檢驗自然資源依賴與肺結核之相關性，2000-2016年

Association between natural resource dependence and tuberculosis, 2000–2016

目標：肺結核對世界而言是重大的健康威脅，但是世界各國在千禧年以來防治肺結核的成效表現不一，其中還有退步者。在解釋國家公共衛生議題的成效差異時，近年來被提出的一個解釋，就是國家對自然資源的依賴程度，但是學者對自然資源產生的效果並沒有共識，對肺結核的討論也付之闕如。本研究期望藉由探討自然資源依賴程度與肺結核防治成效之間的關係，補足這部分的研究缺口。方法：本文以時間序列橫斷面方法中的固定效果模型，檢驗2000–2016年之間97至135個不等的國家或政治實體的肺結核與自然資源依賴程度的相關性，並控制人均GDP、政府效率、15-49歲的人口中HIV發生率、0–14歲的人口佔總人口的百分比、5歲以下兒童死亡率（每千例活產兒）、人口密度、都市化程度以及經常性醫療保健支出占GDP比重（%）等幾個解釋變數。結果：在2000-2016年之間，國家對自然資源的依賴程度愈高，肺結核的發生率以及死亡率就愈高，兩者的統計結果均至少達到0.01的顯著水準。結論：根據研究發現，要降低自然資源與肺結核之間的相關性，依賴自然資源程度較高的國家，可能可以藉由：（1）轉型經濟減少對自然資源的依賴；（2）以及（或是）強化對自然資源收益的管理；（3）改善礦區的工作與衛生狀況，來降低肺結核發生率或死亡率。（台灣衛誌2018；37（5）：566-581）。 Tuberculosis (TB) is a major threat to global public health. However, since 2000, the effectiveness of TB control and prevention has varied considerably across countries; the performance has even deteriorated in some countries. To examine differences in public health performance among countries, researchers can determine the degree to which they rely on natural resources. However, scholars have not reached a consensus regarding whether reliance on natural resources is beneficial. In addition, discussions on the link between TB and natural resources are limited. This study filled this gap by exploring the association between natural resource dependence and TB. Methods: This study applied the time-series cross-sectional model with fixed effects to examine the effects of natural resource dependence on TB between 2000 and 2016 in 97–135 countries or political entities. This study controlled for gross domestic product (GDP) per capita, government efficiency, population density, urbanization, incidence of the human immunodeficiency virus among the uninfected population aged 15–49 years, population aged 0–14 years (% total), mortality rate for the population aged under 5 years, and current health expenditure as a percentage of GDP. Results: During the period of 2000–2016, a state’s natural dependence level was positively associated with a higher incidence and death rate of TB. Both results reached statistical significance at at least the 0.01 level. Conclusions: On the basis of research findings, the researcher suggests that to more effectively control and prevent TB, countries and political entities that rely on natural resources should (1) diversify their economies to reduce natural resource dependence, (2) strengthen natural resource management, and (3) improve the working and sanitary conditions of mining locations. (Taiwan J Public Health. 2018;37(5):566-581).