職業傷害的發生與社會分布：全民健保資料分析

The Occurrence and Social Distribution of Occupational Injury: Analyses of National Health Insurance Data

過往有關職業傷害發生狀況與社會分布之研究，大都僅針對失能超過四天者或死亡個案進行分析，並少有研究分析其社會階層分布。本研究利用全民健康保險給付資料，分析職業傷害的發生狀況與社會分布。分析2016年全民健保資料中，屬15～64歲工作者且以職業傷害患者身分就醫之民眾，比較不同性別、年齡、投保薪資、投保身分與就醫地區發生狀況之差異。在12,109,590人年中，發生154,561件職業傷害案件（發生率為1,276.35件／10^5人年），其中114人在就醫後30天內死亡（死亡率為0.94件／10^5人年、致死率為0.74／1,000）；發生11,813件住院案件（住院率為97.55件／10^5人年），其中49人在住院後30天內死亡（住院後致死率為4.15／1,000）。因職業傷病就醫者之平均每人醫療花費點數為126.74點。多變項迴歸分析顯示，男性的職業傷害發生風險為女性的1.42倍；15～24歲工作者職業傷害發生率最高；投保薪資最高者職業傷害發生率最低，而投保薪資除了最低組，其餘則是投保薪資越低其職業傷害發生風險越高；在各類投保身分中，以受僱者的職業傷害發生率最高，其次為職業工會之投保者，而公教人員最低。本研究發現，職業傷害醫療給付發生率顯著高於勞保職災現金給付發生率，且呈現社會不平等之分布。

Objective: In the past, studies on the occurrence and social distribution of occupational injuries have mostly focused on cases of disability exceeding four days or deaths and few studies have analyzed socioeconomic position of occupational injuries. This study used the national health insurance data to analyze the occurrence and social distribution of occupational injuries. Methods: This study analyzed the workers aged 15~64 in the national health insurance in 2016 who suffered occupational injury, and compared by gender, age, level of insured salary, employment type and treatment location. Results: Among the 12,109,590 person-years, there were 154,561 occupational injury cases (1,276.35 cases/10^5 person-years), of which there were 114 fatal cases within 30 days after admission (mortality rate was 0.94 cases/10^5 person-years, fatality rate was 0.70/1,000); There were 11,813 hospitalization cases (97.55 cases/10^5 person-years), of which there were 49 fatal cases within 30 days of hospitalization (fatality rate was 4.15/1,000); Medical expenses per person was 126.74 points per person. The occupational injury risk of men is significantly higher than women; workers aged 15~24 have the highest incidence rate and workers aged 45∼64 have the highest mortality rate; The higher insured salary workers had the lower risk of occupational injury; Among the units, employees have the highest incidence rate of occupational injuries. Conclusions: This study found that the incidence of occupational injury in medical benefits is higher than the labor insurance compensation benefits, and shows the social inequality of occupational injury.