台灣1997~2007年慢性腎臟病盛行率和發生率趨勢及其危險因素之分析

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题名:	台灣1997~2007年慢性腎臟病盛行率和發生率趨勢及其危險因素之分析 The Annual Prevalence and Incidence, and Risk Factors of Chronic Kidney Disease in 1997-2007 in Taiwan
作者:	李宜苑;Yi-Yuan Lee
贡献者:	公共衛生學院環境醫學研究所碩士班
关键词:	慢性腎臟病;盛行率;發生率;危險因素;糖尿病;存活分析;Chronic kidney disease (CKD);Prevalence;Incidence;Risk factors;Diabetes;Survival analysis
日期:	2010
上传时间:	2010-09-29 12:03:17 (UTC+8)
摘要:	目的：本研究欲分析台灣慢性腎臟病1997~2007年的盛行率及1998~2007年發生率的長期趨勢變化，並檢驗與慢性腎臟病發生有關的危險因素。方法：本研究採用縱向的世代研究設計進行分析，而分析的世代資料來源為全民健康保險資料庫2005年承保的100萬人抽樣歸人檔，追蹤此100萬人的世代在研究期間自1997年1月1日至2007年12月31日止，共11年的慢性腎臟病的盛行率及10年的發生率，並藉此了解這段時間的趨勢變化，並以Cox proportional hazards model檢驗與慢性腎臟病發生有關的危險因素如年齡、性別等社會人口學特質和糖尿病、高血壓、血脂異常等疾病因素。結果：慢性腎臟病的盛行率隨著年代增加而增加(Rho=0.99，p<0.001)，從1997年的814人/每105人增加至2007年的1,447人/每105人，發生率隨著年代的增加有些微的降低(Rho=-0.90，p<0.001)，從1997年的634人/每105人年減少為2007年的436人/每105人年。男性的盛行率及發生率均較女性高，且不管盛行率還是發生率均隨年齡的增加而增加，地區差異上以南部區域的盛行率及發生率為最高。在影響慢性腎臟病發生的危險因素分析中，性別及年齡均為重要的影響因素，其中年齡愈大罹患慢性腎臟病的風險也愈高，而在調整年齡、性別等因素後，發現糖尿病、高血壓及血脂異常均會增加罹患慢性腎臟病的風險，其中有糖尿病者為沒有以上三者疾病者的3.78倍，而有糖尿病及高血壓者更增加到4.18倍，顯示糖尿病為一重要的危險因素。結論：本研究發現年齡愈大罹患慢性腎臟病的風險也愈高，另外也發現每年罹患慢性腎臟病的人有多達六成以上(63%~80%)在隔年並未有回診的紀錄，然而台灣的人口老化問題逐年在提高，且台灣人口的平均壽命也一直在增加，因此針對這些高年齡層及隔年未回診等高危險族群更應提早制定一個預防、篩檢及宣導的衛生教育計畫，以促進其預防疾病的行為。 Objectives: The aims of the present study were to analyze the chronological trends of the prevalence and incidence during 1997-2007 and to examine the risk factors for Chronic Kidney Disease. Methods: A longitudinal study design was conducted to observe a cohort of 1000,000 individuals, a nationally representative sample of health insurance population of Taiwan in 2005. Sample was randomly selected from the National Health Insurance reimbursement data in 2005 and their medical records were traced back to 1997 and followed up to 2007 with the merge of the annual data during this period. CKD was identified using the International Classification of Diseases, Ninth Revision, Clinical Modification Codes and A Codes. Survival analysis with Cox hazards regression models were applied to explore the morbidity rates and to examine the risk factors’ hazard ratios. The risk factors included age, gender, region, diabetes mellitus, hypertension, and dyslipidemia. Results: The one-year prevalent rates of CKD increased significantly with the increase in years, which were from 0.81% in 1997 to 1.45% in 2007 (Rho=0.99, p<0.001). Instead, the one-year incident rates significantly decreased from 0.63/100 person-years to 0.44/100 person-years (Rho=-0.99, p<0.001). Age, gender, diabetes mellitus, hypertension and dyslipidemia were found to be significant risk factors for the occurrence of CKD. In multivariate analyses, after controlling for age and gender, diabetes mellitus had greater hazard ratio of 3.78(95% CI=3.62-3.94) than others, hypertension of 1.94(95% CI=1.88-2.00 and dyslipidemia of 1.45 (95 % CI=1.38-1.52). Conclusions: Chronic kidney disease is prevalent in the elderly population but its negatively potential effect should not be neglected for middle age or even young adult people. The increase in the prevalence in the 11-year period suggested a need to put more public efforts on inhibiting the damage of kidney function for CKD patients and preventing the occurrence of the disease. However, the results also showed the importance of prevention programs on the chronic diseases of diabetes, hypertension and dyslipidemia.
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