運用潛在類別分析探討台灣成人多重慢性病異質性：共病模式與健康生活品質

Abstract

研究背景與目的： 隨著人口高齡化與慢性病患增加，多重共病已成為公共衛生與醫療照護的重要議題。然而，台灣針對成人多重共病模式仍缺乏本土實證。本研究旨在應用潛在類別分析辨識台灣成人慢性病患者之多重共病潛在類別，並探討其在健康生活品質或社會經濟條件上的異質性。 研究方法： 用2017年國民健康訪問調查外釋資料，分析5,669位年齡≥20歲且至少罹患一種慢性病的成人。以14種自述經醫師診斷的慢性疾病作為指標變項進行潛在類別分析，運用貝葉斯資訊準則(BIC)、熵值及類別比例等指標決定最適類別數。採用EQ-5D-5L量表評估健康相關生活品質，並運用卡方檢定及邏輯迴歸分析探討各類別與人口學、社會經濟變項的關聯。健康效用值比較採用Kruskal-Wallis檢定與事後分析。 研究結果： 研究結果顯示台灣成人慢性病患者存在明顯的多重共病潛在類別，成功辨識出七種多重共病模式：心血管-代謝群、肝膽疾病群、氣喘群、高血脂群(16.5%)、高血壓群、糖尿病群及混合疾病群。各類別之間的健康相關生活品質（EQ-5D效用值及五種構面）也呈現顯著差異，某些疾病組合的健康效用明顯較低。此外，人口學與社經因素，例如年齡增加、女性性別、較低教育程度與收入，皆顯著提高屬於特定多重共病類別的風險。 結論： 本研究透過潛在類別分析成功辨識出七個台灣成人慢性病患者之多重共病模式，並確認其與健康生活品質的密切關聯。結果凸顯了針對特定多重共病族群進行精準醫療與整合性照護的重要性，建議未來醫療政策應更加重視不同共病模式之差異化管理策略，以提升患者整體生活品質。

Background and Objective: With population aging and increasing chronic diseases, multimorbidity has become a critical healthcare issue. However, local empirical evidence on multimorbidity patterns among Taiwanese adults remains lacking. This study aims to identify latent classes of multimorbidity among Taiwanese adults with chronic diseases and explore their heterogeneity in health-related quality of life and socioeconomic conditions. Methods: Using 2017 National Health Interview Survey data, we analyzed 5,669 adults aged ≥20 years with at least one chronic disease. Latent class analysis was performed using 14 self-reported physician-diagnosed chronic diseases. The optimal number of classes was determined using Bayesian Information Criterion, entropy, and class proportions. Health-related quality of life was assessed using EQ-5D-5L. Chi-square tests and logistic regression examined associations with demographic and socioeconomic variables. Results: Seven distinct multimorbidity patterns were identified: cardio-metabolic, liver disease, asthma, hyperlipidemia, hypertension, diabetes, and relatively healthy groups. Significant differences in health-related quality of life were observed between classes. Advanced age, lower education, and lower income significantly increased the risk of belonging to specific high-burden multimorbidity classes. Conclusion: This study identified seven distinct multimorbidity patterns among Taiwanese adults and confirmed their associations with health-related quality of life. The findings highlight the importance of differentiated management strategies for various multimorbidity patterns to improve patient outcomes.