以全民健保資料回溯性分析臺灣糖尿病患者之心血管合併症

Comorbid Cardiovascular Conditions in Diabetic Patients: a Retrospective Study of Data from National Health Insurance in Taiwan

目的：本研究以全民健保資料庫分析台灣地區糖尿病患發生心血管合併症之盛行率及發生率。方法：本研究以國家衛生研究院提供之全民健保壹佰萬人系統抽樣檔為資料來源，為二次資料分析；收集2000至2006年之糖尿病患，以發生心肌梗塞、腦血管疾病及鬱血性心臟衰竭等心血管合併症為觀察標的。結果：糖尿病之盛行率在2000年為千分之二十二，然後以每年千分之五的發生率增加，在2006盛行率已增加為千分之四十三，增加將近一倍。從2000至2006年的糖尿病合併症發生率，以每千人口來看：糖尿病患者合併心肌梗塞且經過冠狀動脈介入治療（包括心導管治療、繞道手術、溶血栓療法），其發生率從2000年為千分之二點一增加至2006年為千分之十一；糖尿病患合併腦血管疾病的為千分之十四點九增加至2006年為千分之二十；糖尿病患合併鬱血性心臟衰竭的為千分之十三增加至2006年為千分之十六點七。本研究同時分析從2000至2006年間，台灣地區40-64歲及65-110歲年齡層，糖尿病患合併心肌梗塞、腦血管疾病及鬱血性心臟衰竭之發生率趨勢成正相關成長，但無統計學之顯著意義；糖尿病患合併心肌梗塞分別在40-64歲及65-110歲年齡層男性發生率高於女性，且達統計學之顯著意義。糖尿病患合併腦血管疾病在40-64歲年齡層男性發生率高於女性，而在65-110歲年齡層女性發生率高於男性，且皆達統計學之顯著意義。糖尿病患合併鬱血性心臟衰竭之女性發生率高於男性，特別是在65-110歲年齡層，且部份年份達統計學之顯著意義。結論：糖尿病患合併心肌梗塞、腦血管疾病及鬱血性心臟衰竭之發生率在過去幾年成正相關成長，男性糖尿病患合併心肌梗塞發生率高於女性，老年女性糖尿病患合併鬱血性心臟衰竭發生率高於男性，至於糖尿病患合併腦血管疾病在不同年齡層男女性發生率不同，顯示過去幾年我們治療糖尿病患減少合併症方面，仍有改善的空間。

Objectives: The aim of this study was to investigate the incidence and prevalence of comorbid cardiovascular conditions among diabetic patients in Taiwan. Methods: This was a secondary analysis of claims data from National Health Insurance of Taiwan from January 1st, 2000 to December 31st, 2006. Patients with diabetes mellitus were identified and we analyzed the occurrence of comorbid cardiovascular conditions, including myocardial infarction, cerebral vascular accident and congestive heart failure. Results: The prevalence of diabetes mellitus in Taiwan was 22 per thousand in the year 2000, and increased steadily by 5 per thousand per year. The incidence of myocardial infarction in diabetic patients increased from 2 per thousand in the year 2000 to 11 per thousand by the year 2006, and was significantly higher in males (p<0.05). The incidence of cerebral vascular accident in diabetic patients increased from 14 per thousand in the year 2000 to 20 per thousand by the year 2006, and was also significantly higher in younger males and older females (p<0.05). The incidence of congestive heart failure in diabetic patients increased from 13 per thousand in the year 2000 to 16 per thousand by the year 2006, but was significantly higher in older females (p<0.05). Conclusions: The prevalence of diabetes mellitus and the incidence of comorbid cardiovascular conditions among diabetics increased in Taiwan during the 7-year observation period. The incidence of myocardial infarction significantly increased in diabetic males and congestive heart failure significantly increased in older diabetic females.