| 摘要: | 臺灣原住民占全台灣總人口的2.3%，根據原住民委員會統計，目前臺灣原住民人口數為54萬23人，過去臺灣原住民的健康問題容易被忽略，近年來，美國、澳洲等許多國家已開始注重少數原住民族健康議題。臺灣在1996年成立『行政院原住民族委員會』，開始推動與原住民相關的議題，雖然原住民健康狀況與過去相較之下，有進步的趨勢，但與一般族群相比仍存著差異，例如：平均餘命、疾病發生率和疾病死亡排名等。根據民國101年原委會最新健康統計報告指出，原住民社會平均餘命雖已逐漸上升，但與一般社會之平均餘命仍有差距，在過去，急性傳染疾病已排除於原住民十大死因之外，但現今的十大死因死亡率仍高於一般社會，而在原住民社會中以女性居多，且健康狀況較男性為佳，但與一般社會女性相比仍存有差距。
癌症為目前全世界重要之醫療議題，亦是我國女性十大死因之首，四癌篩檢的預防政策成為政府每年重要檢討項目，國家癌症登記報告顯示四癌除了子宮頸癌發生率逐年下降，其餘口腔癌、乳癌與大腸癌發生率則逐年上升，可見國人在四癌之預防仍有進步空間。 過去研究顯示山地鄉原住民篩檢行為狀況較不佳，最新原住民健康統計報告亦顯示女性原住民四癌之死亡率與非原住民有差距，推測原鄉與非原鄉女性四癌之發生率可能存有差異。過去文獻顯示原住民相較於非原住民，菸、酒、檳榔行為盛行率較高，而肝癌占原住民女性十大癌症死因第二名，且國家統計與過去針對山地原住民之文獻皆顯示原住民女性肝癌死亡率高於非原住民女性，因此本研究探討原鄉與非原鄉女性五種常見癌症(口腔癌、大腸癌、乳癌、子宮頸癌、肝癌)之差異關係。
本研究使用全民健保資料庫(LHID2000)，挑選符合研究條件的對象進行世代追蹤研究，其中排除男性與資料遺漏者，排除以上條件後的2004至2013年女性族群納入本研究當中，探討2004至2013年之原鄉與非原鄉女性乳癌、子宮頸癌、大腸癌和口腔癌之期盛行率、累積發生率與平均病程，並進一步探討山地原鄉與平地原鄉女性口腔癌發生之差異。肝癌同樣以世代追蹤研究法，追蹤時間為2004至2013年，探討原鄉與非原鄉女性發生肝癌之關係，再進一步探討山地原鄉與平地原鄉女性發生肝癌之關係。
本研究四癌結果顯示2004-2013年原鄉女性口腔癌之發生率與盛行率高於非原鄉女性並達統計顯著差異，而口腔癌平均病程原鄉女性亦低於非原鄉女性，而其他三癌(乳癌、子宮頸癌、大腸癌)之發生率，原鄉與非原鄉女性未達顯著差異，進一步探討山地原鄉、平地原鄉女性口腔癌之差異，結果顯示山地原鄉與平地原鄉女性口腔癌之盛行率與發生率未達顯著差異。在肝癌研究結果中，控制干擾因子後，原鄉相較於非原鄉女性有較高發生肝癌之風險(OR=1.80, 95% CI=1.33-2.46)，山地原鄉相較於平地原鄉女性發生肝癌之風險亦無統計顯著差別。
Aborigines accounts for 2.3% of the total population (n= 540,023) in Taiwan according to the Aboriginal Commission statistics. Health problem of Taiwan's Aborigines was easily overlooked in the past. Many countries including United States and Australia recently are concerning and focusing on the health issues of Aborigines more and more. Contrast with the past, we have begun to promote Aboriginal related health issues. There is a progressing trend of the Aboriginal health. However, compared with the general population, it still has a significant gap, for example: the difference of average life expectancy, incidence of disease and disease mortality ranking status. According to the Aboriginal Commission statistical report year 2012, it has showed that Aborigines community average life expectancy has been gradually increased but it still has had big difference comparing with general community. Acute infectious diseases have been excluded from the Aboriginal 10 leading mortality causes although it was before. However, the mortality rate of top ten leading causes among Aborigines community is still higher than the general community currently. Women’s health is better than men in Aboriginal society, but the difference between Aboriginal society women and general population women still is observed.
Cancer is currently an important medical issue worldwide. It is also the top one leading cause of death in women and men. Four-Cancer Screening Project (FCSP) has become an important annual government executing check and review with the project operation. However, the rate of oral cancer, breast cancer and colorectal cancer is still with rising trend year by year. Further improving strategies are needed. Furthermore, studies have shown that health screening behavior among indigenous mountain villages not being as popular as other areas. The latest statistics report also shows that there is an existing gap of four-screening cancer mortality between Aboriginal and non-Aboriginal females. Four-screening cancer morbidity gap between Aboriginal and non-Aboriginal females is an important issue to assess and be prevented. Research shows that Aboriginal population potential has higher probability of tobacco and betel consumption. Liver cancer has been accounted for the second leading cause of cancer mortality among Aboriginal women. Based on the national statistics, Aboriginal women with higher liver cancer mortality than non-Aboriginal women are found. The study is to investigate whether five important cancers, including colorectal cancer, breast cancer, cervical cancer, oral cancer and liver cancer, among women in Indigenous Townships are different with women in non- Indigenous Townships.
The study design was a retrospective cohort study. We used outpatient visits records of Longitudinal Health Insurance Database 2000 (LHID 2000) which included information on patient characteristics, such as age, sex, date of birth, date of visits and diagnoses for outpatient visit (using the International Classification of Disease, Nine Revision, Clinical Modification ICD-9-CM). Male information and missing was excluded from the analyses. We assessed the cancer incidence, prevalence and average disease duration for colorectal cancer, breast cancer, cervical cancer, oral cancer and liver cancer during 2004-2013. Further comparison of female cancer risk in Indigenous Townships (mountain village area and plains area) and non-Indigenous Townships was conducted through multi-variables regression to control potential risk factors.
The result shows that the Indigenous Townships women's oral cancer incidence and prevalence are both statistically significant higher than non-Indigenous Townships women. Furthermore, the average disease duration is lower among women in Indigenous Townships than women in non-Indigenous Townships. The significant difference was not found for other 3 FCSP cancers (colorectal cancer, breast cancer and cervical cancer). Further assessment of exploring the difference of oral cancer morbidity (incidence and prevalence) between mountain-area and plain-area Indigenous Townships shows no significant difference.
Liver cancer risk of females in Indigenous Townships is higher than non-Indigenous Townships females (OR = 1.80 95% CI = 1.33-2.46) after controlling potential risk factors. Further assessment of liver cancer risk between mountain-area and plain-area of Indigenous Townships points out that there is no significant difference. Further study is suggested. |
