糖尿病及其併發症、照護品質之盛行率、發生率於2000年-2007年間之趨勢研究

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Title:	糖尿病及其併發症、照護品質之盛行率、發生率於2000年-2007年間之趨勢研究 Trends in the Prevalence and Incidence of Type 2 Diabetes and Its Complications and Care Process in Taiwan - A Population-Based Study of Taiwan National Health Insurance Research Database 2000-2007
Authors:	蕭至宜;Chih-Yi Hsiao
Contributors:	公共衛生學院醫務管理學研究所碩士班
Keywords:	第二型糖尿病;併發症;照護品質;盛行率;發生率;type 2 diabetes;complications;quality of care;prevalence;incidence
Date:	2010
Issue Date:	2010-09-29 12:05:25 (UTC+8)
Abstract:	研究目的：探討台灣 2000年至2007年間糖尿病及其併發症的盛行率、發生率的時間趨勢；及利用時間趨勢分析評估1997年至2007年間各項檢查的糖尿病病人的受檢率。研究方法：利用健保資料庫之承保抽樣歸人檔定義糖尿病病人及糖尿病病人的急性、小血管及大血管併發症，以及檢查項目。並利用分層分析探討不同年齡、性別、納保金額和都市化程度下之盛行率及發生率；羅吉斯迴歸分析糖尿病及其併發症及受檢率之時間趨勢及其95%信賴區間。受檢率則進一步利用線性迴歸分析比較加入「論質計酬改善方案」實施前後受檢率的時間趨勢是否有顯著不同。結果：第二型糖尿病的粗盛行率由2000年的6.22% 上升至2007年的 11.03%，其每兩年盛行率的調整勝算上升14.6% [OR：1.146; 95% CI 1.142-1.149]。粗發生率則由2000年的9.46每千人年上升至2005的10.96每千人年，無顯著的時間趨勢。併發症其盛行每兩年間的調整勝算比除了腎衰竭減少了2%以外，其餘均呈上升的趨勢：高血糖上升了 30%，酮酸中毒上升15%，截肢上升24%，視網膜病上升20%，腎臟病上升6.6%，神經病上升6%，心肌梗塞上升52%，中風上升24%，慢性心臟病上升20 % 及周邊動脈疾病上升69%。實施「論質計酬改善方案」之後，第二型糖尿病病人的受檢率在蛋白尿肌酐酸比值、糖化血色素值、空腹血脂、血清麩胺酸丙酮酸轉胺基脢及微量白蛋白在2003- 2007間有顯著的上升趨勢。結論： 2000年到2007年，台灣的第二型糖尿病盛行率持續上升，其發生率則於2000年些微上升至2005年，而往後則上下波動直到2007年。糖尿病併發症的盛行率亦呈上升的趨勢，而發生率則呈反向趨勢。糖尿病「論質計酬改善方案」是為了提高糖尿病照護品質的給付政策，本研究亦發現在實施「論質計酬改善方案」之後，糖尿病病人的受檢率有上升的趨勢。 Aim The purpose of the this study is to determine the trends of prevalence and incidence of type 2 diabetes and its complications in Taiwan between 2000 and 2007, and to evaluate the trends of prevalence of laboratory tests of type 2 diabetes between 1997 and 2007. Methods Retrospective population-based study of 1,000,000 residents from Taiwan National Health Insurance Research Database (NHIRD) was used to identify patients with type 2 diabetes, those with diabetic complications and those with laboratory tests. Prevalence and incidence of type 2 diabetes were estimated according to various groups of age, gender, insurance premium and urbanization degree. Prevalence and incidence of complications in patients with type 2 diabetes were determined. Logistic regression model was used to estimate odds ratio and its 95% confidence interval (CI). Linear regression model was used to analyze whether the trends of prevalence of laboratory tests before (1997-2002) and after pay-for-performance (P4P) program (2003-2007) were different. Results The crude prevalence of type 2 diabetes increased from 6.22% to 11.03% between 2000 and 2007. In the population of age >=30 years, the multivariate-adjusted per 2 years increase in odds was 14.6% [OR: 1.146; 95% CI 1.142-1.149]. The crude incidence increased from 9.46 per 1000 in 2000 to 10.96 per 1000 in 2005 and then fluctuated until 2007. Prevalence rate of renal failure in type 2 diabetic patients was declining, with a 2% decrease in odds in 2007. Prevalence odds of hypoglycemia, ketoacidosis, diabetes retinopathy, renal disease, neuropathy, amputation, MI, stroke, CHD and peripheral artery disease in type 2 diabetic patients increased, with 30%, 15%, 24%, 20%, 6.6%, 6% , 52%, 24%, 20% and 69% increase in odds for every 2-year period in 2007, respectively. After implementation of P4P, the prevalence of laboratory tests of type 2 diabetes in 2003 - 2007 increased significantly in ACR, HbA1C, fasting lipid profile, SGPT and microalbumin. Conclusions The prevalence of type 2 diabetes increased in Taiwan between 2000 and 2007. The incidence increased slightly in 2000-2005 and then fluctuated until 2007. The prevalence rates of diabetes-related complications continued to increase, but the incidence rates of most complications were decreasing. The P4P program for diabetes care in Taiwan was designed to increase the quality of care. The prevalence rates of laboratory tests for the period of after implementation of the P4P program were rising faster than those for the period of before implementation of the P4P program.
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