行政院衛生署疾病管制局年度科技研究計畫

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泳锁
7 years ago
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1 DOH93-DC

2 爲 1996~ t-test % %

3 ~4 OR 1.93~1.97 /

4 Abstract Diabetes (DM) and tuberculosis (TB) were the most common diseases and these two diseases often occurred together that was known TB in diabetes. This research would like to analyze the prevalence and relative risk of TB in diabetes and to investigate the relative factors that influence the medical demands for diabetes patients and TB patients with diabetes. This research used national health insurance dataset of diabetics that included all nationwide diabetes claim data from 1996 to 2002 to analyze the prevalence, occurrence, and the relative risk of diabetic patients to general population to suffer from tuberculosis. In addition, public health nurses used structured questionnaires to interview patients by phone in central Taiwan to investigate the treatment status and patients medical demand. There were total 616 valid questionnaires to be collected. Chi-square test was used to test the significant difference between diabetics and TB patients with diabetes in patents characteristics, treatment status and health behaviors. Two-sample t-test was used to compare the different medical demands between diabetics and TB patients with diabetes. Stepwise regression method was applied to analyze the significant factors that influence patients demands. The results showed that the prevalence of diabetes was increased from 3.19% in 1996 to 4.56% in The occurrence of diabetes was dropped down from per ten thousand population in 1997 to per ten thousand population in For TB in diabetes, the highest occurrence was per ten thousand persons in 1997, and it was increased from per ten thousand persons in 1998 to per ten thousand persons in The new diabetics were followed for one year to four years, and we found the relative risk of diabetics combined TB compared to general population was 1.93 to TB patients with diabetes and 3

5 TB had higher physical demands and social support demands than diabetics only. According to regression analysis, patients with higher demands had the following characteristics such as living in the institution, with DM complication, with chronic diseases, forgotten eating medicine, needed family s care, high economic burden and high life or work pressure. The relative risk for diabetics to suffer from TB was higher than general population. TB patients with DM had higher demands than DM patients. Finally, this research has some recommendations for health policy decision makers as follows: (1) TB patients with DM should be tracked regularly by CDC monitor system. (2) TB prevention policy should include the DM patients whose relatives have TB disease, and treat these DM patients as high risk population. (3) Government should reduce the financial burden for TB patients with DM. The recommendations for hospitals or physicians are the following: (1) Enhance the recognition of TB prevention knowledge for DM patents. (2) Increase the professional medical support for TB patients with diabetes. (3) Improve the communication between patients family and physicians to increase the supports from patients family. Key words: diabetes mellitus, tuberculosis, tuberculosis in diabetes mellitus, patient needs odds ratio 4

medicine, needed family s care, high economic burden and high life or work pressure. The relative risk for diabetics to suffer from TB was higher than general population.

6 倂倂

7 ~

8 ~ OR t-test

.. 44 4-5... 55 4-6... 57 4-7... 59 4-8... 61 4-9.

9 ( 2002) ( 2004) ( 2002) 8

10 ( 2002) 爲 (Mugusi et al, 1990) multiple regression 9

11 (mycobacterium tuberculosis) 90%( 1993; 1998) 2000 (Tubercle bacilli) (acid-fast bacilli) (aerosol droplet) 10

12 6-8 (caseous necrosis) ( ) 5-10% 5 (progressive primary TB) ( ) 爲 ( 1) 11

13 WHO, ( )( 2003) , ( 2001)

92 90 1299 5.81 83 2001 16.00 14.00 12.00 10.00 8.00 6.00 4.00 2.00 0.

15 40 5% 1% 爲 90 爲 0.53% 爲爲 ( 1) (Relative Risk) ( 1997) ( Punam Mangtani et al., 1995; N Bhatti et al., 1995) 14

16 爲産爲 80 1/3 AIDS 6. 15

17 (Palmer et al, 1957; Edwards et al, 1971 ; 1994) 倂爲倂 ( 1) 16

18 ( ) 1979 NDDG MRDA 18 American Diabetes Association, ADA Diabetes care

19 mg/dl 2 200/mg/dl casual 3 200mg/dl 2. impaired fasting glucose 110mg/dl 126mg/dl mg/dl 1979 (ADA) (WHO) IDDM NIDDM

20 (Type 1 diabetes) (Type 2 diabetes) Gestational Diabetes mellitus, GDM Type 1 diabetes cell 30 (Type 2 diabetes) % 1~2% 15 95% 19

mellitus, GDM 1998 2000 1999 Type 1 diabetes

21 97% Amos, McCarty et al., % Gestational Diabetes mellitus, GDM (GDM) 1-3%

22 ( 2-4) ( a 2002b 2002) % 9.2% (1.6%) (4.6~4.9%) (7.7%) (11.7%) AMOS % 逹 40 ( 2002)

23 (1997) % % % 11.8% 11.6%

24 , , , , , , , , , , , , ~ a 23

25 ( 2003) KG/M mg/dl 50mg/dl ( 4000 ) 8. 倂倂 ( 1)

26 爲 (Kim, Hong et al. 1995; Oluboyo, Erasmus, 1990; Banuai, 1969; Bloom, 1969) Root

27 (Root, 1934) Nichols % 5% (Nichols, 1957) 2.1%-4.1% ( 1997) % A ( 2) ( 3) 竈爲 26

28 2.1% Marais, 1980 Nichols 5% Nichols, 1957 Mugusi 4% Mugusi, % Weaver, % 65 (OR) PPD 4. 竈 27

29 INH PZA EMB PAS (Marais, 1980; Weaver, 1974) 28

30 ( )

31 (DRG) 30

32 (ICD A-Code A181) ICD A-Code A020-A

33 1,

34 1 (focus group) ( ) ( ) (content validity) Cronbach 19 Cronbach

35 ( ) ( ) ( ) ( ) ( 2 ) t-test (stepwise multiple regression) ( ) ( ) ( 34

36 / ) multicollinearity VIF 10 VIF 10 variable transformation Y i = + 1 X X X i Y i = = i = X i= i = 35

37 36

38 t-test , ~0.16% , ~0.12%

39 4-1 TOTAL ( ) N % N % N % 1997DM(355,115) DM(322,826) 1999DM(279,257) 2000DM(247,944) DM(243,631)

40 % % % , , ,

41 4-2 a b (A) (B) (C) (D) ,471, , , ,683, , ,115 5,245 15, ,870, , ,826 3,460 14, ,034, , ,257 3,305 13, ,216, , ,944 4,639 13, ,339, , ,631 4,568 14, ,453,080 1,023, ,041 4,747 16,758 b b c b (%) (E)=B/A b (F)=C/A c (G)=D/B a b. c b 40

42 2 OR 1996~ , , , , ,

43 4-3 OR DM DM TB DM TB TB TB (OR) DM TB DM (D*(C-F)) (A) (B) (C=A-B) (D) (E) (F=E-D) (F*(B-D)) ,683, ,115 21,328, ,169 14,169 13, ,496 27,665 26, ,478 13,910 41,575 40, ,999 14,486 56,061 54, ,502 16,758 72,819 70, ,870, ,826 21,548, ,496 13,496 13, ,910 27,406 26, ,044 14,486 41,892 40, ,390 16,758 58,650 57, ,034, ,257 21,754, ,910 13,910 13, ,486 28,396 27, ,056 16,758 45,154 44, ,216, ,944 21,968, ,486 14,486 14, ,758 31,244 30, ,339, ,631 22,096, ,758 16,758 16,

44 (OR) 43

45 one sample t-test , a 2 test b test n (%) n (%) p n (%) n (%) p (47.27) 113,676(46.42) 207(67.87) 715(68.55) 164(52.73) 131,222(53.58) 98(32.12) 328(31.45) t-test t-test mean(s.d) mean(s.d) p mean(s.d) mean(s.d) p c 62.57(11.05) 61.71(14.18) (10.50) 66.17(12.77) a b c

46 % 47.27% % % 38.59% 59.16% 88.42% / 57.23% 45.02% % 3.86% 14.79% 39.55% 3.54% % % 53.77% 38.36% 83.28% / 74.75% 66.89% 45

47 % 4.26% 9.18% 25.90% 6.56% % 68.17% 24.11% 39.23% 40.98% 11.58% 88.10% 64.96% 18.97% % 78.36% 14.10% 33.77% 45.63% 2.62% 46

48 88.20% 81.04% 23.28% % 38.69% 45.57% 51.80% 41.31% 44.26% 5.90% 60.66% 27.21% 12.13% 5.90% 66.67% 29.51% 29.51% 26.56% 25.90% 98.36% 93.44% 44.26% 47

49 % 86.82% 50.16% 47.27% 32.48% / 32.15% 10.29% % 75.41% 45.57% 25.25% 37.70% 60.00% / 36.39% 4.59% % 65.25% 48

50 55.74% 44.26% 93.44% 79.67% 20.33% % 43.41% 47.27% 64.95% 86.18% 55.31% 53.06% 86.82% 88.11% % 49

51 39.01% 43.61% 40.33% 80.00% 38.36% 34.10% 34.10% 95.74% 93.44% 94.10% 50

52 t-test 4-5 P< % 47.27% 37.30% 27.54% / 74.75% 57.23% 66.89% 45.02% % 38.69% 67.20% 56.72% 14.79% 9.18% 39.55% 51

53 25.90% 6.56% 3.54% 4-6 P< % 23.15% 78.36% 68.17% 24.11% 14.10% 11.58% 2.62% 4-8 / P< % 9.00% 47.27% 37.70% / 10.29% 4.59% % 52

54 15.41% 33.76% 22.62% 4-10 P< P<

55 4-12 / Adjust R / / 54

56 4-5 2 N=311 % N=305 % p < (BMI) a < / <0.001 / / / < / / / / / / b a.bmi=( / ) b. 55

57 4-5 2 N=311 % N=305 % p < ( 3 ) ( 6 ) ( 9 ) ( 12 ) 寛 < Fisher exact test 56

58 4-6 2 N=311 % N=305 % p < / a a. 57

59 4-6 2 N=311 % N=305 % p < b b. 58

60 4-7 TB N=305 % TB TB a a. 59

61 4-7 N=305 % b b. 60

62 4-8 2 N=311 % N=305 % p ( ) ( ) / a. 61

63 4-9 2 N=311 % N=305 % p a a a a

64 N=311 % N=305 % p < < < < < < Fisher exact test 63

65 N=311 % N=305 % p < < < < < < <

66 N=311 % N=305 % p < < a < < < < a..fisher exact test 65

67 4-11 t-test a t-test mean SD mean SD p-value < < < < < a < < a a <0.001 a a a. 66

68 4-12 p < < < < < < / < <0.001 R Adjust R F=18.60 P<0.001 entry=0.15 stay=

69 1996~ ~ % % ~ % 9.2% %

70 ~ ~

71 Relative Risk

72 % 47.27% / % 2 1 Punam Mangtani et al.,

73 Relative Risk Punam Mangtani et al., Relative Risk

74 / Maher et al,

75 Mellins, 1992 Boad & Torres,

76 / / 75

77 爲 (Kim, Hong et al. 1995; Oluboyo, Erasmus, 1990; Banuai, 1969; Bloom, 1969) % % ~4 OR 1.93~

78 / / / 77

79 1 2 78

80 ~4 OR 1.93~

81 2 3 80

82 81

83 Amos AF, McCarty DJ, Zimmet P. The rising global burden of diabetes and its complications: estimates and projections to the year Diabet Med. 1997; 14: Banyal AL: Diabetes and pulmonary tuberculosis. Am. Rev Tubercle 1931; 24: Bhatti N, Law MR, Morris JK, Halliday R, Moore-Gillon J. Increasing incidence of tuberculosis in England and Wales a study of the likely causes. British Medical Journal Bloom JD: Glucose intolerance in pulmonary tuberculosis. Am Rev Respir Dis 1969; 100: Boad JS, Torres MA. Social support services for tuberculosis clients. Felton National Tuberculosis Center Edwards LB, Acquaviva FA, Palmer CE. Height, weight, tuberculosis infection, and tuberculosis disease. Arch Environ Health : Global Tuberculosis control-surveillance, Planning, Fiancing.WHO report Hatteville L. Mahe C. Hill C. Prediction of the long-term survival in breast cancer patients according to the present oncological status. Statistics in Medicine 2002; 21: Henderson R. Jones M. Stare J. Accuracy of point predictions in survival analysis. Statistics in Medicine 2001; 20: Kim SJ, Hong YP, Lew WJ, Yang SC, Lee EG: Incidence of pulmonary tuberculosis among diabetics. Tubercle and Lung Disease 1995; 76: Maher D, Uplerkar M, Blanc L, Raviglione M. Treatment of tuberculosis. BMJ: British medical journal 2003; 327: Marais RM: Diabetes mellitus in Black and Coloured tuberculosis patients. S Afr Med J 1980; 29:

84 13. Mellins RB, Evans D, Zimmerman B, Clark NM. Patient compliance. Am Rev Respir Dis 1992; 146(6): Mugusl F, Swal ABM, Albertl KGMM, McLarty DG: Increased prevalence of diabetes mellitus in patients with pulmonary tuberculosis in Tanzania. Tubercle 1990; 71: Nichols GP: Diabetes among young tuberculosis patients. Am Rev Tubercle 1957; 76: Ohno-Machado L. Modeling medical prognosis: survival analysis techniques. Journal of Biomedical Informatics 2001; 34: Oluboyo PO, Erasmus RT: The significance of glucose intolerance in pulmonary tuberculosis. Tubercle 1990; 71: Palmer CD, Jablon S, Edward P. Tuberculosis morbidity of young men in relation to tuberculin sensitivity and body build. Am Rev Tuberc Root HF, The association of diabetes and tuberculosis. New Engl J Med. 1934; 210: Weaver RA, Unusual radiographic presentation of pulmonary tuberculosis in diabetic patients. Amer Rev Respir Dis 1974; 109: Wei JN, Sung FC, Lin CC, Lin RS, Chiang CC, Chuang LM. National Surveillance for Type 2 Diabetes Mellitus in Taiwanese Children. JAMA 2003; 290:

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Time Estimation of Occurrence of Diabetes-Related Cardiovascular Complications by Ching-Yuan Hu A thesis submitted in partial fulfillment of the requi

Time Estimation of Occurrence of Diabetes-Related Cardiovascular Complications by Ching-Yuan Hu Master of Science 2011 Institute of Chinese Medical Sciences University of Macau Time Estimation of Occurrence

行政院衛生署疾病管制局 年度科技研究計畫

行政院衛生署疾病管制局年度科技研究計畫