山地鄉與非山地鄉子宮頸癌死亡率趨勢之探討，1986－2010年

Trends in cervical cancer mortality rates between aboriginal and non-aboriginal areas in Taiwan, 1986-2010

目標：子宮頸癌（Cervical cancer）為婦女常見的癌症之一，台灣每年約有2000名子宮頸癌新診斷病例，約800人因其而死亡。本研究目的在於探討1986–2010年山地鄉（含離島）與非山地鄉婦女子宮頸癌死亡率情形及其趨勢。方法：本研究資料源自於1986–2010年「死因資料檔」及「台閩地區人口統計檔」，以2000年全台年中人口數作為標準人口，計算標準化死亡率，並比較1995年將子抹篩檢納入健保給付實施前後的死亡率趨勢變化。結果：全台子宮頸癌死亡率從1986年每十萬人口13.18人降至2010年每十萬人口4.45人。以Joinpoint regression model檢定，可發現2個切點，1997年後的下降幅度大於之前，而以2004–2010年的死亡率下降幅度最大，每年變化百分比（Annual Percent Change，APC）為-8.7％。山地鄉死亡率於研究期間的APC為-2.3％，未見到有切點；非山地鄉死亡率於1986–2002年APC為-2.3％，2002–2010年APC為-9.2％。結論：子宮頸癌死亡率於篩檢實施後的下降幅度大於之前，但山地鄉死亡率仍高於非山地鄉，未來應加強偏鄉的社區衛教宣導與健康促進活動，以增進婦女的健康。

Objectives: Cervical cancer is one of the most common cancers in women. In Taiwan, about 2000 new cases are diagnosed and about 800 women die each year. The objective of this study was to examine the mortality rates and their trends between aboriginal and non-aboriginal areas from 1986 to 2010. Methods: Data were accessed from the mortality registry kept by the Ministry of Health and Welfare. Demographic data were obtained from the Ministry of the Interior. We used the 5-year demographic distribution in Taiwan in 2000 as the standardized population to calculate the direct standardized mortality rates for cervical cancer. We then compared temporal changes in mortality rates that occurred during 1986-2010. Results: The standardized mortality rates for cervical cancer in Taiwan declined between 1986 and 2010, from 13.18 to 4.45 (per 100,000). Joinpoint regression analysis identified two significant inflection points and three distinct trends between 1986 and 2010. A steady decline from 1986 to 1997 (APC = -1.5, p < .05), and then an acceleration downward after 1997 (APC = -5.3, p < .05), were followed by the largest mortality rate decrease from 2004 to 2010 (APC = -8.7, p< .05). Mortality rates in aboriginal areas fell consistently between 1981 and 2010 (APC= -2.3, p< .05), but no inflection point was identified. In non-aboriginal areas, the joinpoint analysis identified one significant inflection point generating two distinct trends between 1986 and 2010. The first was a steady decline in mortality rates from 1986 to 2002 (APC = -2.3, p< .05), and then a downward acceleration after 2002 (APC= -9.2, p < .05). Conclusions: Standardized mortality rates for cervical cancer declined after the Papanicolaou test was implemented in 1995; however, the mortality rates in aboriginal areas were still higher than those in non-aboriginal areas. The health authorities need to focus on health education and health promotion activities to improve female health in aboriginal areas.