台東縣幽門螺旋桿菌感染鄉鎮及族群差異之分析

Abstract

台東縣2019年底總人口數216,781人，其中原住民人口78,695人，約佔全縣人口的36.3%，由於種種醫療照護、生活條件、經濟所得、交通不便及多元族群等健康不平等因素影響下，平均餘命75.8歲最低，與全國相差4.9歲，而原住民平均餘命72.57歲，更與全國差距了8.31歲。就十大癌症死因來看，胃癌死亡率為每十萬人20.8，為全國居高之縣市，原住民胃癌的發生率為每十萬人27.6，死亡率每十萬人15.1亦較其他縣市為高，嚴重威脅縣民健康，因此胃癌防治策略為台東縣積極應發展探討之健康議題，而幽門螺旋桿菌感染經證實為胃癌之危險因子。 故本研究進行各國胃癌防治策略及危險因子之文獻探討彙整後，選定以台東縣16 鄉鎮，對象為20-60歲原住民、非原住民民眾，於2018-2019年進行社區組織性篩檢，以幽門螺旋桿菌篩檢(碳十三尿素呼氣檢測UBT)、治療與追蹤，並進行幽門螺旋桿菌危險因子及鄉鎮族群差異之分析。 本研究共計篩檢2,754人，研究結果顯示幽門螺旋桿菌初篩陽性率整體為49.3%，原住民族為非原住民族群之3.01倍(95%CI=2.54-3.56)，吸菸者陽性率為1.37倍(95%CI =1.16-1.62)，飲酒者為1.72倍(95%CI=1.46-2.02)，嚼食檳榔者為2.05倍(95%CI=1.73-2.44)。經除菌藥物治療後，整體除菌率84.2%，未達藥物治療之預期效果，以年輕族群及吸菸者成效最差。顯見原住民族仍是胃幽門螺旋桿菌感染之高風險族群，同時菸害、檳榔、酒，也是台東縣重要之防治議題。未來應持續針對原鄉加強胃幽門螺旋桿菌篩檢，並改善環境衛生、生活習慣、及家戶重複感染之機率，也藉由進一步飲食習慣之收集，探討更多危險因子，以發展更適切之在地化醫療保健疾病篩檢政策。

Taitung County had a total population of 216,781 people at the end of 2019, of which 78,695 were aboriginal people, accounting for about 36.3% of the county’s population. Due to health inequalities in various issues. such as medical care, living conditions, economic income, inconvenient transportation, and diverse ethnic groups, the average life expectancy in Taitung county is the lowest at 75.8 years old, which is 4.9 years behind the national average. In addition, life expectancy of the aborigines is 72.57 years old, which is 8.31 years behind the national average. In terms of the top ten causes of cancer deaths, the death rate of gastric cancer in Taitung county is 20.8 per 100,000 people, which is the highest in the country. As for the aborigines, the incidence of gastric cancer is 27.6 per 100,000 people, and the death rate is 15.1 per 100,000 people. Therefore, gastric cancer is a top health issue that the government of Taitung County should actively intervene and prevent. Helicobacter pylori infection has been proven to be a risk factor for gastric cancer. Therefore, this study aimed to understand the distribution and risk factors of positive rates in initial screening for Helicobacter pylori (tested by carbon 13 urea breath test UBT), positive rates in second test of Helicobacter pylori after medication, and antibacterial rate. Study participants included 2,754 people (both aborigine and non-indigenous) aged 20-60 residing in 16 towns of Taitung County. The results showed that the overall positive rate in Helicobacter pylori initial screening was 49.3%. The screening rates in aboriginal ethnic group was 3.01 times of that in non-indigenous ethnic group (95%CI=2.54-3.56). Participants who ever smoked ( Odds ratio [OR] = 1.37 ,95% CI=1.16-1.62).drank alcohol(OR=1.72 , 95% CI=1.46-2.02). or chewed betel nut (OR=2.05 , 95% CI=1.73-2.44) had a higher risk of having positive rates in initial screening for Helicobacter pylori . After receiving treatment with antibacterial drugs, the overall antibacterial rate was 84.2%, which did not achieve the expected effect. Young people and smokers had the worst effect. In conclusion, the indigenous peoples are the high-risk groups for gastric Helicobacter pylori infection. At the same time, smoking, betel nuts chewing, and alcohol use are also important prevention and treatment issues in the Taitung County. In the future, we should continue to strengthen gastric Helicobacter pylori screening in Taitung County, and improve environmental hygiene, living habits, and the probability of repeated infections in households. Also, through further collection of dietary habits, we should explore more risk factors to develop localized disease screening policy.