| 摘要: | 目標：癌症病人可能發生後續精神疾患，攸關長期健康問題與
生活品質，國內癌症病人的精神疾患相關研究相對較少。本研究擬以健
康保險資料探討癌症病人發生後續精神疾患的危險及相關因子。
方法：採世代追踨，資料來源為健保資料庫百萬人歸人檔，以2000
年至2008年初診斷癌症病人為對象，用1:4方式依年齡頻數隨機取樣非癌症個案為對照，排除之前已有精神疾患者為2001年世代，追踨精神疾患發生率至2008年底。統計採Cox proportional hazard regression，分析有與無癌症診斷者之精神疾患比較發生、估計危險。
結果：癌症與非癌症世代在精神疾患發生相比，前者之風險稍高，危害比（hazard ratio）為1.37倍( 95%可信限1.32-1.42)。男性與女性相比，前者之危害比為1.02倍(95%可信限1.00-1.06)，具臨界顯著性。年輕三組的發生風險都高於75歲組，且三組皆達顯著，而以35-54歲組的危害比最高為1.47倍(95%可信限1.40-1.55)。雇主與雇員相比，前者之危害比為1.05倍(95%可信限0.96-1.16)，但不顯著。由投保月薪分析，低於11,000元與低於23,000元二組，與薪資大於35,000元組相比，前二者皆達顯著，低於11,000元組的危害比最高為1.37倍(95%可信限1.27-1.48)。地區別發生之風險比，則是桃園新竹苗栗、雲林嘉義台南二組，比台北基隆參考組低，皆為0.92倍(95%可信限分別為0.88 -0.97 與0.88-0.96)。
結論：癌症世代在被診斷出癌症後比非癌症世代發生精神疾患之發生率與危險稍高，其中以男性、較年輕者或投保月薪低於11,000元者為較好發的族群。而低收入及退休人員和居住桃竹苗、雲嘉南地區者危害較低。
Objectives: Previous studies have reported that depression is more prevalent in cancer patients than in the general population. This study investigated whether cancer patients in Taiwan are at higher risk of mental disorders after diagnosis with cancer.
Methods and Materials: We used National Health Insurance claims data to identify 54472 newly diagnosed cancer cases from 2000 to 2008 and 229820 controls with no cancer diagnosis. Both groups were followed up until 2008 to measure the incidence of mental disorders.
Results: During the follow-up period, we identified 3315 persons (1.15 per 100 person-years) with the diagnosis of metal disorders in the cancer cohort and 14570 persons (0.75 per 100 person-years) with the diagnosis of the disorders in the controls. The Cox hazard proportional regression analysis showed that cancer patients had a hazard ratio (HR) of 1.37 (95% confidence interval (CI) =
1.32-1.42) to develop mental disorders. The results also showed that men were at higher risk than women (HR = 1.02, 95% CI 1.00-1.06), younger group of age were at higher risk than older groups (HR = 1.47, 95% CI 1.40-1.55). Employeers were at higher risk than employees (HR = 1.05, 95% CI 0.96-1.16). Individuals with the monthly income of NT11,000 and less were at higher risk than individuals with the highest monthly salary of NT35,000 or higher (HR = 1.37, 95% CI 1.27-1.48). People living in Taoyuan, Hsinchu, Miaoli and Yunlin, Jiayi, Nantou were at lower risk than those living in Taipei, Keelung (HR = 0.92, 95% CI 0.88-0.97~0.96). Among the metal disorders, cancer patients were prone to have higher incident affective psychoses ( 0.18 vs.0.08 per 100 person-years), acute reaction to stress ( 0.39 vs.0.22 per 100 person-years) and neurotic disorders ( 1.49vs.0.99 per 100 person-years). The corresponding hazard ratios associated with these 3 disorders were 2.18 (95% CI 1.90-2.51), 1,65 (95% CI 1.50-1.81) and 1.34 (95% CI 1.28-1.41), respectively.
Conclusion: Our study clearly suggests that male patients with cancer are at an elevated risk of developing mental disorders after the diagnosis. Low income populations and those aged 35-54 years were also at higher risk of these disorders. Prevention education is needed for cancer patients. |
