台灣地區1987-2012年糖尿病相關死亡率的趨勢

Diabetes-related Mortality Trends in Taiwan,1987-2012

目的：以原死因及多重死因死亡率分析台灣1987-2012年糖尿病死亡負擔的年代趨勢變化，並比較兩種死亡率趨勢形態的差異，最後以多重死因死亡率輔助分析原死因死亡率趨勢改變的原因。方法：本研究是不同年代糖尿病死亡率的趨勢分析。以衛生署1987，1992，1997，2002，2007以及2012年死亡資料，計算每一年糖尿病多重死因及原死因標準化死亡率，再以普瓦松迴歸分析模型，推估每個年代相對於1987年的死亡率比及95%信賴區間，並進一步依性別，年齡分層分析，同時以卜瓦松迴歸進行糖尿病死亡率之年代線性趨勢檢定。結果：台灣1987-2012年間，糖尿病原死因與多重死因死亡率趨勢變化有所不同，原死因死亡率無顯著趨勢變化，而多重死因死亡率則有顯著上升趨勢。以性別差異來看，男性多重死因死亡率呈現上升趨勢，而女性則是在原死因死亡率呈現下降趨勢。男性各年齡層原死因死亡率大多無顯著變化，而多重死因死亡率除了45-64歲組外，其他年齡層皆有上升趨勢；女性在45-64歲組及65-74歲組原死因死亡率呈下降趨勢，但45-64歲及大於等於75歲組的女性在多重死因死亡率則上升。結論：台灣糖尿病原死因死亡率趨勢在無顯著變化的同時，多重死因死亡率仍在上升，顯示糖尿病死亡負擔在族群中還未獲得改善。我們推測近年來良好的糖尿病照護，是原死因死亡率並未持續升高的原因，但糖尿病盛行率的增加，使得糖尿病多重死因死亡率仍持續上升。建議像糖尿病這類慢性病，在死亡率趨勢分析時，須同時提供原死因及多重死因死亡率訊息，才能更完整了解疾病的死亡負擔。

Objectives: Multiple cause-of-death (MCOD) data can be used to supplement underlying causeof-death (UCOD) data to provide more information in demonstrating diabetes mortality burden. The study aims to analyze the mortality trends of diabetes using compiled UCOD data and MCOD data. Methods: Multiple cause mortality files for 1987, 1992, 1997, 2002, 2007 and 2012 were used to calculate the age-adjusted death rates from diabetes based on the MCOD and UCOD data in Taiwan. Relative risks of mortality rate between 1987 and subsequent years were estimated by Poisson regression model to examine the temporal trends in diabetes mortality. Results: During the period from 1987 to 2012, diabetes mortality emerged to be on the wane according to the UCOD data but appeared to rise persistently in line with the MCOD data. For men, both the UCOD- and MCOD-based diabetest mortality rates reported a steady increase amont all the four age groups examined. For women, on the other hand, a trend of decline was observed in the UCOD- and MCOD-based death rates of those aged 0-44 years and 75 years or above, while a significant increase was detected in the MCOD- and UCOD-based mortality rates of those in the other two age groups (45-64 and 65-74 years) Conclusion: It should be noted that analysis based exclusively on underlying cause-of-death data can be misleading when it comes to tracing the mortality trends in patients with diabetes in Taiwan. Both UCOD and MCOD data should be taken into consideration to help develop a more effective public health program.