenteritis in Taiwan to further redistribute 1.41 million of them into foodborne illnesses. 2.45 million people were estimated to be patients who did not seek medical care. Non-typhoid Salmonella, norovirus, and Vibrio parahaemolyticus were found to be the leading causes of known foodborne pathogens. Each year, 185,977 people get sick, and 6 people die because of foodborne Non-Typhoid Salmonella infections. Non-typhoid Salmonella and norovirus have the highest incidence rate among children under 5 years old. Hepatitis A virus and Toxoplasma gondii had the highest incidence rate for people age 20-64, while Vibrio cholera, Listeria monocytogenes, Entamoeba histolytica, and food poisoning due to other bacteria had the highest incidence rate for people age 65 and older. Most people diagnosed with acute gastroenteritis caused by unspecified agents sought medical care in winter; however, we cannot tell that it is due to contaminated food or not. Non-typhoid Salmonella infections were more common in summer, whereas norovirus is more common in winter. Geographic variation in the incidence was observed as below: Campylobacter and Rotavirus in Northern Taiwan; Norovirus, Vibrio cholera, and intestinal infections due to E. coli in Central Taiwan; Listeria, and enteritis due to other virus in Southern Taiwan; and Shigella, Ascariasis, Toxoplasmosis, and Adenovirus in Eastern Taiwan. Non-typhoid Salmonella infection had a high incidence in Central and Southern Taiwan. Foodborne illnesses cost at least TWD 1.3 billion medical expense each year, and it is comparable with influenza vaccination intervention in Taiwan. Conclusion：Each year, every 1 in 6 people suffer from foodborne illness in Taiwan. We are the first study using the National Health Insurance Research Database combining with DALY metric to estimate foodborne illnesses in Taiwan. Our study highlights the importance of food safety and it will be important for the policymakers to prioritize public health risk management actions and establish the foodborne illnesses active surveillance system in the future.