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題 名 | 臺灣中醫醫療利用性別差異及其相關因子研究:針對婦女健康議題,月經、妊娠、產後、更年期之分析=Sex Differences on the Utilization of Traditional Chinese Medicine and Associated Factors: The Analyses of Women Health Issues in Menstruation, Pregnancy, Postpartum Period, and Menopause |
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作 者 | 施純全; | 書刊名 | 中醫藥年報 |
卷 期 | 光碟版1:1 2012.10[民101.10] |
頁 次 | 頁537-604 |
專 輯 | 中醫診斷基準及臨床照顧相關研究 |
分類號 | 413.1 |
關鍵詞 | 中醫; 性別主流化; 醫療利用; 醫療品質; Traditional Chinese medicine; TCM; Gender mainstreaming; Medical utilisation; Quality of medical care; |
語 文 | 中文(Chinese) |
中文摘要 | 研究背景:基於落實性別健康平等權的理念,衛生署於 2008年制定婦女健康政策時,特別將性別平等議題納入作為我國照護服務體系的重點。中醫向來為我國健康照護服務系統的一環,過去研究發現,女性較男性容易尋求中醫的照顧,但是深入探討中醫使與性別之間相關性的研究並不多見。了解中醫在性別健康平等議題上所扮演的角色,並進一步分析不同女性生理階段,如月經、妊娠、產後及更年期等,對女性接受中醫服務所可能的影響,有助於促進性別健康平等權的落實,並可提供未來中醫藥衛生政策訂定之參考,提昇中醫醫療與照護品質。 研究目的:本研究目的希望能回答以下問題:中醫醫療利用的使用情形、長期趨勢,及其相關預測因子在不同性別之間使否存在差異?中醫醫療利用在不同疾病之間的比例分布為何?不同性別在中醫醫療利用的疾病別分布使否存在差異,其差異為何?中醫醫療利用在不同女性生理階段的使用情形、長期趨勢,及其相關預測因子在不同性別之間使否存在差異? 材料與方法:本研究使用資料有二:其一,利用 2001年國民健康訪問調查資料檔勾稽全民健康保險申報資料檔,進行中醫使用性別差異的橫斷式分析 (Cross-sectional analysis)。其二,利用 1996-2007年全民健保承保抽樣檔,探討臺灣中醫醫療利用在性別上的長期趨勢差異。此外,利用 2005全民健保承保百萬人抽樣檔,針對不同女性生命週期階段(月經、妊娠、產後及更年期)的中醫醫療利用情形及其相關因子進行探討。 結果:2001年國民健康訪問調查資料檔勾稽全民健康保險申報資料獲得研究樣本 15,420人,其中男性 7,601 (49.3%)人、女性 7,819 (50.7%)人;中醫醫療利用在男性與女性分別為 22.1%與 31.0%,女性明顯高於男性。有助於提高中醫利用情形的因子包括,女性 (OR=1.45, 95% CI=1.31-1.62)、年齡介於 20-29歲之間(OR=1.68, 95% CI=1.07-2.65)、低教育程度(OR=1.35, 95% CI=1.10-1.65)、家庭收入在台幣 50,000-69,999之間 (OR=1.14, 95% CI=1.01-1.30)、佛教信仰 (OR=1.36, 95% CI=1.10-1.69)、已婚 (OR=1.14, 95% CI=1.03-1.27)、曾使用民俗療法 (OR=1.71, 95% CI=1.47-1.99)、定期接受健康檢查 (OR=1.18, 95% CI=1.06-1.31)、沒有菸檳酒等生活習慣 (OR=1.39, 95% CI=1.23-1.57)、自覺生活品質較差 (OR=1.43, 95% CI=1.30-1.57)、中醫師資源較充沛 (OR=1.66, 95% CI=1.46-1.88),以及居住在鄉村地區(OR=1.28, 95% CI=1.14-1.43)。2005年中醫疾病別案件數比例分布前 10名別分別為徵候、病徵及診斷欠明各種病態、骨骼肌肉系統疾病、損傷及中毒、呼吸系統疾病、消化系統疾病、泌尿生殖系統疾病、皮膚與皮下組織疾病、循環系統疾病、內分泌與新陳代謝疾病,以及感覺器官疾病等疾病別。這些常見於中醫門診的疾病分佈比例亦存在性別差異,女性因泌尿生殖系統疾病而尋求中醫治療者高於男性。 中醫醫療利用長期趨勢在不同性別之間都是逐年成長,歷年女性的中醫醫療利用情形均高於男性。不同生理週期階段的女性的長期中醫醫療利用情形均呈現上升趨勢,有月經疾患者的中醫醫療利用盛行情況從 2002年的 27.57%增加到 2007年的 27.86%、孕婦的中醫醫療利用盛行情況從 1996年的 25.24%增加到 2006年的 28.54%、產後婦女的中醫醫療利用盛行情況從 1996年的 11.33%增加到 2006年的 14.75%、停經期婦女的中醫醫療利用盛行情況從 1996年的 33.68%增加到 2007年的 39.25%。影響中醫醫療利用情形的相關因子在不同生理週期階段的女性族群中存在差異。影響月經疾患者使用中醫的相關因子有:年齡介於 35-59歲之間(OR=1.77, 95% CI=1.37-2.27)、白領工作階級 (OR=1.35, 95% CI=1.16-1.57)、中醫師資源較充沛 (OR=2.35, 95% CI=1.92-2.87),以及居住在都市地區 (OR=1.85, 95% CI=1.41-2.44)。影響孕婦使用中醫的相關因子有:年齡介於 40-50歲之間(OR=4.54, 95% CI=2.25-9.16)、白領工作階級 (OR=1.29, 95% CI=1.00-1.67),以及中醫師資源較充沛(OR=1.72, 95% CI=1.23-2.40)。影響停經期婦女使用中醫的相關因子有白領階級工作者(OR=1.10, 95% CI=1.04-1.17)、個人月收入介於新台幣 15,000-29,999元 (OR=1.15, 95% CI=1.10-1.21)、中醫師資源較充沛 (OR=1.59, 95% CI=1.50-1.69),以及居住在都市近郊地區(OR=1.15, 95% CI=1.04-1.28)。 結論:本研究透過統計模型具體量化中醫醫療使用在不同性別之間的差異,同時也發現不同生理週期階段的女性族群在中醫醫療利用上存在差異。根據本研究發現,未來在中醫藥衛生政策訂定時,除應重視性別差異,規劃以女性為主的健康照護政策外,更需考慮女性在不同生命週期間的需求差異,制定一套具綜融性且又能符合不同需要的中醫健康照顧政策。 |
英文摘要 | BACKGROUND: Despite a number of studies addressing health inequality among genders, very few studies were conducted to assess the gender discrepancy in the use of Traditional Chinese Medicine (TCM). Nevertheless, researches carried out to assess TCM use in different phase of women’s life cycle are sparse. AIM: The current study aimed to assess whether gender discrepancy existed in TCM use. Additionally, we also exam the predictor variables of TCM use among women by different phase of life cycle MEYHOD: Study population was based on two data sources, involving part of the 2001 National Health Interview Survey (2001 NHIS) and the Longitudinal Health Insurance Database (LHID) from 1996-2007. Four subgroups, women with menstrual aliments, pregnancy, postpartum, and menopause, were classified to investigate the discrepancy of TCM use in different women’s life cycles. The association between socio-demographic variables and uptake of TCM service was assessed by logistic regression model with adjustment for life-style variables and environment influence. RESULTS: Of total of 15,420 eligible respondents in 2001NHIS, 7,601 (49.3%) are male and 7,819 (50.7%) are female. The prevalence of TCM use in male and female are 22.1% and 31.0%, respectively. Predictor variables significantly associated with TCM use includes female (OR=1.45, 95% CI=1.31-1.62), 20-29-year-old age group (OR=1.68, 95% CI=1.07-2.65), with relative low education level (OR=1.35, 95% CI=1.10-1.65), family income between NTD 50,000 and 69,999 (OR=1.14, 95% CI=1.01-1.30), Buddhist (OR=1.36, 95% CI=1.10-1.69), having married (OR=1.14, 95% CI=1.03-1.27), having use of folk therapies (OR=1.71, 95% CI=1.47-1.99), regularly receiving health check-up (OR=1.18, 95% CI=1.06-1.31), having no unhealthy life-style habit (OR=1.39, 95% CI=1.23-1.57), perceiving poor quality of life (OR=1.43, 95% CI=1.30-1.57), dwelling in areas with sufficient TCM manpower resources (OR=1.66, 95% CI=1.46-1.88), and living in rural cities (OR=1.28, 95% CI=1.14-1.43). The top ten major disease categories for TCM visits were symptoms, signs and ill-defined conditions, diseases of the musculoskeletal system and connective tissue, injury and poisoning, disease of the respiratory system, diseases of the digestive system, diseases of the genitourinary system, diseases of skin and subcutaneous tissue, diseases of the circularity system, endocrine, nutritional and metabolic diseases and immunity disorders, and diseases of the sense organs. The priority of the top ten is discrepant between male and female. The prevalence of TCM use in women with menstrual disorder, pregnancy, postpartum, and menopause all increased with calendar year from 27.57% in 2002 to 27.86% in 2007 for women with menstrual disorder, from 25.24% in 1996 to 28.54% in 2006 for pregnancy women, from 11.33% in 1996 to 14.75% in 2006 for postpartum women, and from 33.68% in 1996 to 39.25% in 2007 for menopausal women. Predictor variables associated with TCM use in female with dysmenorrhea involves 35-59-year-old age group (OR=1.77, 95% CI=1.37-2.27), white-collar workers (OR=1.35, 95% CI=1.16-1.57), having relative sufficient TCM manpower resources (OR=2.35, 95% CI=1.92-2.87), and living in urban cities (OR=1.85, 95% CI=1.41-2.44). Predictor variables associated with TCM use in pregnancy female involves 40-50-year-old age group (OR=4.54, 95% CI=2.25-9.16), white-collar workers (OR=1.29, 95% CI=1.00-1.67), and having relative sufficient TCM manpower resources (OR=1.72, 95% CI=1.23-2.40) have more likely to have use of TCM. For postpartum women, 40-50-year-old age group (OR=2.12, 95% CI=1.18-3.78 is the only variable significantly associated with TCM use in our analysis. Predictor variables associated with TCM use in menopausal women covers white-collar workers (OR=1.10, 95% CI=1.04-1.17), personal monthly income NTDs 15,000-29,999 (OR=1.15, 95% CI=1.10-1.21), having relative sufficient TCM manpower resources (OR=1.59, 95% CI=1.50-1.69), and dwelling in suburban city (OR=1.15, 95% CI=1.04-1.28). CONCLUSIONS: The present study quantified gender discrepancy of TCM use. In addition, discrepancy also existed between women belong to different phases of life-cycle. These results suggests that applied gender mainstreaming in women’s health care policy should take not only a gender specific medical care service system but also a comprehensive health care policy for different phases of woman’s life cycle into account. |
本系統中英文摘要資訊取自各篇刊載內容。