Geographical Analysis of ESRD Incidence and Environment

研究背景與動機：世界各國末期腎臟病(End Stage Renal Disease，ESRD)發生率與盛行率逐年增加，根據USRDS 2009年報告指出自2004年開始，台灣在盛行率與發生率皆位居世界第一，且ESRD之醫療保健支出成長6%，至240億美元，佔總體醫療支出5.8%。因此，瞭解影響ESRD發生的因素，已成為政府與社會大眾關切的議題。許多研究顯示ESRD呈現地理分布差異，且地區之環境因素影響ESRD發生率的高低，然而目前台灣於此方面的研究不足，此外，空間分析的發展快速，使研究者得以探索現象的空間特性。因此，本研究目的即利用空間分析方法，瞭解台灣ESRD發生率之地理分布型態是否存在地理差異，並探討影響地理分布差異之地理環境因素。 研究方法：本研究使用1999-2007年全民健康保險申報資料，取得ESRD病患共計62,856人為研究對象。利用Moran’s I和LISA該兩種探索式空間分析方法，描述1999年-2001年、2002年-2004年和2005-2007年三個研究年段之ESRD發生率於台灣359個鄉鎮的分布是否呈現聚集型態，並瞭解不同年段之熱區分布變異。進一步以國家各項統計資料，透過空間迴歸模型分析，瞭解影響因素除了區域之環境因素外，亦可能受鄰近地區的相互影響。 結果：三個研究年段之ESRD發生率之空間分布皆呈現聚集型態。高疾病發生率主要聚集於中南部山地鄉鎮，且自2002-2004年段開始，於中南部沿海地區開始出現高發生率聚集分布。本研究以空間迴歸模型分析，除獲地區之人口組成與醫療服務資源差異影響空間聚集的形成，並存在空間鄰近效應，使得各鄉鎮之ESRD發生率不僅受本身鄉鎮之環境因素影響，亦受其鄰近鄉鎮外溢效應的影響。 結論：本研究結果有助於相關政策針對高發生率群聚地區施行，除能改善地區之健康狀態外，亦可透過空間外溢影響鄰近鄉鎮的健康狀態，提升政策實行的效益。Background: Accroding to USRD 2009 Annual Report, the incidence and prevalence rates of ESRD in Taiwan were the highest around the world. Total Medicare spending for ESRD rose 6 percent—5.8 percent of the entire Medicare budget. Identifying the factors that affect the occurrence of ESRD has become the government and the public concern issue. Previous research has demonstrated that regional variation in incidence of ESRD, and the environment factors impact the incidence. However, studies of this field is still lacking in Taiwan. The objective of this study is to evaluate regional differences in the incidence of ESRD, and identify the risk factors of the environment associated with the geographic variability of ESRD. Material and Method: The dataset used in this study is from the NHI claims data, a total 62,856 incident patient from 1999-2007 were included. Take advantage of Moran’s I and LISA indicators to exhibit spatial clustering in Taiwan’s 359 townships. Utilizing spatial regression model to identify the regional factors such as demographic, socioeconomic status and medical resource affect the incidence of ESRD. Result: The result has shown that the incidence of ESRD demonstrated a spatial clustering pattern. High incidence of ESRD mainly occurred in central and southern mountain townships. Since the start of the segment in 2002-2004, the clustering area began to appear in central and southern coastal areas. Not only has the area of medical resources and demographic factors but existed neighborhood effect influence the incidence of ESRD. Conclusion: These results will help policies to practice, in addition to improving the health status of regions, the spillover effects can also enhance the effectiveness of policy implementation