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題名 | 「雙重劣勢」的疾病模式:糖尿病病人生活品質相關因子探討=Disease Patterns of "Double Jeopardy": Factors Associated with Health-Related Quality of Life (SF-36) among Diabetes Patients |
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作者 | 陳端容; 陳佳宜; Chen, Duan-rung; Chen, Chia-yi; |
期刊 | 人口學刊 |
出版日期 | 20160600 |
卷期 | 52 2016.06[民105.06] |
頁次 | 頁81-111 |
分類號 | 542.8 |
語文 | chi |
關鍵詞 | 個人社會經濟地位; 地區效應; 糖尿病患者; 多層次分析; Individual socioeconomic status; Contextual effect; SF-36; Diabetes patients; Multilevel analysis; |
中文摘要 | 本研究旨在瞭解臺灣地區糖尿病成人患者(20-65歲)的健康相關生活品質(SF-36),及影響生活品質的個人及地區因素。使用2005年國民健康訪問調查資料串連全民健康保險資料庫,以確診糖尿病患者。個人變項有性別、年齡、婚姻狀況、健康行為(有無吸菸、飲酒、運動和肥胖),及社經地位(工作狀況、教育程度、家戶月收入)。健康相關生活品質分為生理層面(PCS)及心理層面(MCS)。地區變項有兩個,一、縣市層次的地區社經劣勢指標,由2004-2005年縣市的(一)失業率、(二)15歲以上未受過大學以上高等教育人口比率、(三)低收入戶比率三個指標形成的因素分數;二、縣市層次的所得極端值差距指標(index of concentration at theextremes of income, ICE)。以多階層線性模式進行分析。研究結果指出,在控制個人及地區社經變項後,糖尿病人的生理及心理健康相關生活品質,皆較沒有糖尿病的人要來得差。同時,相較於沒有糖尿病人,糖尿病人若居住在社經劣勢的縣市,或是低所得人口居多(ICE為負值)的縣市,其生理健康生活品質會更差,反映出糖尿病人雙重劣勢的疾病模式。此結果顯示出社經劣勢區域可能產生的「破窗」效應,使得居住在社經劣勢地區的糖尿病人承受更多因疾病帶來的生活負擔。相反地,居住在所得分布較為均衡的縣市(ICE接近0),不管是否有糖尿病,心理健康的生活品質會較好,而糖尿病人的心理健康生活品質則會改善更多,顯示降低社會不平等可能減少相對剝奪感,從而增加心理健康的生活品質。有別於傳統所使用的地區社經劣勢指標,所得極端值差距指標亦可做為測量社會不平等的程度,對心理生理及健康生活品質有預測功能。 |
英文摘要 | The purpose of this study is to assess the effects of individual socioeconomic status and county-level variables in a sample of diabetes patients aged 20-64 in Taiwan. Methods: Data on individual-level characteristics, health behavior variables, socioeconomic status and health related quality of life (SF- 36) were obtained from National Health Interview Survey in 2005 (2005 NHIS). The health data was confirmed by National Health Insurance Research Databases. Sex, age, and marital status; health behavior variables including smoking, drinking, betel nut, sports and obesity; and individual socioeconomic status measured by employment, education attainment, and household income per month were included. Health related quality of life was calculated Physical Component Summary (PCS, SF-36) and Mental Component Summary (MCS, SF-36). Two county-level variables were used: (1) area disadvantage index; (2) index of concentration at the extremes (ICE) of income. We excluded missing data on individual information and the remaining study sample included 756 DM patients and 14,360 non- DM patients nested within 23 counties. Individual socioeconomic status such as unemployment and low household income were related to PCS and MCS. County-level variables including area disadvantages and ICE were negatively associated with PCS but not with MCS. However, near-zero ICE is positively associated with better MCS. Disadvantaged diabetes patients lived in area of concentrated disadvantages had worse health-related quality of life. The link between area-based disadvantages and individual-level poverty had created a double jeopardy effect in diabetes patients. |
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