九二一地震對健康影響之世代研究

Abstract

背景:地震不但會造成外傷及死亡，對災民生理健康、心理狀態、生活型態 與週遭環境均會造成不同程度的影響。然而災難公共衛生學上仍有三個重要 問題需待澄清：包括地震後心理上有疾病或創傷的居民其長期之健康影響； 地震後生活品質改變與生理值變化的關係；地震對母親在心理及生理方面影 響是否容易造成新生兒低出生體重。 目的：本研究主要目的在透過世代追蹤研究的方式來評估921 地震災區心理 受創居民之健康狀況及公務人員世代在生活品質與生理變化上之關係；並且 評估地震前後南投縣新生兒低出生體重之變化。 方法：我們以南投縣政府於2001 年社區複合式篩檢活動所收集的居民作為 921 地震後心理上有疾病或創傷的研究對象，透過該活動所收集的中國人健 康量表(Chinese Health Questionnaire, CHQ)和體檢結果，聯結健保檔就醫資 料，得到5,390 人以進行長期健康追蹤。其次，透過過去兩年研究建立的南 投縣公務員世代，連結「台灣簡明版世界衛生組織生活品質問卷」 （WHOQOL-BREF ）與社區複合式篩檢結果，共553 人來評估生活品質與 生理在地震後的關聯性。最後，以問卷調查新生兒低出生體重之相關危險因 子及家中地震受災情況，利用1,593 名於1998 年9 月至2004 年8 月間出生 之新生兒作為新生兒世代，透過1997 年到2003 年南投縣出生兒的登記資料 名來分析新生兒地震後低出生體重的趨勢。我們利用邏吉斯迴歸模式 (Logistic Regression Model)進行調整干擾因子後，評估生理與心理健康兩者 的相關性，比較生活品質與生理指標表現之間的關聯，以及新生兒低出生體 重和地震影響之關係。 結果：本研究結果顯示災區民眾罹患缺血性心臟病，心血管疾病，慢性呼吸道疾病，關節炎以及糖尿病與心理健康有關，而生活品質與生理指標兩者間 並沒有統計上的顯著相關。此外地震經歷與新生兒低出生體重沒有統計上的 顯著相關。

Backgrounds: Earthquakes not only caused traumas and deaths but also changed seismic victims’ physiological health, mental health, lifestyle and environment. However, three key disaster public heath issues remain to be clarified including the association between acute psychological effects and long-term physiological effects, the relationship between quality of life and psychological health, the effects of maternal psychological impact and child low-birth weight. Objective: This study evaluated the health effects of the 921 earthquake including psychological and physical health effects, quality of life and infant low-birth weight by following the cohorts of adults and children in the disaster areas. Method: We followed an adult cohort of 5,390 residents in Nantou County’s community-based integrated screening programs to study their psychological impacts on disease-screened outcomes by linking the data from National Health Insurance Research Database. The Chinese Health Questionnaire (CHQ) had been used to collect the 1999 Taiwan Earthquake’s impact on these residents’ psychological health in 2001. We also used the public employee cohort with 553 persons established between 2000 and 2003 to investigate the relationship between WHOQOL and physiological index of chronic diseases. We examined trends in the changes of low-birth weight for a birth cohort of 1,593 children born in Nantou County between 1998 and 2004. We used logistic regressive models to analyze collected data. Results: The results showed that the people suffering from ischemic heart disease, cerebrovascular disease, chronic respiratory tract disease, diabetes and arthropathy were associated with mental health. There was no significant different risk of people with abnormal reports of biochemical tests by changing WHOQOL-BREF scores, and no statistical significant between earthquake experience and low-birth weight after adjusting relative risk factors.