空氣污染對於巴金森氏症患者之醫療利用及存活影響

目的：隨著全球人口老化的發展，許多老年疾病也越來越被重視，巴金森氏症便是其一，巴金森氏症屬於老年慢性神經退化性疾病，隨著病程發展醫療利用也會隨之增長，因此本研究欲比較 2008 年至 2015 年巴金森氏症個案於不同人口學、醫療及健康因素、空氣品質下，其醫療利用及存活因素之差別。 方法：本研究資料來源為衛生福利部衛生福利資料科學中心之健保資料庫兩百萬人抽樣檔及行政院環境保護署空氣品質監測網的資料，研究個案為2008年新確診個案，再加入個案追蹤期間暴露之各污染物年平均濃度。本研究使用SAS 9.4版本進行描述性及推論性分析，以複回歸探討影響巴金森氏症病患醫療利用之相關因素，再利用Cox對比涉險模式探討影響巴金森氏症病患存活之相關因素。 結果：本研究樣本共856人，其中以女性、低齡、投保金額28,000元以上區間、教育程度高中職以上等人口學特徵者死亡風險較低；而在醫療及健康因素方面，主要就醫機構層級為醫學中心者存活天數較多，共病程度越嚴重者，其醫療利用較多然而存活天數較低；最後在空氣品質部分，暴露於高濃度的PM10及PM2.5年平均濃度環境中者，其死亡風險顯著高於暴露低濃度者。 結論：本研究發現性別、年齡、投保金額、主要就醫層級、共病程度、中斷治療情形、PM10及PM2.5年平均濃度皆為影響巴金森氏症病患之存活因素；而在醫療利用部分，年齡、主要就醫層級、主要就醫科別及共病程度會影響到病患的醫療次數利用，婚姻狀況、主要就醫層級、共病程度則會影響醫療費用的不同。關鍵字：巴金森氏症、空氣品質、醫療利用、存活天數

Objectives: As the global population ages, many elderly diseases are becoming more and more important, Parkinson''s disease is one of them. Parkinson''s disease is a kind of chronic neurodegenerative diseasesin the elderly, therefore, while the disease going, the medical utilization will grow. This study is to figure out the differences in medical utilization and survival between different demographics, medical and health factors, and air quality in the cases of Parkinson''s disease from 2008 to 2015. Methods: The source of the study was the data of the 2 million sample of the Health and Welfare Data Science Center and the Air Quality Monitoring Network of the Environmental Protection Administration Executive Yuan, R.O.C. The cases were newly confirmed cases in 2008, and the study input the data of the Annual average concentration of each pollutant exposed in the tracking period. This study used SAS version 9.4 for descriptive analysis, inferential analysis, and Multiple regression analysis to explore the medical utilization of patients with Parkinson''s disease. And finally use Cox regression analysis to explore the factors affecting the survival of patients with Parkinson''s disease. Results: There are 856 samples in this study. Among them, the demographic characteristics of women, young age, insured amount of more than 28,000 TWD, and higher education level have lower risk of death. In terms of medical and health factors, the main medical institutions are medical centers’ patients have more survival days, and more serious comorbidity, the more medical utilization, but lower survival days. Finally in the air quality, exposure to high concentrations of PM10 and PM2.5 annual average concentration was significantly higher than those exposed to low concentrations. Conclusion: The study found that gender, age, insured amount, major medical level, comorbidity, PM10 average annual concentration and PM2.5 average annual concentration were all factors affecting survival in patients with Parkinson''s disease. In the medical use section, age, major medical level and comorbidity will affect the number of medical treatments; marital status, major medical level and comorbidity will affect the difference in medical expenses. Key Words: Parkinson''s disease, air quality, medical utilization, survival days