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Title: | 飲品攝取與腎病變相關性研究-社區篩檢資料分析 A Population-Based Study of the Association between Beverage and Chronic Kidney Disease |
Authors: | 張毓哲 YU-CHE CHANG |
Advisor: | 陳秀熙 Hsiu-Hsi Chen |
Keyword: | 慢性腎臟病,盛行率,發生率,勝算比,飲品,社區篩檢,初期預防,次級預防,風險因子, Chronic kidney disease,prevalence,incidence,odds ratio,beverage,population-based study,primary prevention,secondary prevention,risk factors, |
Publication Year : | 2023 |
Degree: | 碩士 |
Abstract: | 研究動機與目的:台灣地區慢性腎臟病、末期腎臟病接受透析者在全世界上有極高的發生率與盛行率,許多患者在無病識感或是控制不良的期況下進展到末期腎病變並接受透析治療,造成衛生保健財務上沉重的負擔,根據2019年台灣醫療費用排行報告,慢性腎臟病排名第1,治療費用高達新台幣533億元。然而台灣本土慢性腎病變盛行率、發生率以及惡化或保護因子的大規模統計,近10年只有2018年發表針對基隆市106094個案的統計分析,顯然需要有更多的資訊供各界參考。由於慢性腎病變為多因子、逐步進展且在初期尚有扭轉餘地的疾病,如能透過分析統計整理較有相關性之惡化因子及保護因子,並依照個人接觸予以排除或增強,可預期能減少進入中晚期慢性腎病變甚至洗腎風險,也減少健保資源損耗。
研究方法:本研究為回溯性研究,將重複測量資料進行分析。資料來自彰化縣萬人健檢歷年(2005-2020,2021-2022因疫情部分停辦)數據,包含參與個案的血液生化、尿液生化檢驗數據以及取得參與者同意後填寫之健康行為問卷。研究分為二階段進行,第一階段找出重複參加個案,使用初次參加的數據計算各期別盛行率,並透過健康問卷彙整可能健康行為及風險因子作為後續統計變項;第二階段將重複參與個案分為二組(正常、正常到輕度腎病變),計算出分層各自目標的發生率數值,並透過發生率差異及勝算比推論可能的風險及保護因子。 研究結果:背景盛行率分析顯示,性別之全期別盛行率男性較女性為高;年齡部分,65歲以上個案全期別盛行率則是較未滿65歲者為高;血壓偏高族群背景盛行率較正常族群高;血糖偏高族群背景盛行率較正常族群高;血脂部分,異常族群背景盛行率較正常族群高;代謝症候群族群之背景盛行率也較正常族群高;吸菸、喝酒、檳榔等有害健康行為族群背景盛行率也較高;接觸二手菸的間接有害行為族群盛行率為,較一般群體為高;飲食習慣中纖維攝取的類別,素食主義者盛行率較低;飲品習慣有無如咖啡、茶,盛行率略低。從新發生慢性腎臟病的方向探討,保護因子為素食主義、茶葉飲品攝取;風險因子則為男性、高血壓、BMI偏高、腰圍偏高、抽菸、檳榔、飲酒。從慢性腎臟病罹病者後續惡化率來探討,保護因子為茶葉飲品攝取;風險因子則同樣為男性、高血壓、BMI偏高、腰圍偏高、抽菸、檳榔、飲酒,證明茶葉飲品攝取不論在新發生慢性腎臟病或者罹病者惡化上都有保護效果,然而在探討劑量反應關係(Dose-Response Relationship)時卻證明並非飲用茶飲頻率越高越能提升保護效果,然而相對地發現酒精飲品的危害隨飲用頻次升高。 結論與建議:本次研究證明腎臟病的發生以及惡化受到諸多因素的影響,不論是環境、疾病、生理、甚至健康行為等因子等都有顯著的差異性。但研究中多個限制也可能對於結果造成影響,例如類似健康工人偏差、時空背景誤差、疾病統計本身的限制、統計方式造成的誤差。為了克服以上的限制,我們認為必須要找出更多干擾因子才能將干擾減至最小,做出明確的結論。 Background and objectives: Taiwan has a notably high incidence and prevalence of chronic kidney disease (CKD) and end-stage renal disease (ESRD) requiring dialysis globally. Many patients progress to end-stage kidney disease and undergo dialysis treatment, either without being aware of their disease or due to poor disease management, imposing a heavy financial burden on the healthcare system. According to the 2019 Taiwan Medical Expenses Ranking Report, chronic kidney disease ranked first with treatment costs reaching as high as 53.3 billion New Taiwan Dollars. However, comprehensive statistics on the prevalence, incidence, and deteriorating or protective factors of local CKD in Taiwan in the past ten years are limited, with only one statistical analysis conducted in 2018 focusing on 106,094 cases in Keelung City. Clearly, more information is needed for various sectors to reference. Given that chronic kidney disease is a multifactorial condition, gradually progressive, and potentially reversible in its early stages, it would be beneficial to identify and analyze relevant deteriorating and protective factors. By eliminating or enhancing these factors based on personal exposure, we could potentially reduce the risk of progressing to moderate or severe CKD and even requiring dialysis, thus also reducing the consumption of health insurance resources. Materials and Methods This is a retrospective study, using stratified analysis on repeated data. The data come from the Changhua County ten-thousand-people health check over the years (2005-2020; partially suspended in 2021-2022 due to the COVID-19 pandemic), including blood biochemical data, urinalysis data, and health behavior questionnaires completed after obtaining participants' consent. The study is carried out in two stages. In the first stage, repeated participants are identified, and the data from their initial participation is used to calculate the prevalence rate for each period. Potential health behaviors and risk factors are compiled from the health questionnaires for subsequent statistical variables. In the second stage, the repeated participants are divided into two groups (normal, and normal to mild kidney disease). The incidence rate for each target in the stratified groups is calculated, and possible risk and protective factors are inferred through differences in incidence rates and odds ratios. Results Prevalence analysis of the background revealed that the overall prevalence rate of gender is higher in males than females. In terms of age, the prevalence rate of all age groups is higher in individuals aged 65 and above compared to those under 65. The prevalence rate is higher in the population with high blood pressure compared to the normal population. Similarly, the prevalence rate is higher in the population with high blood sugar compared to the normal population. Regarding blood lipids, the prevalence rate is higher in the abnormal population compared to the normal population. The prevalence rate of metabolic syndrome is also higher in the population with the condition compared to the normal population. The prevalence rates are higher in populations engaging in harmful behaviors such as smoking, drinking alcohol, and betel nut consumption. The prevalence rate of indirect harmful behavior from secondhand smoking is higher than that of the general population. Among dietary habits, the prevalence rate of fiber intake is lower in vegetarians. The prevalence rate of beverage habits, such as coffee and tea, is slightly lower. Examining the direction of newly occurring chronic kidney disease, protective factors include vegetarianism and consumption of tea beverages, while risk factors include being male, high blood pressure, high BMI, increased waist circumference, smoking, betel nut consumption, and alcohol consumption. Exploring the subsequent progression rate of chronic kidney disease in affected individuals, the protective factor is the consumption of tea beverages, while the risk factors remain the same: being male, high blood pressure, high BMI, increased waist circumference, smoking, betel nut consumption, and alcohol consumption. This proves that the consumption of tea beverages has a protective effect, whether in the onset or progression of chronic kidney disease. However, when investigating the dose-response relationship, it is found that the higher frequency of tea consumption does not necessarily enhance the protective effect. On the other hand, it is observed that the harmful effects of alcohol increase with higher frequency of consumption. Conclusion and Recommendation This study proves that the occurrence and deterioration of kidney disease are affected by many factors, whether it is environment, disease, physiology, or even health behaviors, etc., there are significant differences. However, multiple limitations in the research may also affect the results, such as deviations from healthy workers, space-time background errors, limitations of disease statistics itself, and errors caused by statistical methods. In order to overcome the above limitations, we believe that more interference factors must be found in order to minimize the interference and make a definite conclusion. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/89505 |
DOI: | 10.6342/NTU202302407 |
Fulltext Rights: | 未授權 |
Appears in Collections: | 公共衛生碩士學位學程 |
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