| 摘要: | 背景介紹：
國人使用中醫的用途甚廣，除了一些慢性病的治療，中醫也同時扮演預防保健的角色，然後過去對於中醫診療習慣與整體健康的關係仍不明確，因此本研究嘗試以餘命以及死亡風險作為主要觀察結果，進而探討使用中醫診療習慣與健康之間的關係。
材料與方法：
本研究的樣本是來自國民健康訪問調查，包括2001、2005、2009、2013四個年度的問卷樣本。在中醫診療使用習慣的定義上，會進一步串聯全民健保門急診檔，計算研究個案受訪之前過去一年半內使用中醫門診服務佔所有健保門急診服務的比例，區分成有無使用中醫診療習慣兩組。並透過串聯全民健保資料與死亡登錄資料，觀察有無使用中醫診療習慣兩組的平均餘命、死亡風險、以及重大疾病的發生風險是否有差異，追蹤時間至2020年的12月31日。在統計方法的部分，描述性分析會使用t檢定以及卡方檢定去進行兩組基本人口學、生活型態、共病等因子是否存在差異。使用Integration of Survival and Quality of Life(ISQOL)進行餘命預測外推，並計算兩組的餘命之間是否存在差異。使用Cox proportional hazard regression model推估死亡和疾病發生風險。另外也會進行性別、年齡、共病上的分層分析。
結果：
研究樣本共計14,222人，包括中醫診療習慣組1,560人，非中醫診療習慣組12,662人。在存活餘命的部分，經過存活外推的估計後發現，中醫診療習慣組的平均餘命為18.08年；非中醫診療習慣組組的平均餘命為15.56年，兩組餘命差為2.53年。並且在性別、年齡分層的情況下，兩組依然存在顯著的餘命差。此外，相較於非中醫診療習慣組，中醫診療習慣組的死亡風險Hazard Ratio = 0.852(95%CI = 0.760－0.954)，具有統計上的顯著意義；將中醫診療習慣以劑量暴露進行分組的結果也表明，使用中醫診療服務傾向越高的族群其死亡風險越低；或者逐年更新研究族群每人的中醫門診佔比，代表每人每年的就醫傾向，也發現隨著中醫門診比例每提升10%，死亡風險為原來的0.955倍(95%CI = 0.948－0.962)，達統計上顯著意義。而觀察重大疾病的發生風險也可以看到，使用中醫門診比例的提升與心血管疾病、糖尿病、肝膽疾病、慢性腎臟病、失智症發生風險下降有關。
結論：
無論是從餘命或是死亡和重大疾病發生風險來看，本研究發現中醫診療習慣對健康而言存在顯著的保護作用，證明了中醫的就醫傾向對整體健康有一定的幫助，在部分常見慢性病或是癌症的治療上，多篇過去文獻也指出中醫藥的治療策略對改善疾病狀況、提高存活機率具正面效益。因此本研究結果支持未來醫療體系的發展或是醫療資源的利用上，除了西醫系統之外，亦可以考慮搭配中醫藥治療策略的輔助。透過中醫藥的幫助也許不僅能提升治療效益，也可能達到預防保健的效果。然而中醫的治療方式與用途多元且廣泛，未來還需進一步研究去探討不同種類的中醫藥介入方式對健康的影響。
Background:
Traditional Chinese Medicine(TCM) is widely utilized in Taiwan, not only for treating chronic diseases but also for preventive healthcare. However, the relationship between TCM treatment habits and health outcomes has been unclear. This study aims to investigate this association, focusing on life expectancy and mortality risk as the primary outcomes.
Materials and Methods:
A study cohort was assembled from the National Health Interview Surveys for the years 2001, 2005, 2009, and 2013. TCM utilization habits were defined by integrating National Health Insurance Research Database to calculate the proportion of respondents utilizing TCM outpatient services within the previous year and half of the baseline. Participants were categorized into TCM users and non-TCM users. We estimated the differences in average life expectancy, risk of mortality, and risk of critical illness occurrence between the two groups, with follow-up extending to December 31, 2020. Student's t-tests and chi-square tests were used to detect the difference of demographic, lifestyle, and comorbidity factors between groups. The Integration of Survival and Quality of Life(ISQOL) was used for survival function extrapolation, and we further compared the difference in life expectancy between groups. Cox proportional hazard regression models were used to explore the risk of mortality and disease occurrence. Stratified analyses were conducted based on sex, age, and comorbidities as well.
Results:
A total of 14,222 study population were recruited, including 1,560 TCM users and 12,662 non-TCM users. According to the results of survival extrapolation, the TCM user group exhibited an average life expectancy of 18.08 years, compared to 15.56 years in the non－TCM user group, resulting in a difference of 2.53 years. Notably, even when stratified by sex and age, the significant difference in life expectancy persisted between the two groups. Additionally, the TCM user group had a lower mortality risk(Hazard Ratio = 0.852, 95% CI = 0.760－0.954) compared to the non-TCM user group. Dose-response analysis suggested that higher TCM utilization was associated with lower mortality risk. Increasing the proportion of TCM outpatient visits by 10% corresponded to a 0.955 times lower risk of mortality(95% CI = 0.948－0.962) based on the results of the time dependent Cox proportional hazard model. The study also identified a correlation between TCM utilization and decreased risks of incident cardiovascular diseases, diabetes, liver and gallbladder diseases, chronic kidney disease, and dementia.
Conclusion:
Our study demonstrates a significant protective effect of TCM utilization on overall health, in terms of life expectancy and the risk of mortality and major disease occurrences. Our findings suggest that the inclination toward TCM care has a considerable beneficial impact on overall health, aligning with existing literature emphasizing positive benefits of TCM on disease progression and increased survival rates in the treatment of common chronic diseases and cancer. Therefore, the results of this study support the integration of complementary TCM treatment strategies in the future development of the healthcare system and the utilization of medical resources. The assistance of TCM may not only enhance treatment efficacy but also potentially contribute to preventive healthcare. However, given the diverse and extensive nature of TCM treatment strategies and applications, further research is needed to explore the impact of different types of TCM interventions on health. |
