探討身體質量指數對台灣第二型糖尿病死亡率的影響：不同肥胖情境下的當前與未來趨勢

Abstract

背景：第二型糖尿病（Type 2 Diabetes Mellitus, T2DM）為全球主要的健康負擔之一，而高身體質量指數（Body Mass Index, BMI）為T2DM死亡率的重要危險因子。本研究旨在探討不同之未來過重及肥胖情境下，對台灣T2DM死亡率趨勢的影響及預測結果。

方法：本研究採用全球疾病負擔計畫（Global Burden of Disease, GBD）所開發之比較風險評估（Comparative Risk Assessment, CRA）方法，利用2001-2020年資料估算2021-2035年族群可歸因分率及不可歸因之糖尿病死亡負擔，進而推算未來BMI不同情境下所致T2DM死亡率。數據來源包括全國第二型糖尿病死亡統計資料、人口統計資料及國健署BMI盛行率調查。族群可歸因分率（Population Attributable Fractions, PAFs）根據BMI分布、相對風險估計值(Relative Risk)及理論最小風險暴露水平（Theoretical Minimum Risk Exposure Level, TMREL）計算。死亡率預測結合了四種未來過重及肥胖情境，並利用蒙地卡羅模擬（Monte Carlo simulation）進行不確定性分析(uncertainty analysis)與使用及三種基線非BMI歸因死亡率模型作為敏感性分析(sensitivity analysis)。

結果：資料顯示自2021年起糖尿病粗死亡率呈上升趨勢，然而年齡標準化後的T2DM死亡率持續下降，反映人口老化趨勢及實際死亡人數的重要性。根據2001至2020年歷史資料，T2DM每年死亡人數約介於一萬至一萬三千人之間；高BMI於該期間對T2DM死亡的可歸因分率約為男性26-30%，女性25-28%。在2021至2035年的累計死亡預測中，若能將全國過重及肥胖率降至32.7%，可避免約15,821例死亡；若降至43.3%，則可避免約8,787例；若穩定於50%，則約可避免4,130例死亡。年長者及男性死亡率較高，顯示政策應優先針對特定族群進行介入。

結論：積極且持續的過重及肥胖控制對降低台灣T2DM死亡率至關重要。但實質減少總死亡負擔，需同步推動針對肥胖及非肥胖相關因素的綜合公共衛生策略。本研究為政策制定者提供的科學數據，可供未來肥胖管理、糖尿病照護與公共衛生長期規劃參考。

Background: Type 2 diabetes mellitus (T2DM) is a major global health burden, with high body mass index (BMI) being a significant risk factor for T2DM mortality. This study aims to examine the impact of various future overweight and obesity scenarios on projected T2DM mortality trends in Taiwan.

Method: This study applied the Comparative Risk Assessment (CRA) methodology developed by the Global Burden of Disease (GBD) project. Using data from 2001 to 2020, we estimated population attributable fractions (PAF) and non-attributable diabetes mortality burdens for 2021–2035, and further projected T2DM mortality attributable to high BMI. Data sources included national T2DM mortality statistics, demographic data, and BMI prevalence surveys from the Health Promotion Administration. PAFs were calculated based on BMI distribution, relative risk estimates, and theoretical minimum risk exposure levels (TMREL). Mortality projections incorporated four overweight and obesity scenarios and three non-attributable death rate models, with sensitivity and uncertainty analyses conducted using Monte Carlo simulations.

Results: While crude T2DM mortality showed an increasing trend after 2021, age-standardized mortality continued to decline, reflecting the impact of population aging and underscoring the importance of absolute death counts. From 2001 to 2020, annual T2DM deaths ranged from 10,000 to 13,000. During this period, high BMI contributed to an estimated 26–30% of T2DM mortality in males and 25–28% in females. In cumulative mortality projections for 2021–2035, reducing the national overweight and obesity rate to 32.7% could prevent approximately 15,821 deaths; reducing it to 43.3% could prevent about 8,787 deaths; and stabilizing it at 50% could prevent around 4,130 deaths. Higher mortality rates were observed among older adults and males, indicating the need for targeted interventions for these populations.

Conclusion: Aggressive and sustained interventions to reduce overweight and obesity are essential for lowering future T2DM mortality in Taiwan. However, to substantially reduce the overall mortality burden, comprehensive public health strategies addressing both obesity-related and non-obesity-related factors are necessary. This study provides scientific evidence to inform policymakers in the planning of obesity management, diabetes care, and long-term public health strategies.