臺灣腦中風病患類型與死亡之相關危險因子研究

Risk Factors Related to the Subsequent Death of Patients with Different Stroke Subtypes in Taiwan

目的：腦中風的病因與類型所造成之疾病的病況嚴重度有極大的不同，死亡率也差異甚大。本研究將探討台灣不同類型腦中風病患比率，並瞭解腦中風住院病人的死亡之相關因素。方法：使用臺灣全民健康保險研究資料庫，擷取2011年至2014年間有腦中風疾病相關診斷者，排除前一年有腦中風病史者，共230,638人。分析不同類型腦中風其死亡之因素，同時分析腦中風之患者2年內之死亡率與死亡因素。結果：在腦中風的四大亞型分類，以腦梗塞最多佔62.21%；其次為腦出血佔18.37%；在其次為其他未明之腦血管疾病佔16.50%；而蜘蛛網膜下腔出血此類約佔2.92%。若以其他未明之腦血管疾病為參考組，則其餘腦中風亞型之死亡勝算比(adjusted odds ratio, AOR)分別為腦梗塞2.07倍(AOR=2.07, CI=2.00-2.14)、腦出血(AOR=5.80, CI=5.57-6.03)、蜘蛛網膜下腔出血(AOR=9.66, CI=9.06-10.29)。在不同層級別來看，醫學中心住院診治之腦中風病患2年內死亡之勝算比相較於地區醫院來的較低，僅有0.94倍。年齡每增加1歲腦中風發生機率會增加0.06；男性發生腦中風之勝算比是女性的1.1倍；居住於都會區之死亡勝算比相對較低為0.94倍。結論：台灣每年發生腦中風之人數男性高於女性，中風類型以以腦梗塞最多佔62.21%，不同類型腦中風、年齡、性別、居住區域及收治醫院層級均會影響其中風2年內死亡之機率。

Objectives. Subtypes of stroke and their risk factors differ considerably in the severity of induced symptoms and patients’death rate. This study explored the ratio of patients with each stroke subtype in Taiwan and factors affecting the mortality of inpatients with strokes.
Methods. Data of patients diagnosed with stroke between 2011 and 2014 were retrieved from the National Health Insurance Database. After excluding patients who had experienced stroke in the previous year, the data of 230,638 patients were included in this study. The mortality risk of these patients was analyzed with regard to their stroke subtypes. In addition, the death rate and mortality within 2 years of diagnosis were determined.
Results. Of the four major subtypes of stroke, cerebral infarction was the most common(62.21%), followed by cerebral hemorrhage(18.37%), unspecified cerebrovascular diseases(16.50%), and subarachnoid hemorrhage(2.92%). When the group of patients with unspecified cerebrovascular diseases was used as the reference group, the odds ratio of patients with cerebral infarction, cerebral hemorrhage, and subarachnoid hemorrhage increased by 2.07(confidence interval [CI]=2.00-2.14), 5.80(CI=5.57-6.03), and 9.66(CI=9.06-10.29) fold, respectively. Exploring patients in medical institutes of different levels revealed that the 2-year odds ratio of inpatients with stroke in medical center was 0.94 times that of their counterparts in regional hospital. The occurrence rate of stroke increased by 0.06 when patient age increased by 1 year. The odds ratio of male patients experiencing stroke was 1.1 times that of female patients. The odds ratio of stroke patients living in urban regions was 0.94 times that of their counterparts living in rural regions.
Conclusion. In Taiwan, the occurrence rate of stroke was higher in men than in women. Cerebral infarction was the most common stroke subtype(62.21%). The 2-year odds ratio of patients was affected by stroke subtype, age, sex, place of residence, and level of medical institute providing treatment.