身心障礙者中風相對死亡風險及影響因素之探討

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Title:	身心障礙者中風相對死亡風險及影響因素之探討 The Relative Risk of Ischemic Stroke in People with Disabilities and Associated Factors
Authors:	劉恒豪;Heng-Hao Liu
Contributors:	醫務管理學系碩士在職專班
Keywords:	身心障礙;梗塞性;中風;相對死亡風險;disabilities;ischemic;stroke;mortality
Date:	2013-07-22
Issue Date:	2013-10-16 14:47:43 (UTC+8)
Publisher:	中國醫藥大學
Abstract:	目的：身心障礙者平時較少運動或健康管理上較困難，故罹患心血管疾病機會可能較高，或者病發時可能較嚴重。當身心障礙者發生中風時，無法適時、正確地表達身體的不適，或想要就醫時其便利性比一般人低，需花費的時間和困難度比較高，以致中風死亡風險可能較高。方法：本研究為回溯性世代研究，資料來源為「全民健康保險學術研究資料庫」之2000年100萬人承保抽樣歸人檔（LHID2000）。本研究以2000年之承保資料，擷取1996-2000年未發生任何中風住院之身心障礙者，往後追蹤至2010年底期間有因梗塞性中風(ICD-9-CM前3碼為433至434)住院者為研究對象，觀察中風到出院7天內或中風365天內是否死亡；並與梗塞性中風一般民眾以性別、年齡作1：1配對，以羅吉斯迴歸分析，比較其相對死亡風險，並分析身心障礙者中風住院死亡之影響因素。結果：2000年計有2,084位梗塞性中風身心障礙者，身心障礙者中風到出院7天內相對死亡風險，為配對民眾的1.04倍(95% CI : 0.81~1.33)，中風365天內相對死亡風險，為配對民眾的1.07倍(95% CI : 0.90~1.26)，但均未達統計顯著意義。身心障礙者中風住院死亡之影響因素為年齡、有無其他重大傷病及是否手術。結論：台灣身心障礙者中風住院相對死亡風險，相較一般民眾還是有偏高的傾向，醫院對於高危險群身心障礙者住院照護需多加注意，以減少相對死亡風險。 Objective : Disabled patients exercise seldom or they face with difficulty in managing their health, so the risk of suffering from cardiovascular disease is higher, or when the disease breaks out, their condition will be more serious；There is less research investigating about stroke in disabled patients. When these patients deal with stroke, there are several situations that may cause delay in receiving medical treatment, which further contribute to the higher mortality rate due to stroke, including: unable to express their physical discomfort properly or at the right moment, inconvenience in seeking medical treatment comparing to others, time-consuming and higher level of difficulty. Method : This research was designed through retrospective cohort study. The origin of resource decided randomly from one million insurers in 2000 who was included in “data bank of academic research of National Health Insurance”. This research was based on data declared in 2000, including patients with disability, who did not suffer from stroke during warding between 1996-2000. They were followed until 2010 to search for patients with admission due to ischemic stroke (ICD-9: 433-434), who were enrolled in this study. They were followed whether died within the time form stroke to 7 days after discharge or within 365 days. These patients were matched 1:1 with general public according to sex、age, and analyzed through logistic regression analysis, to compare the difference of mortality risk. Besides, logistic regression analysis was also used to analyze factors related to the cause of death of disabled patients who were warded due to stroke. Result : 2084 disabled patients with ischemic stroke were enrolled in this study in 2000, and totally account 4168 after matched with general public with ischemic stroke. The odds ratio of death within 7 days after discharging from warding due to ischemic stroke for disabled people comparing to paired general public is 1.04 (95% CI : 0.89~1.33), without attaining remarkable discrepancy statistics；The odds ratio of death within 365 days after stroke for disabled people comparing to matched general pubic is 1.07 (95% CI : 0.90~1.26) without attaining remarkable discrepancy statistics. Death-associated factors are contributed mostly by the age、major medical disease and surgery. Conclusion : This research displayed that there is tendency of higher risk for disabled patients who were warded due to ischemic stroke in Taiwan in 2000. The care still needs to be paid more attention to decrease mortality especially on the high risk group (elder age、major medical disease).
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