賴美淑臺灣大學:預防醫學研究所周煦文Chou, Hsu-WenHsu-WenChou2010-06-022018-06-292010-06-022018-06-292008U0001-2507200800322200http://ntur.lib.ntu.edu.tw//handle/246246/184787糖尿病和結核病的研究，大多偏重於結核病患中合併糖尿病之分析，亦或是針對特定族群、以醫療院所為背景的研究，缺乏以糖尿病族群為研究對象之前瞻性世代追蹤研究。因此，本研究欲藉台灣的全民健康保險資料庫及疾病管制局之中央傳染病通報系統，藉二次資料庫分析，了解全國糖尿病合併結核病之發生危險比、死亡率，及其細菌學診斷通報分析。研究由行政院衛生署九十四年度委託之三年研究計劃，建立之2000年全民健康保險糖尿病世代中，抽選出之研究樣本154,347人為主要研究對象。追蹤年度就醫紀錄中有結核病相關診斷碼之病患，同時串聯疾病管制局之結核病通報系統、死亡檔，確認每年結核病新發個案並追蹤存活人數。使用存活分析(Survival analysis)方式進行分析，以Life table analysis、log-rank test檢定不同分層之存活曲線是否有差異，使用Cox Proportional Hazard Model計算不同影響因子危險比(Hazard Ratio)，分析相關因子包括性別、年齡、地理區域，並進一步以Time-Dependent Covariate方式校正Cox’s model之存活分析。糖尿病世代中，糖尿病病患罹患結核病的年發生率五年平均為每千人3.39，經年齡標準化後為每千人1.91，約為我國2006年全國結核病新案發生率每千人0.67的2.9倍，男性糖尿病患的結核病發生率約為女性的2.3倍，全國人口發生率的七倍。痰塗片陽性個案每年有34.6%~46.6%，五年整體發生率之地理分布由高至低則為高屏分局、東區分局、中區分局、南區分局、北區分局、台北分局。年死亡率自2001年至2005年分別為每千人158.90、189.66、182.24、180.85、222.22。糖尿病患合併結核病之相關因素部份，以多變項分析結果呈現，男性糖尿病患合併發生結核病的危險為女性的2.39倍， 65歲以上危險比最高(HR: 7.31, p=0.005)，高屏分局轄區內危險比為 (HR: 1.74, p<0.0001)，其次為東區分局(HR: 1.62, p<0.0001)。在控制性別、年齡、居住區域及交互作用的情況下，合併結核病對糖尿病患存活的危險為2.36倍(p <0.0001)。次級資料追蹤研究顯示，我國糖尿病患發生結核病的機率為一般族群的2.9倍之多，重要之相關因素為年齡、性別、居住區域等，研究結果對未來結核病之防治策略提供了重要的參考資料。Current literature about the diabetes and tuberculosis co-infection is limited to studies on diabetes among tuberculosis patients, or hospital-based studies on specific populations. Therefore, the objectives of this study are to estimate the incidence and mortality of a diabetes cohort with tuberculosis co-infection in Taiwan using the National Health Insurance database and the Central Communicable disease notification system of the Center of Disease Control(CDC), and to compare survival between diabetics with tuberculosis and those without, and define the high risk group in these co-morbid population.e followed the diabetes cohort sample (n=154347) for five years starting in 2001, traced diagnosis records of diabetes patients (ICD-9-CM code 010~018) from the National Health Insurance database with the tuberculosis records from the Central Communicable Disease notification system of CDC. We also followed diabetics with tuberculosis to track new tuberculosis cases per year and to confirm death status using the death registration system. Survival analysis using the life table method and the log-rank test was conducted to compare the survival curves, Cox Proportional Hazard Model for testing the hazard ratios among the potential risk factors, and included time-dependent covariate to adjust for the Cox’s model.ncidence of co-morbidity with tuberculosis in the five-year diabetes cohort is 3.39 per thousand persons on average, and 1.91 per thousand persons after adjusting for age, which is 2.9 times higher than the incidence of tuberculosis (0.67 per thousand persons) of the general Taiwan population. Tuberculosis incidence in male diabetics is approximately 2.3 times that of female diabetics, and 7 times higher than that of the Taiwan population. About 34.6%~46.6% of the diabetes cohort are tuberculosis smear positives every year between 2001 and 2005. Mortality rates for the diabetes cohort from 2001 to 2005 are 158.90, 189.66, 182.24, 180.85, and 222.22 per thousand persons per year, respectively. The hazard ratio for male diabetics co-morbidity with tuberculosis is 2.39 times that of female diabetics, and diabetes patients of age 65 and over have the highest risk of tuberculosis co-morbidity with diabetes (HR: 7.31, p=0.005). After controlling for age, gender, and living area, diabetics with tuberculosis have a higher risk of death compared to diabetics without tuberculosis co-infection (HR: 2.36, p<0.0001).sing secondary database, our research indicates that diabetes patients are almost 3 times more likely to be co-infected with tuberculosis, after adjusting for age, gender, and living area. The results of this study will provide the critical information needed to create strategy in tuberculosis control in the future.摘要 Ibstract III 錄 V目錄 VII目錄 IX一章 前言 1一節 研究背景 1二節 研究目的 2二章 文獻探討 3一節 台灣及國際糖尿病及結核病流行病學研究 3二節 結核病與糖尿病並存之相關研究 4三節 疾病管制局之中央傳染病追蹤管理系統 7四節 疾管局建立「中央傳染病追蹤管理系統」中結核病之相關研究 9五節 結核病細菌學診斷工具探討 17六節 糖尿病研究世代追蹤資料建立 18三章 研究材料與方法 20一節 次級資料庫來源及主要變項 20二節 研究變項定義 23一、糖尿病患定義 23二、結核病患研究對象選取之定義 24三、人口學變項 25四、細菌學診斷分析 26五、存活分析 26三節 研究方法與架構 27四節 統計方法 29四章 研究結果 30一節 結核病診斷在健保申報資料庫與疾管局結核病通報資料庫之相關性分析..……………………………………………………………………………...30一、「健保申報資料」與「結核病診斷與通報資料」之描述性分析 30二、結核病診斷在健保申報資料及疾管局通報資料之比較 30二節 糖尿病世代中結核病患之細菌學診斷分析 36三節 糖尿病世代追蹤合併結核病之發生率與死亡率 38四節 糖尿病患合併發生結核病之相關因素分析 47五節 糖尿病患有無合併結核病之存活分析 52五章 討論 60考文獻 63application/pdf714858 bytesapplication/pdfen-US糖尿病結核病世代研究存活分析台灣DiabetesTuberculosisCohort studySurvival analysisTaiwan[SDGs]SDG3thesishttp://ntur.lib.ntu.edu.tw/bitstream/246246/184787/1/ntu-97-R95846007-1.pdf