| 摘要: | 目的：在2019年底全世界爆發新冠肺炎疫情，統計至2022年10月全世界已逾6億人感染新冠肺炎，感染者在急性期會有嚴重的呼吸道症候群且會發燒、疲勞、喉嚨痛及味覺或嗅覺喪失等症狀，其中一部份的患者會有長期新冠肺炎的症狀，推估可能會增加醫療資源的利用。因此本研究遂以次級資料庫來探討長期新冠肺炎患者的醫療資源利用及費用情形。
方法：本研究採世代研究法(Cohort Study)，使用「臺北醫學大學臨床研究資料庫」，擷取2021年12月01日至2022年04月30日間新冠肺炎核酸檢測陽性患者，並篩選確診後至2022年7月31日止於門診(含急診)及住院基本檔之就醫紀錄中ICD-10-CM長期新冠肺炎相關代碼，分為長期新冠肺炎患者與未有長期新冠肺炎患者兩組，控制變項為性別、年齡、身體質量指數及共病症，以探討長期新冠肺炎患者對醫療資源利用影響。
結果：本研究共納入研究對象1,709人，為長期新冠肺炎患者416人及未有長期新冠肺炎患者1,293人。研究結果顯示，有長期新冠肺炎患者在門診次數、急診次數及醫療總費用有顯著影響，另外急診次數為負相關，即門診次數及醫療總費用與未有長期新冠肺炎者較多，而急診次數較少。在長期新冠肺炎患者之人口學特性中，之性別於醫療資院利用及費用未有統計上的顯著影響；年齡方面對門診次數的影響不明顯，但75歲(含)以上者對急診次數、住院日數及醫療總費用有顯著的影響；身體質量指數上，過輕的患者有較多的急診次數；共病症方面，相較無共病症的參考組，有糖尿病(負相關))及心臟疾病的患者在門診次數上有顯著影響，有高血壓的患者在急診次數及住院日數有顯著影響，有慢性腎臟病的患者則在門診次數及醫療總費用有顯著影響。
結論：長期新冠肺炎患者年齡高、有高血壓及慢性腎臟病者有較多的醫療資源利用。根據我國國家發展委員會推估2025年將進入超高齡社會，如今新冠肺炎感染人數已近一半人口，未來可能會對醫療保健及公共衛生造成影響。而我國在長期新冠肺炎對醫療資源的影響相關研究甚少，期望本研究發現可提供給醫療管理者參考，為未來研擬因應方案。
Purpose: The COVID-19 pandemic broke out worldwide at the end of 2019, and as of October 2022, over 600 million people have been infected with COVID-19. During the acute phase of infection, patients experience severe respiratory symptoms, including fever, fatigue, sore throat, and loss of taste or smell. Some patients may experience long-term symptoms (Long-Covid 19), which may increase the utilization of medical resources. Therefore, this study aimed to investigate the utilization and costs of medical resources among patients with Long-Covid 19 using a secondary database.
Methods: This study employed a cohort study design and used the "Taipei Medical University Clinical Research Database" to extract data on COVID-19-positive patients between December 1, 2021, and April 30, 2022. Patients who were diagnosed with COVID-19 and had ICD-10-CM codes related to Long-Covid 19 in their medical records from outpatient (including ER) and hospitalization visits between the time of diagnosis and July 31, 2022, were selected, and divided into two groups: those with Long-Covid 19 and those without. The control variables included sex, age, body mass index (BMI), and comorbidities, to investigate the impact of long-term COVID-19 on the utilization of medical resources.
Results: A total of 1,709 subjects were included in this study, including 416 patients with Long-Covid 19 and 1,293 patients without. The results showed that patients with Long-Covid 19 had a significant impact on the number of outpatient visits, emergency room visits, and total medical costs. Additionally, emergency room visits were negatively correlated, meaning that patients without Long-Covid 19 had more outpatient visits and higher total medical costs, but fewer emergency room visits. Among the demographic characteristics of patients with Long-Covid 19, sex did not have a statistically significant impact on medical resource utilization and costs. Regarding age, those aged 75 or older had a significant impact on emergency room visits, hospitalization days, and total medical costs, but the impact on outpatient visits was not significant. Patients who were underweight had more emergency room visits. Regarding comorbidities, patients with diabetes and heart disease had a significant impact on outpatient visits (with a negative correlation for diabetes patients), while patients with hypertension had a significant impact on emergency room visits and hospitalization days. Patients with chronic kidney disease had a significant impact on outpatient visits and total medical costs.
Conclusion: Patients with Long-Covid 19 who are older, have hypertension, and have chronic kidney disease have higher utilization of medical resources. According to Taiwan's National Development Council, it is estimated that Taiwan will enter an ultra-aging society by 2025. With nearly half of the population infected with COVID-19, it may have an impact on healthcare and public health in the future. There is currently a lack of research on the impact of Long-Covid 19 on medical resources in Taiwan, and it is hoped that the findings of this study can provide reference for healthcare managers in developing response plans. |
