台灣地區酒精使用型態與醫療使用行為之關係探討

The relationship between the pattern of alcohol consumption and healthcare utilization in Taiwan

目標：本研究旨在評估台灣地區不同的問題飲酒型態與醫療利用的關係。方法：此研究設計為一橫斷性研究，以2009年國民健康訪問調查資料（National Health Interview Survey，NHIS）中，青壯年（18－39歲）及中年族群（40－64歲）的受訪者（n=16,881）為研究對象。問題飲酒型態包括狂飲（binge drinking）與酒癮，醫療利用含括西醫門診利用次數、急診與住院的使用情形。統計分析按年齡分層，並以調查統計分析方式，卜瓦松與邏輯斯迴歸模式評估飲酒型態與醫療利用的相關性。結果：受訪時間過去一年中，青壯年及中年族群每天喝酒的盛行率為1.82％與4.82％，可能酒癮則分別為2.40％及2.27％。在調整相關干擾因素後，相較於未飲酒者，中年族群可能酒癮者過去一年急診（aOR=2.06，95％ CI：1.21－3.52）及住院（aOR=1.68，95％ CI：0.95－2.96）醫療利用的機會偏高；青壯年族群的近期門診使用次數增加（aRR=1.78，95％ CI：1.11－2.85）。結論：問題飲酒形態與西醫門診、急診與住院利用的關係，因年齡族群而異。為避免問題飲酒型態造成的健康傷害，未來可考慮於醫療院所（尤其是基層醫療與急診）與職場，進行問題飲酒的篩檢及提供酒癮問題諮商介入。

Objectives: The problematic drinking of alcohol may not only elevate the risk of health problems but also increase healthcare utilization. The aim of this study was to explore the relationship between different patterns of problematic alcohol consumption and healthcare utilization in Taiwan. Methods: This was a cross-sectional study design. The data source was the 2009 National Health Interview Survey (NHIS). The study population (n=16,881) included young (aged 18-39 years) and middle-aged (aged 40-64 years) adults. Problematic drinking of alcohol was defined as binge drinking and probable alcoholism. Healthcare utilization covered outpatient, emergency and inpatient medical services. Complex survey analyses in poisson and logit distribution were used to assess estimates of the association with stratification by age. Results: During the year preceding the survey, approximately 1.82% of the young adults and 4.82% of the middle-aged adults drank alcohol on a daily basis; the corresponding estimates for probable alcoholism were 2.40% and 2.27%. After adjustment for socio-demographic characteristics, health behaviors, and other medical diseases, middle-aged probable alcoholics were more likely to use emergency room services (adjusted Odds Ratio [aOR]=2.06, 95% CI: 1.21-3.52) and inpatient services (aOR=1.68, 95% CI: 0.95-2.96) as compared with those who never drank. For young adults, having problems with alcohol was associated with increased utilization of outpatient services (aRR=1.78, 95% CI: 1.11-2.85). Conclusions: There was a relationship between problematic drinking and healthcare utilization, and such links differed slightly by age group. To reduce the healthcare burden associated with problematic drinking, screening and behavioral counseling interventions in primary care and the workplace should be considered.