台灣2001-2013年婦女乳房、生殖、泌尿、結直腸腫瘤之門急診利用率趨勢

Ambulatory Care Utilization for Taiwanese Women with Tumors of the Breast, Genital, Urinary or Colorectal System: Trends from 2001-2013

目的：探討台灣女性常見癌症之門急診利用率趨勢。方法：以回溯性動態世代(dynamic cohort)研究法，根據良性腫瘤、原位癌、惡性癌症等三種類別，探討2001-2013年13年間台灣女性的乳房、生殖、泌尿、結直腸腫瘤之全國性門急診醫療利用分佈狀況。結果：乳房、生殖、泌尿、結直腸腫瘤最常發生的年齡為30-59歲，個案數最多者為良性生殖腫瘤、良性乳房腫瘤、惡性乳房腫瘤、惡性生殖腫瘤及惡性結直腸腫瘤。4類惡性腫瘤病人的年平均門診次數及年平均急診次數皆明顯高於非惡性腫瘤病人，相對的門診每人次費用及急診每人次費用也是如此。13年間，門診、急診就診率的平均年百分比變化(average annual percentage change, AAPC)同時呈現顯著增加趨勢的有惡性泌尿腫瘤(AAPC: 1.3%, 0.7%)、惡性結直腸腫瘤(AAPC: 1.0%, 0.8%)及非惡性結直腸腫瘤(AAPC: 0.8%, 1.5%)。4類腫瘤病人的門診每人次費用都呈現顯著的增加趨勢(惡性AAPC: 3.2%-6.1%;非惡性AAPC: 1.2%-5.2%)。以生殖腫瘤為參考值，乳房腫瘤、泌尿腫瘤與結直腸腫瘤的調整後就診發生率比值(Incident rate ratios, IRRs)分別為1.05-1.55, 1.04-1.42和1.00-1.20倍。結論：2001-2013年間，台灣女性乳房、生殖、泌尿和結直腸腫瘤之門急診醫療利用率(含：平均門急診次數、門急診平均每人次費用)皆出現顯著增加趨勢。

Objectives. The aim was to explore the outpatient clinic and emergency care utilization for Taiwanese women with common neoplasms.
Methods. We conducted a retrospective, dynamic cohort study to evaluate the ambulatory care utilization among female patients with neoplasms of the breast, genital, urinary and colorectal systems using nationwide insurance data from 2001-2013 for the neoplasm population in Taiwan. Patients were categorized into three groups according to disease severity.
Results. In the female population of Taiwan, the most common age strata of patients who suffered one of the four female-specific neoplasms studied were 30-44 y/o and 45-59 y/o. The most prevalent neoplasms were benign genital organ tumor and benign breast tumor, followed by malignant breast cancer, malignant genital organ cancer and malignant colorectal cancer. Among the female patients with breast, genital, urinary or colorectal neoplasms, the mean number of OPD or ED visits/year was significantly higher in the malignant cancer group than in the non-malignant group. The related medical expense per ambulatory care visit was also significantly higher in the malignant subgroup than in the non-malignant subgroup. During the 13-year study period, simultaneous increasing trends in the numbers of OPD and ED visits were noted in the malignant urinary cancer group (average annual percentage change, AAPC: 1.3% and 0.7%, respectively, p<0.05), malignant colorectal cancer group (AAPC: 1.0% and 0.8%, respectively, p<0.05) and non-malignant colorectal tumor group (AAPC: 0.8% and 1.5%, respectively, p<0.05). The medical expense per OPD visit exhibited a significant increasing trend in the four locational neoplasms groups, in both the malignant and non-malignant subgroups (AAPC range: 3.2-6.1% and 1.2-5.2%, respectively). Selecting the genital neoplasms group as the reference group, the adjusted incident rate ratios (IRRs) of all ambulatory visits were significant, ranging from 1.05-1.55, 1.04-1.42 and 1.00-1.20 for the subgroups of breast, urinary, and colorectal neoplasms, respectively.
Conclusion. From 2001 to 2013, the female prevalence of cases of breast, genital, urinary and colorectal neoplasms increased year on year in Taiwan. The ambulatory care utilization of the patients, in terms of ambulatory visits (OPD or ED) or medical expense (per OPD visit or per ED visit), exhibited significant increasing trends year on year.