DOH93-DC-1013-93 1 1 93 12 31
爲 1996~2002 311 305 t-test 1996 3.19% 2002 4.56% 1997 163.77 2002 101.12 1997 69.55 1998 2002 1
39.71 46.38 1~4 OR 1.93~1.97 / 1 2 3 1 2 3 2
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 2002. The occurrence of diabetes was dropped down from 163.77 per ten thousand population in 1997 to 101.12 per ten thousand population in 2002. For TB in diabetes, the highest occurrence was 69.55 per ten thousand persons in 1997, and it was increased from 39.71 per ten thousand persons in 1998 to 46.38 per ten thousand persons in 2002. 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 1.97. TB patients with diabetes and 3
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
... 8... 8... 9... 10... 10... 14 倂... 16... 17... 20... 24 倂... 24... 25... 29... 30... 31... 31... 33... 36 5
... 37... 37... 44... 45... 51... 54... 68 1996~2002... 68... 70... 71... 74... 76... 76... 78... 81... 82... 85... 89 6
2-1... 13 2-2 1997... 19 2-3 92... 23 2-4 1996~2000... 23 4-1... 38 4-2... 40 4-3 OR... 42 4-3-1... 43 4-4... 44 4-5... 55 4-6... 57 4-7... 59 4-8... 61 4-9... 62 4-10... 63 4-11 t-test... 66 4-12... 67 2-1... 13 2-2... 22 7
( 2002) ( 2004) 40.79 ( 2002) 8
( 2002) 爲 (Mugusi et al, 1990) 1. 2. 3. 4. 5. 6. multiple regression 9
(mycobacterium tuberculosis) 90%( 1993; 1998) 2000 (Tubercle bacilli) (acid-fast bacilli) (aerosol droplet) 10
6-8 (caseous necrosis) ( 2002 1997) 5-10% 5 (progressive primary TB) ( 2002 1997) 爲 ( 1) 11
800 1000 200 300 90 2003 WHO, 2003 74 75 10 ( 2-1 2-1)( 2003) 90 12 1,299 5.81 ( 2001) 1999 12
2-1 70 2586 14.39 71 2378 13.00 72 2257 12.14 73 2113 11.20 74 2051 10.72 75 1854 9.58 76 1836 9.38 77 1894 9.57 78 1900 9.50 79 1939 9.58 80 1847 9.03 85 1699 7.92 90 1299 5.81 83 2001 16.00 14.00 12.00 10.00 8.00 6.00 4.00 2.00 0.00 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2-1 2001 13
40 5% 1% 爲 90 爲 0.53% 爲 爲 6 7 600 50 150 24 2 ( 1) (Relative Risk) 4.16 70( 1997) ( 1 2003 Punam Mangtani et al., 1995; N Bhatti et al., 1995) 14
1. 2. 20 爲 70 3. 20 産 4. 5. 爲 80 1/3 AIDS 6. 15
7. 8. 9. (Palmer et al, 1957; Edwards et al, 1971 ; 1994) 倂 爲 倂 ( 1) 16
( 2002 1989 2002) 1979 NDDG 1985 1979 MRDA 18 American Diabetes Association, ADA 1995 1997 7 Diabetes care 1998 17
1997 7 1998 1. 1 8 126mg/dl 2 200/mg/dl casual 3 200mg/dl 2. impaired fasting glucose 110mg/dl 126mg/dl 3. 110mg/dl 1979 (ADA) (WHO) 1985 1997 IDDM NIDDM 2-2 1998 2000 1999 18
2-2 1997 (Type 1 diabetes) (Type 2 diabetes) 1 2 3 4 5 6 7 8 Gestational Diabetes mellitus, GDM 1998 2000 1999 Type 1 diabetes cell 30 (Type 2 diabetes) 40 20-30% 1~2% 15 95% 19
97% 40 1998 Amos, McCarty et al., 1997 2% Gestational Diabetes mellitus, GDM (GDM) 1-3% 2-3 2-2 20
( 2-4) ( 2004 2002a 2002b 2002) 1985 1996 4.9% 9.2% (1.6%) (4.6~4.9%) (7.7%) (11.7%) AMOS 2010 50% 1997 1 2001 1 逹 40 ( 2002) 1984-1989 1.5 1151 140 173 21 21
(1997) 1970 40 5.1% 1978 40 7.4% 1987-1988 30 11.3% 11.8% 11.6% 45.00 40.00 35.00 30.00 25.00 20.00 15.00 10.00 5.00 0.00 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2-2 2004 22
2-3 92 1 35,201 156.01 27.10 2 12,404 54.98 9.55 3 11,785 52.23 9.07 4 10,013 44.38 7.71 5 8,191 36.30 6.31 6 5,185 22.98 3.99 7 5,099 22.60 3.93 8 4,306 19.08 3.32 9 3,195 14.16 2.46 10 1,844 8.17 1.42 11 1,461 6.48 1.12 12 1,309 5.80 1.01 13 801 3.55 0.62 14 772 3.42 0.59 15 539 2.39 0.42 2004 2-4 1996~2000 1996 1997 1998 1999 2000 297076 344338 382257 404475 411408 360303 417641 462990 782358 481521 657379 761979 845247 886833 892929 58927 64771 70727 76287 80387 62383 67063 73549 78787 81487 121310 121834 144276 155074 161824 2002a 23
( 2003) 1. 45 2. 3. 24KG/M2 90 80 4. 140 90 5. 35mg/dl 50mg/dl 6. 7. ( 4000 ) 8. 倂 倂 ( 1) 1. 2. 3. 24
4. 5. 6. 7. 8. 9. 爲 (Kim, Hong et al. 1995; Oluboyo, Erasmus, 1990; Banuai, 1969; Bloom, 1969) Root 1934 25
(Root, 1934) Nichols 1957 178 22% 5% (Nichols, 1957) 2.1%-4.1% ( 1997) 3-5 10-15% A ( 2) ( 3) 竈 爲 26
2.1% Marais, 1980 Nichols 5% Nichols, 1957 Mugusi 4% Mugusi, 1990 11.0% Weaver, 1974 1993-1996 16.90% 65 (OR) 4.2 2000 1. 2. 3. PPD 4. 竈 27
1. 2. 3. 4. INH PZA EMB PAS 5. 6. (Marais, 1980; Weaver, 1974) 28
( 2001 2001 2000 2000) 1. 2. 3. 4. 29
90 10 11 (DRG) 30
1 1996-2002 7 (ICD-9 250 A-Code A181) ICD-9 010-018 A-Code A020-A029 600 320 311 2001 2002 31
1,043 337 305 616 2 2004 9 24 3 32
1 (focus group) ( ) ( ) (content validity) 10 10 Cronbach 19 Cronbach 0.80 33
2 1996-2002 7 ( ) ( ) ( ) ( ) ( 2 ) t-test (stepwise multiple regression) ( ) ( ) ( 34
/ ) 19 19 76 multicollinearity VIF 10 VIF 10 variable transformation Y i = + 1 X 1 + 2 X 2 + 3 X 3 +..+ i Y i = = i = X i= i = 35
36
t-test 1996 2002 4-1 1997 355,115 467 443 24 0.13~0.16% 1998 322,826 1999 317 0.10~0.12% 1999 2001 4-1 37
4-1 TOTAL ( ) N % N % N % 1997DM(355,115) 1998 443 0.12 24 0.01 467 0.13 1999 414 0.12 32 0.01 446 0.13 2000 517 0.15 48 0.01 565 0.16 2001 451 0.13 70 0.02 521 0.15 2002 448 0.13 55 0.02 503 0.14 1998DM(322,826) 1999DM(279,257) 2000DM(247,944) 1999 292 0.09 25 0.01 317 0.10 2000 345 0.11 38 0.01 383 0.12 2001 301 0.09 43 0.01 344 0.11 2002 311 0.10 35 0.01 346 0.11 2000 338 0.12 49 0.02 387 0.14 2001 299 0.11 37 0.01 336 0.12 2002 297 0.11 36 0.01 333 0.12 2001 303 0.12 51 0.02 354 0.14 2002 312 0.13 38 0.02 350 0.14 2001DM(243,631) 2002 278 0.11 36 0.01 314 0.13 38
4-2 1996 3.19% 1999 4.15% 2002 4.56% 1996 163.77 1999 126.74 2002 101.12 101 1999 6.13 2002 7.46 1997 5,245 2000 4,639 2002 4,747 1997 69.55 1998 39.71 2002 46.38 46 4-2 39
4-2 a b (A) (B) (C) (D) 1996 21,471,448 684,061 - - 11,591 1997 21,683,316 780,037 355,115 5,245 15,386 1998 21,870,876 871,419 322,826 3,460 14,169 1999 22,034,096 913,423 279,257 3,305 13,496 2000 22,216,107 919,477 247,944 4,639 13,910 2001 22,339,759 977,972 243,631 4,568 14,486 2002 22,453,080 1,023,401 227,041 4,747 16,758 b b c b (%) (E)=B/A b (F)=C/A c (G)=D/B 1996 3.19-5.41-1997 3.60 163.77 7.11 69.55 1998 3.98 147.61 6.49 39.71 1999 4.15 126.74 6.13 36.18 2000 4.14 111.61 6.27 50.45 2001 4.38 109.06 6.48 46.71 2002 4.56 101.12 7.46 46.38 a. 2003 b. c. 2003 b 40
2 OR 1996~2002 4-3 1997 355,115 1998 2.05 2002 2.15 1998 322,826 1999 1.61 2002 1.62 1999 279,257 2002 1.87 2000 247,944 2 2002 2.05 2001 243,631 1.73 1.97 1.97 1.93 4-3-1 41
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)) 1997 21,683,316 355,115 21,328,201 1998 1999 467 467 14,169 14,169 13,702 2.05 446 913 13,496 27,665 26,752 2.05 2000 565 1,478 13,910 41,575 40,097 2.22 2001 521 1,999 14,486 56,061 54,062 2.23 2002 503 2,502 16,758 72,819 70,317 2.15 1998 21,870,876 322,826 21,548,050 1999 2000 317 317 13,496 13,496 13,179 1.61 383 700 13,910 27,406 26,706 1.75 2001 344 1,044 14,486 41,892 40,848 1.71 2002 346 1,390 16,758 58,650 57,260 1.62 1999 22,034,096 279,257 21,754,839 2000 387 387 13,910 13,910 13,523 2.23 2001 336 723 14,486 28,396 27,673 2.04 2002 333 1,056 16,758 45,154 44,098 1.87 2000 22,216,107 247,944 21,968,163 2001 354 354 14,486 14,486 14,132 2.22 2002 350 704 16,758 31,244 30,540 2.05 2001 22,339,759 243,631 22,096,128 2002 314 314 16,758 16,758 16,444 1.73 42
4-3-1 1997 1998 2.05 1998 1999 1.61 1999 2000 2.23 2000 2001 2.22 2001 2002 1.73 1.97 1997 1999 2.05 1998 2000 1.75 1999 2001 2.04 2000 2002 2.05 1.97 1997 2000 2.22 1998 2001 1.71 1999 2002 1.87 1.93 1997 2001 2.23 1998 2002 1.62 1.93 (OR) 43
one sample t-test 2002 244,898 2001 2002 1043 4-4 4-4 a 2 test b test n (%) n (%) p n (%) n (%) p 0.764 0.821 147(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) 0.494 65.20(10.50) 66.17(12.77) 0.500 a. 2002 b. 2004 c. 2004 44
1 311 52.73% 47.27% 56-64 33.44% 65 42.77% 38.59% 59.16% 88.42% / 57.23% 45.02% 3 60.77% 3.86% 14.79% 39.55% 3.54% 4-5 305 67.87% 65 52.13% 53.77% 38.36% 83.28% / 74.75% 66.89% 45
3 38.69% 4.26% 9.18% 25.90% 6.56% 4-5 2 4-6 43.09% 68.17% 24.11% 39.23% 40.98% 11.58% 88.10% 64.96% 18.97% 4-6 42.30% 78.36% 14.10% 33.77% 45.63% 2.62% 46
88.20% 81.04% 23.28% 4-7 39.34% 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
3 4-8 87.78% 86.82% 50.16% 47.27% 32.48% / 32.15% 10.29% 4-8 80.98% 75.41% 45.57% 25.25% 37.70% 60.00% / 36.39% 4.59% 4 4-9 65.27% 65.25% 48
55.74% 44.26% 93.44% 79.67% 20.33% 4-9 5 4-10 62.06% 43.41% 47.27% 64.95% 86.18% 55.31% 53.06% 86.82% 88.11% 4-10 70.82% 49
39.01% 43.61% 40.33% 80.00% 38.36% 34.10% 34.10% 95.74% 93.44% 94.10% 50
t-test 4-5 P<0.05 67.87% 47.27% 37.30% 27.54% / 74.75% 57.23% 66.89% 45.02% 3 60.77% 38.69% 67.20% 56.72% 14.79% 9.18% 39.55% 51
25.90% 6.56% 3.54% 4-6 P<0.05 4-10 36.39% 23.15% 78.36% 68.17% 24.11% 14.10% 11.58% 2.62% 4-8 / P<0.05 19.02% 9.00% 47.27% 37.70% / 10.29% 4.59% 4-9 21.54% 52
15.41% 33.76% 22.62% 4-10 P<0.05 4-11 P<0.05 19 76 9 36 6 24 4 16 39.87 19.07 7.65 38.19 18.14 7.23 53
4-12 / Adjust R 2 0.31 4-12 1-2 3 / / 54
4-5 2 N=311 % N=305 % p <0.001 164 52.73 98 32.13 147 47.27 207 67.87 0.128 45 20 6.43 15 4.92 46-55 54 17.36 48 15.74 56-64 104 33.44 83 27.21 65 133 42.77 159 52.13 (BMI) a <0.001 7 2.25 24 7.87 120 38.59 164 53.77 116 37.30 84 27.54 48 15.43 24 7.87 20 6.43 9 2.95 275 88.42 254 83.28 0.288 8 2.57 9 2.95 / 5 1.61 9 2.95 23 7.40 33 10.82 <0.001 / 178 57.23 228 74.75 / 45 14.47 35 11.48 / 42 13.50 29 9.51 46 14.79 13 4.26 <0.001 13 4.18 16 5.25 26 8.36 24 7.87 / / 8 2.57 2 0.66 / / / 32 10.29 26 8.52 / 32 10.29 22 7.21 60 19.29 11 3.61 b 140 45.02 204 66.89 a.bmi=( / ) b. 55
4-5 2 N=311 % N=305 % p <0.001 3 ( 3 ) 189 60.77 118 38.69 3 6 ( 6 ) 79 25.40 102 33.44 6 9 ( 9 ) 20 6.43 48 15.74 9 12 ( 12 ) 11 3.54 24 7.87 12 12 3.86 13 4.26 0.998 16 5.14 16 5.25 1 0.32 1 0.33 294 94.53 288 94.43 0.025 寛 90 28.94 119 39.02 209 67.20 173 56.72 12 3.86 13 4.26 0.032 265 85.21 277 90.82 46 14.79 28 9.18 0.003 159 51.13 177 58.03 80 25.72 52 17.05 37 11.90 24 7.87 6 1.93 3 0.98 29 9.32 49 16.07 <0.001 275 88.42 235 77.05 11 3.54 20 6.56 25 8.04 50 16.39 0.662 281 90.35 278 91.15 24 7.72 19 6.23 6 1.93 8 2.62.Fisher exact test 56
4-6 2 N=311 % N=305 % p <0.001 1 34 10.93 7 2.30 1-4 71 22.83 58 19.02 4-10 72 23.15 111 36.39 10 134 43.09 129 42.30 0.007 212 68.17 239 78.36 48 15.43 41 13.44 33 10.61 13 4.26 18 5.79 12 3.93 / 0.006 236 75.88 262 85.90 1-2 59 18.97 36 11.80 3 16 5.14 7 2.30 0.160 189 60.77 202 66.23 122 39.23 103 33.77 a - 50 40.98 47 45.63 11 9.02 7 6.80 17 13.93 13 12.62 41 33.61 36 34.95 43 35.25 22 21.36 6 4.92 0 0.00 12 9.84 22 21.36 a. 57
4-6 2 N=311 % N=305 % p <0.001 36 11.58 8 2.62 73 23.47 83 27.21 202 64.95 214 70.16 0.971 37 11.90 36 11.80 274 88.10 269 88.20 b - 123 44.89 218 81.04 65 23.72 142 52.79 14 5.11 27 10.04 178 64.96 75 27.88 17 6.20 35 13.01 15 5.47 8 2.97 0.190 252 81.03 234 76.72 59 18.97 71 23.28 b. 58
4-7 TB N=305 % 20 6.56 165 54.10 120 39.34 TB 19 6.23 168 55.08 118 38.69 TB 14 4.59 152 49.84 139 45.57 158 51.80 126 41.31 21 6.89 18 5.90 152 49.84 135 44.26 185 60.66 83 27.21 37 12.13 287 94.10 18 5.90 a 4 22.22 12 66.67 2 11.11 a. 59
4-7 N=305 % 215 70.49 90 29.51 90 29.51 81 26.56 79 25.90 67 21.97 27 8.85 23 7.54 20 6.56 20 6.56 300 98.36 5 1.64 20 6.56 285 93.44 b 197 64.59 149 48.85 33 10.82 193 63.28 60 19.67 170 55.74 1-4.9 34 11.15 5-9.9 57 18.69 10 44 14.43 b. 60
4-8 2 N=311 % N=305 % p 0.143 273 87.78 247 80.98 1 10 3.22 16 5.25 1-3 12 3.86 18 5.90 4 16 5.14 24 7.87 0.001 270 86.82 230 75.41 1-2 13 4.18 17 5.57 ( ) 28 9.00 58 19.02 0.679 69 22.19 77 25.25 1 28 9.00 31 10.16 1-4 58 18.65 58 19.02 ( ) 156 50.16 139 45.57 0.016 164 52.73 190 62.30 147 47.27 115 37.70-101 32.48 69 60.00 37 11.90 33 28.70 10 3.22 6 5.22 18 5.79 10 8.70 13 4.18 12 10.43 13 4.18 6 5.22 4 1.29 5 4.35 4 1.29 12 10.43 14 4.50 8 6.96 / 0.023 179 57.56 180 59.02 100 32.15 111 36.39 32 10.29 14 4.59 a. 61
4-9 2 N=311 % N=305 % p 0.035 203 65.27 199 65.25 41 13.18 59 19.34 67 21.54 47 15.41 0.483 15 4.82 9 2.95 253 81.35 254 83.28 43 13.83 42 13.77 0.006 14 4.50 22 7.21 192 61.74 214 70.16 105 33.76 69 22.62 a - - 170 55.74 - - 135 44.26 a - - 5 1.64 - - 285 93.44 - - 15 4.92 a - - 62 20.33 - - 243 79.67 a. - - - 62
4-10 2 N=311 % N=305 % p <0.001 46 14.79 7 2.30 72 23.15 82 26.89 114 36.66 202 66.23 79 25.40 14 4.59 <0.001 59 18.97 14 4.59 117 37.62 172 56.39 97 31.19 116 38.03 38 12.22 3 0.98 <0.001 144 46.30 42 13.77 112 36.01 237 77.70 44 14.15 26 8.52 11 3.54 0 0.00 <0.001 166 53.38 69 22.62 121 38.91 214 70.16 22 7.07 22 7.21 2 0.64 0 0.00 <0.001 179 57.56 65 21.31 107 34.41 216 70.82 24 7.72 22 7.21 1 0.32 2 0.66 <0.001 178 57.23 82 26.89 93 29.90 174 57.05 30 9.65 43 14.10 10 3.22 6 1.97.Fisher exact test 63
4-10 2 N=311 % N=305 % p <0.001 73 23.47 14 4.59 91 29.26 158 51.80 117 37.62 122 40.00 30 9.65 11 3.61 <0.001 43 13.83 13 4.26 66 21.22 169 55.41 148 47.59 108 35.41 54 17.36 15 4.92 <0.001 94 30.23 49 16.07 127 40.84 202 66.23 60 19.29 49 16.07 30 9.65 5 1.64 <0.001 72 23.15 16 5.25 122 39.23 188 61.64 95 30.55 88 28.85 22 7.07 13 4.26 <0.001 14 4.50 6 1.97 29 9.32 55 18.03 161 51.77 207 67.87 107 34.41 37 12.13 <0.001 95 30.55 20 6.56 101 32.48 224 73.44 100 32.15 61 20.00 15 4.82 0 0.00 <0.001 61 19.61 26 8.52 78 25.08 162 53.11 127 40.84 113 37.05 45 14.47 4 1.31 64
4-10 2 N=311 % N=305 % p <0.001 64 20.58 15 4.92 82 26.37 186 60.98 116 37.30 97 31.80 49 15.76 7 2.30 <0.001 162 52.09 45 14.75 105 33.76 227 74.43 30 9.65 30 9.84 14 4.50 3 0.98 a - - - 27 8.85 - - 174 57.05 - - 97 31.80 - - 7 2.30 <0.001 8 2.57 1 0.33 33 10.61 12 3.93 149 47.91 224 73.44 121 38.91 68 22.30 <0.001 6 1.93 2 0.66 15 4.82 18 5.90 150 48.23 244 80.00 140 45.02 41 13.44 <0.001 14 4.50 2 0.66 51 16.40 18 5.90 142 45.66 241 79.02 104 33.44 44 14.43 <0.001 11 3.54 2 0.66 26 8.36 16 5.25 198 63.67 254 83.28 76 24.44 33 10.82 a..fisher exact test 65
4-11 t-test a t-test mean SD mean SD p-value 2.27 1.00 2.27 0.58 0.946 2.37 0.93 2.35 0.58 0.842 1.75 0.83 1.95 0.47 <0.001 1.55 0.65 1.85 0.52 <0.001 1.51 0.65 1.87 0.54 <0.001 1.59 0.79 1.91 0.69 <0.001 2.33 0.94 2.43 0.64 0.157 2.68 0.92 2.41 0.65 <0.001 2.08 0.94 2.03 0.62 0.427 18.14 4.10 19.07 3.09 0.001 2.22 0.88 2.32 0.64 0.008 a 1.84 0.77 2.10 0.61 <0.001 2.11 0.90 2.13 0.50 0.708 2.50 0.97 2.31 0.64 0.004 2.48 0.99 2.31 0.60 0.011 1.67 0.83 1.97 0.53 <0.001 12.82 2.98 13.15 2.23 0.116 a 1.77 0.74 1.82 0.49 0.282 a 1.64 0.67 1.94 0.47 <0.001 a 1.92 0.82 1.93 0.47 0.878 a 1.91 0.68 1.96 0.43 0.301 7.23 2.14 7.65 1.53 0.006 38.19 7.41 39.87 5.46 0.001 a. 66
4-12 p 34.088-1.769 <0.001 0.162 0.012 0.467 0.729 0.012 0.019 0.022 0.601 1.454 0.049 0.995 0.144 13.268 0.115 3.950 <0.001 3.041 0.118 0.894 0.001 1.788 0.041 1.489 0.230 1-2 1.346 0.074 0.621 0.031 3 2.089 0.060 1.178 0.077 2.304 0.176 0.470 <0.001 1.732 0.127 0.496 0.001 2.654 0.176 0.537 <0.001 3.864 0.152 0.921 <0.001 2.957 0.184 0.560 <0.001 1.177 0.089 0.475 0.014 / 2.057 0.149 0.511 <0.001 4.668 0.187 0.923 <0.001 R 2 0.33 Adjust R 2 0.31 F=18.60 P<0.001 entry=0.15 stay=0.05 67
1996~2002 1996~2002 1996 3.19% 2002 4.56% 2002 1985~1996 4.9% 9.2% 2003 4.5% 1996 16.38 2002 10.11 2003 1999 12 68
1997 69.55 2000 50.45 1997 1999 1997 2000 1997 2000 1998~2002 36.18 ~50.15 2001 36.30 2004 6-9 69
1.97 2-4 1.93-1.97 Relative Risk 4.16 1997 3-5 2 3 70
2001 2002 2002 2003 67.87% 47.27% / 2003 44.26% 2 1 Punam Mangtani et al., 1995 2003 71
Relative Risk 4.16 1997 2003 Punam Mangtani et al., 1995 2003 Relative Risk 70 1997 72
/ Maher et al, 2003 2003 2003 73
Mellins, 1992 Boad & Torres, 1999 74
/ / 75
爲 (Kim, Hong et al. 1995; Oluboyo, Erasmus, 1990; Banuai, 1969; Bloom, 1969) 1996 3.19% 2002 4.56% 1997 163.77 2002 101.12 1997 69.55 1998 2002 39.71 46.38 1~4 OR 1.93~1.97 76
/ / / 77
1 2 78
3 8 277 1 1~4 OR 1.93~1.97 79
2 3 80
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