| 摘要: | 目的：利用國家衛生研究院建立的全民健康保險歸人檔的資料，分析資料中藥物濫用的逐年盛行及新個案特徵，進而探討其與精神疾病共病情形。並探討精神分裂症及情感性精神病之就醫情形與藥物、酒精使用之共病狀況。方法：我們利用國家衛生研究院建立的全民健康保險歸人檔1996-2003年的資料，分析有申報診斷藥物濫用或藥物依賴記錄的逐年盛行及新個案，進而以1：3的方式抽對照樣本，進行病例對照分析，比較兩者精神疾病的差異。之後，我們接著使用國家衛生研究院建立的全民健康保險歸人檔1997-2006年一百萬人的資料來分析精神分裂症及情感性精神病的逐年盛行及新個案，和其中與藥物及酒精濫用共病之情形。結果：在200,000人的世代檔中，合計有796人（男72.7％）在1996到2003年間接受藥物濫用的治療，其中37名為未成年患者，發生率由1997年的1.76/10,000增加到2003年的11.9/10,000，達6.8倍。相對應之盛行率為1.92/10,000和14.7/10,000。進一步的nested case-control分析顯示，藥物濫用的人有精神疾病的盛行率比非藥物濫用者高，尤其是情感性精神病（66.6/1000對19.3/1000）、藥物性精神病（40.2/1000對1.26/1000）、精神分裂症（33.9/1000對12.1/1000）和酒癮徵候群（30.2/1000對6.7/1000）等，這些主要精神疾病的勝算比為4.65（95%信賴區間3.53-6.13），藥物性精神病的勝算比則可達33.3（p<0.0001）。在健康保險歸人檔1997-2006年一百萬人的世代檔中， 精神分裂症及情感性疾患新發生的個案數比率有逐年下降的情況(精神分裂症在1997 年是9.97/10000至2006年是4.46/10000，情感性疾患在1997 年是40.11/10000至2006年是27.38)。而在酒精依賴、酒精濫用、藥物依賴及藥物濫用則是增加。結論：健康保險資料不僅顯示國人藥物濫用的成長快速，有精神疾病的危險較高，應予重視。
Purpose: This study investigated the trend of drug abuse care in a national representative sample, and estimated the risk for co-occurring mental disorders among abusers. We also investigated schizophrenia and affective disorders and their co-morbidity relationship with alcohol and drug use disorders. Method: Using a randomly selected cohort with 200,000 persons in 2000 from the insured in the National Health Insurance (NHI) program, the Department of Health, Taiwan, we assessed the annual prevalence and new claims rates for drug abuse treatment in 1996-2003, and conducted a nested case-control analysis to compare the psychiatric co-morbidity between users and nonusers (1:3). Then, we used another randomly selected sample with 1,000,000 persons from 2005. We assessed the prevalence of schizophrenia, affective disorder, alcohol dependence, alcohol abuse, drug dependence and drug abuse in 1997-2006. We also calculated the relative rate ratio to compare the drug and alcohol use disorders by age and year among the persons having schizophrenia or affective disorder and general population. Results: Among 796 persons with diagnosed drug use disorders in the 1996-2003 cohort (72.7% males), 37 persons were teens. There was a 6.8-fold increase of new medical claims for drug use disorders in six years, from 1.76/10,000 in 1997 to 11.9/10,000 in 2003. The corresponding prevalence had a 7.1-fold increase, from 1.92/10,000 to 14.7/10,000, respectively. The case-control analyses showed that abusers were more prevalent than nonusers in mental disorders, particularly for the affective psychosis (ICD 296) (66.6 per 1000 vs. 19.3 per 10000), drug related psychosis (ICD 292) (40.2 per 1000 vs. 1.26 per 1000), schizophrenia (33.9 per 1000 vs. 12.1 per 1000) and alcohol dependence syndrome (30.2 per 1000 vs. 6.7 per 1000). With an overall odds ratio of 4.65 (95% confidence interval (CI) 3.53-6.13) for having psychiatric diseases, the risk to have the drug-associated psychosis was 33.3 folds greater for substance users than for controls. The odds ratio increased to 85.8 if the neurotic disorders were excluded from the data analysis (p<0.0001). In the 1996-2006 cohorts, we found the incidence rates of schizophrenia and affective psychosis declined annually, while the incidence rates of substances dependent and substance abuse were increasing. There was a higher risk of substance use disorders among individuals with schizophrenia or affective disorder. Conclusions: There was a rapid increase in substance use disorders in the recent years in Taiwan. Higher prevalence rates of psychiatric co-morbidities among drug abusers and vise versa underscore the urgent need to target public health prevention. |
