慢性疾病與女性乳癌篩檢的相關性探討―以臺灣非都會區單一區域醫院病人為例

Abstract

背景與目的： 女性乳房惡性腫瘤於近十幾年都是國內女性惡性腫瘤的榜首，因此國民健康署於2002年起就推動免費女性乳癌篩檢，可是多年來實際的使用率仍然不高，最高的僅僅是2019年的40.7%，並存在地區差異。因此能夠找出女性乳癌篩檢利用率相關的因素，尤其在非都會地區，將有助於後續政策與活動推行的方向。本研究以非都會區的單一區域醫院的女性病患為研究對象，探討其慢性病與乳癌症篩檢的相關性。 方法： 利用該區域醫院的2021年度健保申報資料來進行分析，篩選所有40至69歲女性病患之健保申報資料來進行分析，探討是否在接下來的三年內於該醫院接受過女性乳癌篩檢，當中排除僅僅看過門診一次，或是已具有惡性腫瘤診斷的患者，減少確定有相關惡性腫瘤而產生的篩檢需求所造成誤差，本研究從醫療服務利用行為模式(Behavioral Model of Health Services Utilization，Andersen Model)的理論出發，對於是否具有慢性疾病、共病因子、身心障礙、年齡族群、是否為多重慢病患者對乳癌篩檢的影響進行分析；所得到的結果再依照Andersen Model進行相關探討。 結果： 本研究樣本共有12960人。整體的篩檢率在最一開始未排除特定條件的資料中只有12.22%，篩檢率遠低於全國平均值，且三年間接受乳癌篩檢的民眾並未重覆，乳癌篩檢集中在中間年齡族群，小於44歲者可能因為篩檢資格，造成篩檢率不及其他組別的一半，但是在超過60歲的組別亦有明顯的下降趨勢；在慢性疾病的部分，除了高血脂病患有較高的篩檢率，而腦血管疾病的患者卻是有著相對較低的篩檢率；將慢性疾病、共病因子、年齡族群、身心障礙、慢病情況進行多變數分析後，反而發現「心律不整、心臟瓣膜性疾病、糖尿病伴隨併發症、肝臟疾病、消化性潰瘍、缺鐵性貧血、嚴重精神疾病、憂鬱症」等八項共病因子，對於乳癌篩檢的負向影響，可以了解到無論是慢性疾病、共病因子，若是造成患者日常生活、身體狀況、行動能力受影響後，都會明顯的減低乳癌篩檢的意願，而多重慢病有正向的影響。 結論： 慢性疾病可能影響女性接受乳癌症篩，若是慢性疾病不影響病患日常生活、身體狀況、行動能力等情況時，定期的門診就診，能明顯提升病患接受醫療服務、預防保健的意願，反之當慢性疾病或其他共病因子造成了行動不便、身體狀況不佳、其他醫療服務需求增加的時候，將降低病患對於乳癌篩檢的意願。

Background and Objectives: Breast cancer have been the most common female malignancies in the country for more than a decade. Therefore, the National Health Administration has been promoting free female breast cancer screening since 2002. However, the actual utilization rate has remained low over the years, with the highest being only 40.7% in 2019, and there are regional differences. Therefore, it is possible to identify factors related to the utilization rate of female breast cancer screening, especially in non-metropolitan areas, which will help in the direction of subsequent policy and promotion. This study took female patients from a single regional hospital in an urban area as the research subjects to explore the correlation between their chronic diseases and breast cancer screening. Methods: The 2021 health insurance declaration data of the regional hospital was used for analysis. The health insurance declaration data of all female patients aged 40 to 69 were screened for analysis to explore whether they had undergone female breast cancer screening in the hospital in the next three years. Patients who had only visited the outpatient clinic once or had a malignant tumor diagnosis were excluded to reduce the errors caused by the screening needs caused by the determination of related malignant tumors. This study started from the theory of the Behavioral Model of Health Services Utilization (Andersen Model) to analyze the impact of chronic diseases, comorbidities, physical and mental disabilities, age groups, and whether the patient had multiple chronic diseases on breast cancer screening; the results obtained were then discussed in accordance with the Andersen Model. Result: The first thing we found from the data is that the overall screening rate was only 12.22% in the data that did not exclude specific conditions at the beginning. The screening rate is far lower than the national average. In addition, the number of people who received breast cancer screening in the three years did not repeat. Breast cancer screening is concentrated in the middle age group. People under 44 years old may have screening qualifications, resulting in a screening rate of less than half of other groups, but there is also a clear downward trend in the group over 60 years old. In terms of chronic diseases, except for patients with hyperlipidemia who have a higher screening rate, patients with cerebrovascular diseases have a relatively low screening rate. After multivariate analysis of chronic diseases, comorbidities, age groups, physical and mental disabilities, and multiple chronic diseases, it was found that eight comorbidities, including "arrhythmia, valvular heart disease, complications of diabetes, liver disease, peptic ulcer, iron deficiency anemia, severe mental illness, and depression," had a negative impact on breast cancer screening. It can be seen that whether it is a chronic disease or a comorbidity, if it affects the patient's daily life, physical condition, and mobility, it will significantly reduce the willingness to undergo breast cancer screening, while multiple chronic diseases have a positive impact. Conclusions: Chronic diseases may affect women's acceptance of breast cancer screening. If the chronic disease does not affect the patient's daily life, physical condition, mobility, etc., regular outpatient visits can significantly increase the patient's willingness to receive medical services and preventive health care. On the contrary, when chronic diseases or other comorbid factors cause mobility problems, poor physical condition, and increased demand for other medical services, the patient's willingness for breast cancer screening will be reduced.