健康行為群聚類別與醫療利用之關係－－以台灣成年初顯期族群為例

Clustering of health-related behaviors and healthcare services utilization amongst emerging adults in Taiwan

目標：探討18～25歲成年初顯期族群健康行為群聚類別與醫療利用之相關性。方法：本研究使用2009年國民健康訪問調查，以18～25成年初顯期族群為研究對象，運用二階段群聚分析法依健康行為型態進行群聚分析，並使用羅吉斯迴歸及零膨脹負二項迴歸模型分析群聚類別與急診及西醫門診醫療利用與否及醫療利用次數之相關性。結果：成年初顯期族群可分為「菸酒不離族」、「飲食不均族」以及「健康保健族」三個群聚類別。相較於健康保健族，在急診醫療利用與否方面，菸酒不離族較可能使用到急診醫療（OR=1.59；95％ CI=1.14－2.21）；在急診醫療利用次數方面，飲食不均族使用較多次數的急診醫療（IRR=1.49；95％ CI=1.08－2.05）；群聚類別與西醫門診利用與否或其利用次數則無統計顯著相關。結論：成年初顯期健康行為具有群聚之現象且群聚類別與急診醫療利用之機率與急診使用次數有統計顯著相關。未來不管是學校或職場健康促進方案，可針對具有共同健康行為特性之成年初顯期族群，規劃整合及客制化之介入方案。

Objectives: This study aims to investigate the association between clustering of health-related behavirs and heathcare services utilization amongst emerging adults. Methods: This study utilized a sub-sample between 18 and 25 years of age from the 2009 National Health Interview Survey. A two-step cluster analysis was used to identify groups of emerging adults with similar behavior patterns. Logistic regression and a zero-inflated negative binomial regression model were used to determine the association between groups of clustering and utilization of emergency care and outpatient healthcare services. Results: Three clusters were identified, including 'smoking-alcohol,' 'unbalanced diet,' and 'healthy lifestyle.' Those who were classified in the 'smoking-alcohol' cluster were more likely to use emergency care services (OR=1.59; 95% CI=1.14-2.21), and those who were in the 'unbalanced diet' cluster were more likely to use emergency care service (IRR=1.49; 95% CI=1.08-2.05) when compared to those in the 'healthy lifestyle' cluster. The current study showed no relationship between the clusters and outpatient healthcare services, whether or not use or the number of visits was considered. Conclusions: Health-related behaviors tend to cluster amongst emerging adults. In addition, health behavior clusters were shown to be associated with a higher risk of using emergency care and more visits of emergency care services. These findings suggest that whether school- or workplace-based, health promotion program could adopt an integrated approach and taior-made programs, when taking into account the common determinants across different types of health behaviors.