探討中風對台灣地區中老年人醫療服務利用之影響

Influence of Stroke History on Health Care Utilization of The Middle-Aged and Elderly Population in Taiwan

目的：中風是造成中老年人身心障礙的主因。本研究目的在探討中風狀態對台灣地區中老年人醫療服務利用之影響。方法：分析國健署「中老庫身心社會生活狀況長期追蹤調查」2003年及2007年之訪談貢料，研究對象依中風狀態分為「無中風病史組」3207人、「新發病個案組」170人及「既有中風病史組」109人。醫療服務利用指標包括：門診使用、急診使用、住院情形健康檢查及長期照顧服務。以成對樣本t檢定及廣義線性方程式分析三組中老無人在二年度間醫療服務利用之差異。結果：中老無人隨著年齡增長，身心健康功能下降，醫療服務利用增加。「新發病個案組」在罹患中風後，急診及住院使用增加；變化趨勢明顯大於「無中風病史組」。「既有中風病史組」因長期罹患中風，僅接受健康檢查項目之變化趨勢大於「無中風病史組」。結論：老化對於中老年人健康狀況有全面性的影響。中風狀態的改變，導致身體功能顯著下降，急性醫療利用需求增加。本研究以縱貫性分析中風狀態對於中老年身心健康狀況及醫療服務利用之影響，結果可對於政府在社會醫療福利措施和中風患者照護資源等政策規劃上，提供實質且重要的參考依據。

Purpose: Stroke is one of the main causes of elderly disability in physical and mental health. The aim of this study is to investigate the influence of stroke history on health care utilization of the middle-aged and elderly adults. Methods: Subjects who completed the interviews of the 'Survey of Health and Living Status of the Elderly in Taiwan' in both years of 2003 and 2007 were included. According to their stroke history, these subjects were divided into three groups: 3207 subjects never have strokes, 170 subjects got strokes between the two years and 109 subjects got stroke before 2003. The paired-t test and the generalized estimating equations approach were used to analyze the changes and their differences of the health care utilization for the three groups. Results: After 4 years of follow-up, the middle-aged and elderly health care utilization increased. ‘new stroke group’ emergency & hospitalization utilization rates higher than ‘no stroke group’. ‘old stroke group’ health examination utilization rates higher than ‘no stroke group’ between 2003 and 2007. Conclusion: Aging for the middle-aged and elderly had a comprehensive health impact. The changing of stroke status induced physical health disability and acute medical care utilization increased. The study has roughly quantified the impact of strokes on older people and could offer substantial reference materials for planning the social welfare and allocating the resource of health care.