應用全民健保資料庫探討流行病學之時序性關係--第一部: 精神疾病與物質關聯疾患之時序性關係、第二部: 及時使用克流感降低流感病患之醫療及死亡風險

CMUR > College of Public Health > Department of Public Health > Thesis & dissertation > Item 310903500/57805

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Title:	應用全民健保資料庫探討流行病學之時序性關係--第一部: 精神疾病與物質關聯疾患之時序性關係、第二部: 及時使用克流感降低流感病患之醫療及死亡風險 The Study of Temporal Relationship in Epidemiology using the National Health Insurance Research Database--Part 1: The Temporal Relationship between Selected Mental Disorders and Substance-Related Disorders: A Nationwide Population-Based Cohort Study、Part 2: Prompt Oseltamivir Therapy Reduces Medical Care and Mortality for Patients With Influenza Infection: An Asian Population Cohort Study
Authors:	邱慕霖;Mu-Lin Chiu
Contributors:	公共衛生學系博士班
Keywords:	健保資料庫;時序關係;物質關連疾患;精神疾病;克流感;National Health Insurance Research Data;Temporal Relationship;Substance-related Disorders;Mental Disorders;Oseltamivir
Date:	2016-07-27
Issue Date:	2017-03-22 10:10:24 (UTC+8)
Publisher:	中國醫藥大學
Abstract:	流行病學研究中，探討兩種疾病或兩種藥物治療之間的時序性關係，可以幫助臨床醫師或研究者瞭解哪種疾病先發生或後發生，及時或延遲藥物治療效果較佳。本研究利用全民健保資料庫探討流行病學的時序性關係，第一個研究主題為「精神疾病與物質關聯疾患之時序性關係：全民世代研究」，第二個研究主題為「及時使用克流感降低流感病患之醫療及死亡風險：亞洲族群世代研究」。第一個研究旨在探討精神疾病與物質關聯疾患的先後時序關係及其所帶來的風險，釐清哪一種疾病先發生、引發後續疾病的風險有多高，以及哪些是高風險族群。研究方法是回溯性世代研究。研究結果發現精神疾病會增加物質關聯疾患發生的風險，而且精神疾病患者後續發生物質關聯疾患平均只需短短兩年的時間。精神疾病患者中，具有人格違常(personality disorders)、男性、中年人、居住於低都市化地區，以及低收入者有更高的風險後續罹患物質關聯疾患。分層分析發現10-19歲青少年中，有精神疾病的人比沒有精神疾病的人後續發生物質關聯疾患的風險高了15倍。第二個研究旨在探討及時或延遲服用克流感對於流行性感冒病患後續的門診、急診、住院及死亡風險。研究方法是回溯性世代研究。研究結果發現及時服用克流感可有效降低流感病人50%再次門診、46%住院及29%之死亡風險。無論任何研究年份、任何年齡層或任何性別，及時服藥都較延遲服藥具有較佳的治療效果。因此克流感對於亞洲流感病人至今依然有效。 This study investigated the temporal relationship of epidemics by using the National Health Insurance Research Data (NHIRD). The first study is “The Temporal Relationship between Selected Mental Disorders and Substance-Related Disorders: A Nationwide Population-Based Cohort Study” and the second is “Prompt Oseltamivir Therapy Reduces Medical Care and Mortality for Patients With Influenza Infection: An Asian Population Cohort Study.” The first study was to examine whether patients with mental disorders (MDs) had a higher risk for developing the later onset of substance-related disorders (SRDs). Our findings determined that preceding MDs will lead to the subsequent onset of SRDs and the duration was about 2 years among people with MDs. Among people with prior MDs, those with personality disorders, males, middle age, low urbanization and low income had a higher risk for developing SRDs compared to their counterparts. Teenagers with MDs showed a 15-fold higher risk for developing SRDs compared to those without MDs. The second study was to evaluate the efficacy of oseltamivir therapy for patients diagnosed with influenza infection. We found that the in-time treatment was consistently superior to the lag-time treatment in the reduction of adverse events, including overall 50% reduction in repeat outpatient visits, 46% reduction in hospitalization, and 29% reduction in mortality. The superior effects of the in-time treatment appeared in each study year, each age group, males, and females.
Appears in Collections:	[Department of Public Health] Thesis & dissertation

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