台灣勞工發生急性心肌梗塞後工作狀態與影響因素探討

The employment status and related factors of Taiwanese workers after acute myocardial infarction

目標：台灣急性心肌梗塞的發生率攀升與年輕化，可能對勞動市場帶來衝擊，但罹病後對工作變動的長期影響，卻不清楚。本研究透過30-59歲新發急性心肌梗塞的勞工，探討急性心肌梗塞發病後的工作變動與影響因素。方法：採回溯性世代研究，根據2011-2017年全民健康保險資料庫、勞工保險資料庫、死因統計檔及戶籍檔，篩選個案為2013到2014年間首次因急性心肌梗塞住院就醫之30至59歲勞工。觀察存活者於發病後第6、12、24及36個月之工作趨勢， 並探討影響工作的因素與效應。結果：納入本研究的新發急性心肌梗塞勞工個案共2,659人。存活者之工作比例從發病後第六個月的94.1%下降至第36個月的86.4%。雖然整體工作比例表現尚可，但高齡、低薪、多共病者越容易沒有工作，以第36個月無工作的風險為例，50-59歲較30-39歲高2.63倍（95%CI: 1.57-4.41），薪資不滿2萬較6萬以上高2.86倍（95%CI: 1.67-4.92）， 查爾森共病指數（Charlson Comorbidity Index, CCI）3分以上相較無共病者高1.57倍（95%CI: 1.07-2.31）。而性別、都市化程度及教育程度對工作的影響無統計顯著差異。結論：本研究為台灣第一篇探討急性心肌梗塞對工作趨勢影響的研究，除了死亡造成的勞動力損失，應注意高齡、低薪、共病多者較容易在發病後轉變為無工作。未來應進一步了解這些族群在發生急性心肌梗塞後的工作困境，並推動友善罹病者的職場環境。

Objectives: In Taiwan, the rising incidence of acute myocardial infarction and younger patients with the infarction may have implications for the labor market. However, the long-term effects of the illness on the labor market remain unclear. Therefore, we explored the changes in the employment status and factors influencing the employment of patients with acute myocardial infarction. Methods: This cohort study used data from the National Health Insurance Research Database, Labor Insurance Database, Cause of Death Statistics, and household registration records from 2011 to 2017. Patients aged 30-59 years who were hospitalized for acute myocardial infarction for the first time between 2013 and 2014 were enrolled in this study. We observed the employment rate of the survivors at 6, 12, 24, and 36 months after the onset of the disease and the factors influencing their employment status. Results: We enrolled 2,659 workers with acute myocardial infarction. The proportion of employed survivors decreased from 94.1% at 6 months to 86.4% at 36 months after the onset. The likelihood of not being employed was higher among patients who were older, with lower salary, and with more comorbidities. In terms of the risk of unemployment at 36 months after the onset, patients aged 50–59 years had a 2.63 times higher risk than those aged 30–39 years (95% CI: 1.57–4.41); patients with a salary of less than NT$20,000 had a 2.86 times higher risk than those earning more than NT$60,000 (95% CI: 1.67–4.92); and patients with Charlson Comorbidity Index of more than 3 points had a 1.57 times higher risk than those without comorbidities (95% CI: 1.07–2.31). The difference in the effects of gender, urbanization, and education level on employment did not reach statistical significance. Conclusions: In Taiwan, this study is the first to explore the effects of acute myocardial infarction on the employment status. Patients who are older, with low salary, and multiple comorbidities are more likely to become unemployed after the onset of the disease, in addition to unemployment cause by death. Understanding the difficulties related to employment of such patients with acute myocardial infarction is necessary in promoting a patient-friendly workplace environment.