2013-08-012024-05-17https://scholars.lib.ntu.edu.tw/handle/123456789/692872摘要：糖尿病與癌症之相關性近來受到學界之矚目，吾人過去的研究發現有些癌症與糖尿病有關，有些則沒有關係。本三年期計畫擬利用全民健康保險給付之資料庫來比較臺灣地區之糖尿病病人與無糖尿病者之癌症盛行率及發生率，並探討其相關之危險因子(包括用藥及共病症等)與醫療花費。在第一年擬購買取得國衛院建立之 2000 年之 1,000,000人抽樣歸人檔及相關健保給付之資料庫後，將先分析糖尿病、癌症、及相關疾病之地理分布，並由橫斷式之資料探討糖尿病與癌症的關係，包括地域分布、職業、年齡、性別、是否有糖尿病、用藥及共病症等。於第二年時，吾人將分析糖尿病與癌症發生率的關係。首先將 2000 年以前曾經罹患癌症的病人予以排除，再將所有人分為有糖尿病與無糖尿病者，追蹤至2009年底，各自計算其癌症之發生率，並利用Cox proportional hazards model探討在調整了其他干擾因子後，糖尿病是否仍然與癌症之發生有關，並分析糖尿病用藥、其他用藥及共病症等與癌症發生率的關係。在第三年時，吾人將分析有與無糖尿病者在罹患癌症後之醫療花費、治療方式、住院日數及住院中之死亡率等之差別。本計畫之完成將有助於瞭解臺灣各地區之糖尿病與癌症之分布，釐清糖尿病與癌症的關係，各種危險因子的角色，以及對醫療支出的影響。<br> Abstract: According to our previous studies, diabetes mellitus is a risk factor for some cancers, but not all. To further clarify the relation between diabetes/anti-diabetic drugs and cancer risk, this 3-year research proposal is aimed at evaluating the prevalence and incidence of various cancers and their associated risk factors and medical expenses in the diabetic and non-diabetic subjects in Taiwan by using the reimbursement databases of the National Health Insurance (NHI). In the first year, after purchase of the NHI databases from a random sample of 1,000,000 insurants enrolled in the year 2000, we will examine the geographical distribution of diabetes, various cancers and associated comorbidities, and the association between diabetes/anti-diabetic drugs and various cancers based on cross-sectional prevalence data. All cancers and site-specific cancers involving different organs and systems will be analyzed. Descriptive analysis will be conducted for different geographical regions, occupations, age, sex, diabetes status, anti-diabetic drugs and comorbidities. For the second year, we will focus on the analyses of the relation between diabetes and incident cancers. Patients with a previous diagnosis of any cancer before the year 2000 will be excluded first, and those without cancer from the start of the year 2000 will be divided into 2 groups of diabetic and non-diabetic subjects. The subjects will be followed to the end of 2009 for any newly diagnosis of cancers during the follow-up period. The incidences of different cancers between diabetic and non-diabetic subjects will be calculated based on a person-years denominator. The risk factors will be assessed by Cox’s proportional hazards models. In the third year, we will analyze and compare the medical expenses for different cancers in patients with and without diabetes. Length of stay for hospitalization, therapeutic regimens and in-hospital mortality will also be evaluated. With the completion of this research proposal, we will be able to know the distribution of diabetes and cancers in different regions of Taiwan. We will also be able to clarify whether diabetes is significantly associated with a higher risk of various cancers based on prevalence and incidence data. The risk factors associated or interacted with diabetes on the development of cancer will also be clarified. In addition the impact of diabetes and cancer on medical expenses will be evaluated.糖尿病癌症流行病學全民健康保險醫療花費臺灣DiabetescancerepidemiologyNational Health Insurancemedical expenseTaiwan