臺灣地區老年人使用玻尿酸注射液治療膝部退化性關節炎之回溯分析

Hyaluronic Acid Injection for Osteoarthritis of the Knee: a Retrospective Study of the Elderly in Taiwan

目的：探討台灣地區自2001年起至2006年間，65歲以上老年人口中，退化性關節炎的盛行率、發生率；玻尿酸關節注射液於退化性關節炎人口中的注射盛行率、發生率，及其相關影響因子。方法：本研究為全民健康保險資料庫之二次資料分析，由西元2001年1月1日到2006年12月31日，以每年年滿65歲以上之老人之所有健保資料納入分析。主要收集門診資料中，具有退化性關節炎診斷之患者，包括使用玻尿酸關節注射液者；統計方法包括描述性分析，雙變數相關分析、與邏輯斯複回歸分析。結果：在6年期間，總共收集到2,801,925筆具有退化性關節炎診斷者，其盛行率有逐年增加的情形，由西元2001年的19.24%，增加至西元2006年的23.05%，而且女性之增加具有顯著性(p=0.005, r=0.941)。在每年退化性關節炎人口中，玻尿酸關節注射液的注射盛行率，不論男、女均呈現逐年增加的正相關趨勢，並具有統計之顯著性，且男女比為3:5。至於每年使用玻尿酸關節注射液者之發生率，六年期間共收集有77,596筆資料，其中男、女比率分別為30.92%，69.08%；進一步進行年度趨勢分析發現，女性，以及大於85歲以上族群呈現顯著正成長；在男性、65-74歲族群及選擇在醫學中心就醫者，呈現顯著負成長。結論：本研究發現，在台灣地區65歲以上老年人口中，退化性關節炎的盛行率，與玻尿酸關節注射液的注射盛行率逐年增加。使用玻尿酸關節注射液者發生率的趨勢研究則發現，顯著增加的為女性及年紀大於85歲者，且女、男比為7:30。

Objectives: To investigate the prevalence and incidence of osteoarthritis (OA) and intra-articular hyaluronic acid (HA) injection in elderly patients (age over 65) in Taiwan from 2001 to 2006. Methods: This was a secondary analysis of claims data from National Health Insurance of Taiwan from January 1st, 2001 to December 31st, 2006. Patients over the age of 65, diagnosed with OA, and treated with intra-articular HA were included. Descriptive analyses, bivariate correlations, and multiple logistic regressions were performed. Results: There were 2,801,925 patients with the diagnosis of OA during the six-year data collection period. The prevalence of OA increased from 19.24% in 2001 to 23.05% in 2006. The prevalence in female increased significantly (p=0.005, r=0.941). The prevalence of intra-articular HA injection for both females and males also increased significantly. The ratio of treated males to females was 3:5. In addition, new users (incidence) of HA included 77,596 patients (30.92% male and 69.08% female) during the 6 year period. Trend analysis of the incidence of HA injection demonstrated that such treatment for females and the age group over 85 increased significantly. New treatment for males, the 65-74 group, and patients in academic medical centers decreased significantly. Conclusions: The prevalence of osteoarthritis in the elderly and the prevalence of intra-articular (HA) injection increased in Taiwan during the 6-year period. Trend analysis of the incidence demonstrated that treatment of females and the over 85 age group increased significantly.