The Health Related Studies in Disadvantaged People of Taiwan
Date Issued
2008
Date
2008
Author(s)
Lin, Ching-Feng
Abstract
From the viewpoint of sociology, the disadvantaged and minority of a society refers to a group of people, who are relatively weak sociologically and economically. In Taiwan, the disadvantaged group includes aboriginal people, lonely-living aged people and prison inmates, because they are weak sociologically and economically , which reflect that they always have inferior social status and poor health conditions. Generally speaking, the aboriginal people always have higher rate of cigarette smoking, alcohol drinking and betel quid chewing, but how to control and reduce the using rate, it is very hard in implementation. Besides chronic liver disease is one of the ten leading causes of death among the aboriginal people. The Department of Health, with the objectives to improve the health condition of the aboriginal people, and to screen and control of disease, pays special attention to the study on the control of cigarette smoking, alcohol drinking and betel quid chewing among the aboriginal people; Liver disease is one of the ten leading causes of death in Taiwan, besides hepatitis virus infection, cigarette smoking, alcohol drinking and betel quid chewing are the risk factors leading to chronic liver disease, according to related studies which showed that the prevalence of chronic liver disease among the aboriginal people is more serious than that among the non-aboriginal people. In order to understand the chronic liver disease and the abnormal function of liver among the aboriginal people, we joined Taoyuan Hospital of the Department of Health took charge of the IDS（Integrated Delivery System）program, which was supported by National Health Insurance, that project started from 2001 to 2002 and the study area was in the aboriginal communities of the Fu-shing Township of Taoyuan County , people over the age of 18 in the Fu-shing Township received the screenings of liver disease, the situation of betel quid chewing among the aboriginal people was also studied, to investigate the risk factors leading to chronic liver disease through epidemiological study, and the effect of betel quid on such disease, finally the result of the study would provide useful information to health organizations to form health policy for the aboriginal people. Our finding as follow: There were 2,063 Atayal Aboriginal and 947 non-Aboriginal in this study. The result showed overall prevalence rates for hepatitis B surface antigen (HBsAg) and hepatitis C virus (HCV) were 21.2 % and 2.9 %, respectively. There were 16.5 %, 15.1 % and 22.4 % subjects with abnormal alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma glutamyl transpeptidase (GGT), accordingly. Multiple logistic regression analysis showed that combined infections with HBV and HCV presented with the highest risks with OR of 4.2 and 3.8, respectively for elevation of ALT and AST; followed by alcohol (1.7 and 3.1), male gender (1.7 and 1.6), betel quid (1.5 and 1.3), smoking (1.4 and 1.8), and aboriginal (1.4 and 1.3). Among 1,382 subjects consenting to abdominal ultrasonography, 41(3.0%) were found to have liver cirrhosis with the same factors associated with higher risks. Therefore, our further study conducted such investigations as the prevalence of cigarette smoking, alcohol drinking and betel quid chewing, and their relative risk factors and quitting behavior. This study was initiated in July of 2002, it covered 30 aboriginal townships in the mountain and 18 plan aboriginal townships, this study conducted interviews and completed standard questionnaires. The experimental design was based on stratified sampling method and probability stratified sampling method, there were about 10,000 aboriginal people over 18 years old in 30 townships in the mountain and 18 townships on the plain were interviewed in this study ; the standard questionnaires included: unified definitions on the use of tobacco, alcohol and betel quid and the conditions of using them ; general demographical information; related understanding on health hazard, the attitude and behavior status towards abusing them. This study found out the quitting intention , quitting behavior or retarding factors which resulted in unsuccessful quitting , the experience of successful quitting , all of the information would provide useful information in the formation of quitting plan and implementation procedures , in order to help those people to quit the habit of chewing areca nut. Our finding as follow: The prevalence of betel quid chewers was 46.1%. Betel quid chewing was closely associated with obesity (OR=1.61; 95% CI: 1.40-1.85). Betel quid chewers were most likely to use alcohol and cigarettes together. Quit rate of betel quid chewers was 7.6%. Betel quid chewers who did not drink alcohol were more likely to quit (OR=1.89; 95% CI: 1.43-2.50). Alcohol use is a significant factor related to cessation of betel quid chewing, but smoking is not. Besides, prison inmates are the high risk group of hepatitis B, especially those narcotic addicts with past history of using the same syringe and tattoo, they are easily to get infected, therefore, we must find out the hazardous factor and relevant preventive measures. A total of 15,007 prisoners were surveyed. The response rate was 92.6 %. The result showed an overall prevalence rate for HBsAg was 21.7 %. 3333 subjects (22.2%) with a history of blood transfusion (BT), 3071 subjects (20.5%) with a history of intravenous drug abuse (IVDA), and 6908 tattooed prisoners (46.0%) showed positivity of HBsAg. IVDA appeared to be the strongest risk factor among the three with an adjusted odds ratio (aOR) of 1.54(95 % C.I. 1.27-1.86), which was followed by tattoo 1.40 (95 % C.I. 1.23-1.55) and blood transfusion 1.27(95 % C.I. 1.05-1.61). A combination of three factors significantly increased the aOR to 2.76(95 % C.I. 2.20-3.47), followed by BT and IVDA (aOR =1.72), BT and tattoo (aOR =1.69), and IVDA and tattoo (aOR=1.41). The overall prevalence rate for positive VDRL tests was 1.0 % and there was no significant association between its positivity and any one of the three major determinants of horizontal transmission.
Subjects
Disadvantaged people
Aboriginal
prisoner
betel quid
HBsAg carrier
SDGs
Type
thesis
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