兒童風濕疾病及其醫療利用與罹癌風險之探討

A population-based cohort study of the risk of cancer in children with rheumatic disease and their precancerous medical utilization

目標：風濕疾病為一種慢性的炎症，可能會增加罹癌風險，因此本研究目的在探討台灣地區兒童風濕病人罹癌之風險及其罹癌前醫療利用之情形。方法：本研究採回溯性研究設計，運用次級資料分析，資料來源為全民健保資料庫，選取2000年至2012年診斷為風濕疾病之兒童，以紅斑性狼瘡及幼年特發性關節炎等八種風濕疾病進行觀察；使用Cox models分析罹癌症風險，並以Mann-Whitney U Test檢定病人罹癌前醫療利用之變化。結果：整體兒童風濕病人相較於兒童非風濕病人高出3.71倍罹癌風險，其中紅斑性狼瘡、幼年特發性關節炎與修格連氏症候群的罹癌風險分別為3.94倍、5.93倍與5.29倍；藥物中，曾使用免疫調節劑者罹癌風險約增加5.65倍，曾使用生物製劑罹癌風險高出約26.01倍；另外，兒童風濕病人在罹癌前的醫療利用變化呈現門診利用增加、住院利用減少，經Mann-Whitney U Test檢定均未達顯著差異。結論：綜合研究結果，兒童罹患風濕疾病會增加其罹癌風險，因此本研究建議衛生主管機關應加強重視兒童風濕病人的醫療照護，避免將來支出更多的社會成本。

Objectives: A clinical manifestation of rheumatic disease is chronic inflammation that may increase the risk of cancer. The purpose of this study was to explore the risk of cancer and the precancerous medical utilization by children with rheumatism in Taiwan. Methods: This was a retrospective study with secondary data analysis. The data were drawn from the National Health Insurance Research Database from 2000 to 2012. Patients under the age of 18 with a diagnosis of pediatric rheumatic disease, including systemic lupus erythematosus, juvenile idiopathic arthritis, Sjögren’s syndrome, scleroderma, polymyositis, dermatomyositis, vasculitis and Behçet’s disease. A total of 1,741 cases were identified. The Cox proportional hazards model was used to analyze the risk of cancer, and the Mann-Whitney U Test was used to assess whether the patient’s medical use was different from that in the year prior to the diagnosis of cancer. Results: The overall risk for children with rheumatism compared with non-rheumatic patients was 3.71 times the risk for cancer; for systemic lupus erythematosus, juvenile idiopathic arthritis and Sjögren’s syndrome, the cancer risk was 3.94 times, 5.93 times and 5.29 times, respectively. The risk for cancer was increased by 5.65 times in those who had used immunoregulatory drugs, and this was 26.01 times more than that of those who had used biological agents. For children with rheumatism, in the year before the diagnosis of cancer and in terms of overall medical use before cancer, the number of outpatient visits and expenses increased, but the number of hospitalizations, hospital days, and cost reduction were not significantly different. Conclusions: Based on the results of this study, we suggest that the health authorities pay more attention to the medical care of children with rheumatism in order to avoid future social costs.