敗血症流行病學及住院死亡相關因子－－採用2013年台灣健保學術資料庫

Epidemiological characteristics and related factors analysis for hospital mortality of sepsis using Taiwan 2013 data as example

流行病學研究顯示，敗血症具有高發生率及高死亡率；台灣學者的研究顯示，由1997年敗血症的發生率135人／十萬人，增加到2006年的217人／十萬人，而10年平均死亡率30.8%。2013~2015年衛福部公佈十大死因，敗血症在女性排名第十位；敗血症在各國的研究顯示，發生率317~560人／十萬人，估計死亡率18~33%；台灣缺乏2006以後敗血症流行病學的研究，急需要一個代表全國樣本的研究以估算敗血症對大眾健康的影響。使用2013年健保資料庫，瞭解敗血症病人於住院期間死亡與存活在病人、疾病、環境特性的差異，以及探討住院病人診斷為敗血症病人，於住院期間死亡在病人、疾病、環境特性的相關風險。樣本選擇優先排除住慢性病床、2013年前住院及無出院日期的病人後，以主診斷為敗血症病人，再進行歸人，將資料庫的項目依病人、疾病、環境特性分類及變項的建立後，設定參考組及Code，使用SPSS 22.0版軟體進行統計分析。敗血症發生率2.9%，女性高於男性；住院死亡率19.3%，男性高於女性；男性風險是女性的1.461倍，發生率與住院死亡率隨年齡增加而增加，每增加1歲住院死亡風險增加3.9%。敗血症住院死亡病人之住院天數0-1天佔19.7%，住院天數2-3天佔16.3%；死亡病人的住院天數為0-1天沒有發生器官衰竭佔8.24%，住院死亡病人以呼吸衰竭佔最多（15.95%）。敗血症病人於住院期間死亡的平均住院天數低於敗血症存活病人的住院天數，但是，敗血症住院死亡病人之平均醫療費用比敗血症存活病人高85.4%；然而，敗血症住院死亡病人沒有發生器官功能障礙的病人佔43.2%，與其他國家的研究顯示，敗血症住院死亡病人沒有發生器官功能障礙小於20%，有差異。敗血症病人的住院死亡風險與性別、年齡、器官衰竭、醫院等級、季節、住院天數有關；本研究僅根據住院病人的住院診斷碼進行估計發病率及住院死亡率，若能再運用死亡登記資料庫，更能準確地估計死亡率，及建議相關預防、治療措施應參考本國的流行病學研究資料，例如疫苗施打年齡層可以根據發病率及死亡率做調整。 Epidemiological studies have shown that sepsis has a high incidence and a high mortality rate; Taiwan scholar studies have shown that the incidence of sepsis in 1997 was 135 per 100,000 people, increasing to 217 per 100,000 people in 2006 and 10 The average annual mortality rate was 30.8%. 2009 ~ 2015 Ministry of Health and Welfare announced the top ten causes of death, sepsis in the women ranked tenth; sepsis in various countries, the study showed that the incidence of 317 ~ 560 people / 100,000, estimated mortality rate of 18 to 33%; Taiwan lack of seizures after 2006 Epidemiological research, the urgent need for a representative of the national sample of the study to assess the impact of sepsis on public health .Use the 2013 Healthcare Database to understand the differences in patient, disease, and environmental characteristics during the hospitalization of sepsis patients, and to explore the risk associated with death, patient, disease, and environmental characteristics during hospitalization for patients with sepsis diagnosed with sepsis. The sample selection prioritized the removal of chronic beds, patients who were hospitalized and without discharge date after 2013. The patients were diagnosed with sepsis and were re-assigned. The database was classified according to patient, disease, environmental characteristics and establishment of variables, Set the reference group and Code, using SPSS 22.0 software for statistical analysis. The incidence of sepsis was 2.9% and that of women was higher than that of men. The hospital mortality rate was 19.3% and that of men was higher than that of women. The male risk was 1.461 times that of females and the incidence of hospitalization increased with age. The risk of hospitalization increased 3.9%. The number of hospitalized days for hospitalized patients was 19.7% and the number of hospital days was 16.3%. The number of hospitalized days for death was 8.24% in 0-1 days without organ failure, and respiratory failure Up to (15.95%). The average number of hospitalizations for sepsis patients during hospitalization was lower than the number of hospitalizations for sepsis survivors, but the average cost of hospitalized patients with sepsis was 85.4% higher than that of patients with sepsis. However, patients with sepsis died without organ dysfunction Accounting for 43.2%, with other countries of the study showed that sepsis hospitalized patients died without organ dysfunction less than 20%, there are differences.The risk of hospitalization death in patients with sepsis was related to gender, age, organ failure, hospital grade, season, and hospital days. This study was based on the hospitalized diagnostic codes for inpatients and hospitalized mortality. If the death registration database, More accurately estimate the mortality rate, and suggest that the relevant prevention and treatment measures should be based on national epidemiological research data, such as vaccine age can be adjusted according to morbidity and mortality.

Epidemiological studies have shown that sepsis has a high incidence and a high mortality rate; Taiwan scholar studies have shown that the incidence of sepsis in 1997 was 135 per 100,000 people, increasing to 217 per 100,000 people in 2006 and 10 The average annual mortality rate was 30.8%. 2009 ~ 2015 Ministry of Health and Welfare announced the top ten causes of death, sepsis in the women ranked tenth; sepsis in various countries, the study showed that the incidence of 317 ~ 560 people / 100,000, estimated mortality rate of 18 to 33%; Taiwan lack of seizures after 2006 Epidemiological research, the urgent need for a representative of the national sample of the study to assess the impact of sepsis on public health .Use the 2013 Healthcare Database to understand the differences in patient, disease, and environmental characteristics during the hospitalization of sepsis patients, and to explore the risk associated with death, patient, disease, and environmental characteristics during hospitalization for patients with sepsis diagnosed with sepsis. The sample selection prioritized the removal of chronic beds, patients who were hospitalized and without discharge date after 2013. The patients were diagnosed with sepsis and were re-assigned. The database was classified according to patient, disease, environmental characteristics and establishment of variables, Set the reference group and Code, using SPSS 22.0 software for statistical analysis. The incidence of sepsis was 2.9% and that of women was higher than that of men. The hospital mortality rate was 19.3% and that of men was higher than that of women. The male risk was 1.461 times that of females and the incidence of hospitalization increased with age. The risk of hospitalization increased 3.9%. The number of hospitalized days for hospitalized patients was 19.7% and the number of hospital days was 16.3%. The number of hospitalized days for death was 8.24% in 0-1 days without organ failure, and respiratory failure Up to (15.95%). The average number of hospitalizations for sepsis patients during hospitalization was lower than the number of hospitalizations for sepsis survivors, but the average cost of hospitalized patients with sepsis was 85.4% higher than that of patients with sepsis. However, patients with sepsis died without organ dysfunction Accounting for 43.2%, with other countries of the study showed that sepsis hospitalized patients died without organ dysfunction less than 20%, there are differences.The risk of hospitalization death in patients with sepsis was related to gender, age, organ failure, hospital grade, season, and hospital days. This study was based on the hospitalized diagnostic codes for inpatients and hospitalized mortality. If the death registration database, More accurately estimate the mortality rate, and suggest that the relevant prevention and treatment measures should be based on national epidemiological research data, such as vaccine age can be adjusted according to morbidity and mortality.