| 摘要: | 本研究之研究目的為探討台灣慢性自發性蕁麻疹病人之相關合併症以及其醫療利用之情形。透過慢性自發性蕁麻疹疾病嚴重程度的分類，以期探討在不同疾病嚴重程度下，有無慢性自發性蕁麻疹與其相關合併症之情形以及在不同疾病嚴重程度下，有無慢性自發性蕁麻疹與其醫療利用之情形。
本研究以國家衛生研究院申請之「全民健康保險資料庫」特殊需求檔中，2010至2012年所有接受門診或住院且主或次診斷前四碼為708.1、708.8或708.9之病患進行資料之分析。並依照本研究對於疾病嚴重度之分類原則分為重度、中度及輕度，再各別對重度、中度及輕度病患，依照性別、年齡及投保區域都市化程度，採1：4 的比例隨機抽樣，分別取出無罹患慢性自發性蕁麻疹之研究對象。
本研究之慢性自發性蕁麻疹合併症包括風溼性相關疾病(rheumatic diseases)、甲狀腺相關疾病(thyroid disorders)、發炎性相關疾病(inflammatory diseases)與精神相關疾病(psychiatric disorders)；醫療利用情形包括醫療照護次數和醫療照護成本，醫療照護次數包括門診次數、急診次數、住院次數；醫療照護成本包括門診費用、急診費用、住院費用、檢查費用、藥品費用以及總醫療費用。統計方法則分為描述性統計與推論性統計，其中推論性統計係使用Two-Part Model進行醫療利用分析，第一階段使用廣義估計方程式之二項式分佈(Binomial distribution)，以分析研究對象有無使用醫療服務之機率。第二階段則是使用廣義估計方程式之負二項分佈(Negative binomial distribution)及伽瑪分佈(Gamma distribution)，分別對於各項醫療利用進行分析。本研究使用工具則以SAS 9.3統計軟體為主，EXCEL套裝軟體為輔助整理工具。
本研究結果顯示，在相關合併症方面，有慢性自發性蕁麻疹之病人患有風濕性相關疾病、甲狀腺相關疾病、發炎性相關疾病和精神相關疾病的比率相對於沒有慢性自發性蕁麻疹之症狀的人較高。有慢性自發性蕁麻疹之病人在門診次數、急診次數、住院次數、門診費用、急診費用、住院費用、檢查費用、藥品費用以及總醫療費用相較於沒有慢性自發性蕁麻疹之症狀的人較高，在總醫療費用方面，重度、中度與輕度病患因慢性自發性蕁麻疹而增加之就醫費用分別為22,659.6元、10,295.0元及5,902.3元；在次數方面則是以門診次數差異最大，重度、中度與輕度病患因慢性自發性蕁麻疹而增加之門診就醫次數分別為15.1次、16.2次及13.5次。
This study aims to examine the comorbidity and health care utilization of chronic spontaneous urticaria (CSU) patients by level of disease severity in National Health Insurance (NHI) program of Taiwan.
The prevalent cases of CSU in 2011 were identified from the National Health Insurance Research Database (NHIRD). Cases were further classified into 3 levels of disease severity groups according to their types of medication treatment. After excluding subjects who were prevalent cases of CSU in the 2005 sample cohort files, a comparison cohort was established by matching the CSU cases at a 4: 1 (controls: cases) ratio on the basis of age, gender, and urbanization level of residential areas.
Four groups of comorbidities were analyzed, including rheumatic diseases,thyroid disorders, inflammatory diseases and psychiatric disorders. Two aspects of medical utilization were analyzed -- the frequency of care and associated resource costs. Frequency and service costs were further broken down by types of medical services, including outpatient care visits, emergency room (ER) visits, inpatient services, medical tests and drugs. Incremental medical utilization or costs between cases and comparisons were assumed to be attributed to CSU. Medical utilization and costs were predicted using a two-part model: a logistic regression to predict the probability of service use, and a generalized linear model to predict the frequency of care and costs among those with positive visits/admissions. Controlled variables entering in the models to predict utilization included age, gender, and urbanization level of residential areas.
The study group had significantly risk for rheumatic diseases,thyroid disorders, inflammatory diseases and psychiatric disorders than the control group.The study group had significantly more outpatient care visits, outpatient medical expenditures, emergency room (ER) visits, emergency room (ER) medical expenditures, inpatient services, inpatient medical expenditures, medical tests, drugs and total medical expenditures than the control group. The annual total costs attributed to mild CSU, moderate CSU and severe CSU were NT$5,902, NT$10,295 and NT$22,659, respectively. On the other hand, mild CSU, moderate CSU and severe CSU consumed 13.5, 16.2 and 15.1 more outpatient visits than their respective comparisons. |
