探討城鄉差距在急性心肌梗塞病患於急診就醫存活情形之差異

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Title:	探討城鄉差距在急性心肌梗塞病患於急診就醫存活情形之差異 The Differences in Survival of ED Patients with Acute Myocardial Infarction between Urban and Rural Residents.
Authors:	陳俊烈;Chun-Lieh Chen
Contributors:	公共衛生學院醫務管理學研究所碩士班
Keywords:	急性心肌梗塞;城鄉差距;都市化程度;死亡率;Acute Myocardial Infarction (AMI);Difference between Urban and Rural Residents;Urbanization;Mortality rate
Date:	2010
Issue Date:	2010-09-29 12:05:39 (UTC+8)
Abstract:	背景與目的：2009年約有15萬人死於心臟疾病，且在國人十大死因中僅次於惡性腫瘤，其中急性心肌梗塞係為最嚴重之心臟疾病，因該急性疾病發生後，會送往醫療院所之急診進行治療，且發生急性心肌梗塞之病患若未能即時獲得妥善治療，猝死情形會相對較高。因此，本研究主要係為探討城鄉差距對發生急性心肌梗塞病患於急診就醫後存活情形之影響。研究方法：以1997年至2008年全民健保百萬人資料庫中於急診就醫之2701位急性心肌梗塞患者為本研究對象。本研究以都市化程度代表城鄉差距，並以羅吉斯迴歸分析，探討病患基本特性、地區特性、健康狀況（相關疾病史）、就醫狀況及醫療照護者（醫院、醫師）特性等因素，影響急性心肌梗塞患者於急診就醫後存活之情形。研究結果：2701位於急診就醫之急性心肌梗塞病患平均年齡為65.1歲，主要居住在都市化程度第1~2級之地區（54.6%），居住在第6~7級之病患為10.9%。跨醫療區就醫者約26.0%，而有13.4%的病患當次發生急性心肌梗塞後死亡。羅吉斯迴歸分析顯示，「病患年齡」、「重大傷病」、「腦血管疾病」、「腎臟病」、「曾於急診治療急性心肌梗塞」、「3天內住院」、「醫院屬性」、「醫療院所所在分局別」、「醫師年資」及「急診服務量」皆顯著影響急性心肌梗塞病患於急診就醫後之存活情形，而病患居住地之「都市化程度」及病患「性別」則未與急性心肌梗塞之急診病患存活情形有顯著之影響。結論：疾病史、醫療照護者特性為影響急性心肌梗塞病患於急診就醫後存活之重要因素，雖病患居住地之城鄉差距未顯著影響急性心肌梗塞病患於急診就醫後之存活，但病患就醫醫療院所所在地則顯著影響了急性心肌梗塞病患於急診就醫後之存活情形。 Background & Objective: In Taiwan, approximate 150 thousand people die of Coronary heart disease (CHD) in 2009. Coronary heart disease (CHD) became the second leading cause of death in Taiwan. The mortality rate of CHD was only lower than cancer disease. The patients who have AMI but do not receive adequate treatment in time have a higher ratio of sudden death. This study would like to analyze the differences in survival of emergency department(ED) patients with acute myocardial infarction (AMI) between urban and rural residents. Methods: National Health Insurance (NHI) medical claim data from the cohort of 1,000,000 samples representing 23 million insured people during 1997 to 2008 were used to analyze the survival of ED patients with AMI. This study adopts seven levels of classification for urbanization as the differences between urban and rural areas. The frequency and percentage were used to describe the distribution of the variables. Finally, this study performed logistic regression analysis to examine the factors which influence the survival of ED patients with AMI. Results: Among 2701 ED patients with AMI, the average age is 65.1. Areas located in the 1st-2nd levels of urbanization have 54.6% of patients and areas located in the 6th-7th levels have 10.9%. The mortality rate is 13.4%. The factors associated with the survival of ED patients with AMI included patients’ age, catastrophic illness, cerebrovascular disease, renal disease, AMI treated in ED before, 3-day admission, institution ownership, institutions’ geographic location of NHI, emergency service volume, and practice years of physician. However, the geographic location of urbanization and sex of patient are not significantly influential factors for the death of ED patients with AMI. Conclusion: Health status and characteristics of health providers are the important factors of survival of ED patients with AMI. However, there is no significant difference in survival of ED patients with AMI between urban and rural residents.
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