台灣重要死因變動趨勢對潛在生命年數與經濟損失影響探討

The Effects of Trends in Mortality due to the Leading Causes of Death on Potential Lost Life and Economic Loss in Taiwan

目標：事故傷害、惡性腫瘤與糖尿病長期以來一直位居台灣前十大死因，三者分別為青少年，中、老年及老年人口的主要死因，本研究藉此探討三個重要死因對台灣潛在生命年數及經濟損失之影響。方法：利用Lee-Carter模式探討近30年來重要死因死亡率變動趨勢，另以平均餘命為基礎推算出其預期生命年數損失與工作年數損失，再以人力資本法計算1985－2012年重要死因所造成的經濟損失，最後利用時間序列ARIMA模式探討並預測重要死因的經濟損失變動趨勢。結果：事故傷害與惡性腫瘤的死亡水平指數近年來呈下降趨勢，而糖尿病則為上下震盪起伏；生命年數暨工作年數損失方面，事故傷害呈下降趨勢，惡性腫瘤與糖尿病則為直線上升趨勢；經濟損失方面，三死因自1985～2012年皆呈先上升後下降趨勢，惟惡性腫瘤自2001年後其經濟損失已超越事故傷害。結論：事故傷害經濟損失呈下降趨勢，意謂政府政策有所成效，應持續努力；惡性腫瘤疾病經濟損失自2001年即位居第一，對於其之防範與治療仍須加強；至於糖尿病經濟損失金額相對較小，惟其屬老年重要疾病，容易導致其他併發症發生，其防治仍有改善空間。

Objectives: Injuries, malignancies and diabetes are always among the top 10 causes of death in Taiwan. Their occurrence varies among the young, the middle-aged, and the elderly. The aim of this study was to explore the effects of death due to these 3 causes on potential lost life and economic loss for the past 30 years. Methods: The Lee-Carter Model was used to explore the change in trends and to predict the future mortality rates of the 3 causes of death. The years of potential life lost/working life lost (YPLL/WPLL) were calculated based on information about life expectancy, and the Human Capital Method was used to determine the economic losses. Finally, a time series autoregressive integrated moving average (ARIMA) model was used to predict the economic losses. Results: The mortality indices for injuries and malignancies have decreased in recent years, while that of diabetes has fluctuated up and down. The YPLL/WPLL due to injuries decreased while the losses due to cancer and diabetes increased. The economic losses due to the 3 causes of death increased at the beginning and then went down from 1985 to 2012. Specifically, since 2001, the loss due to malignancies has been significantly higher than that caused by injuries. Conclusions: Economic loss due to injuries decreased, implying that the government's preventive policies were quite effective. Economic loss due to malignancies is the highest since 2001, meaning that effective preventive measures are still needed. Although diabetes causes a relatively small economic loss, prevention cannot be ignored since diabetes is highly correlated with metabolic syndrome in the elderly. There is still room for improvement in the prevention and treatment of diabetes.