健康檢查對老人高血壓及糖尿病之自我認知率、治療率和控制率的影響

The Effect of Health Examination on Awareness, Treatment and Control Rate of Hypertension and Diabetes Mellitus among Older People

目的：根據衛生福利部統計，2016年國人十大死因當中糖尿病和高血壓分居第五位和第八位，已經嚴重地威脅現在國民的健康。本研究藉由分析台北市接受老人健康檢查族群的高血壓及糖尿病盛行率、自我認知率、治療率及控制率，分析健康檢查所帶來的效益。方法：本研究採回溯性世代研究（retrospective cohort study），研究2008-2014年至台北市立聯合醫院仁愛院區接受老人健康檢查的長者中高血壓、糖尿病盛行率的變化；並追蹤接受兩次老人健康檢查的次族群中對於這兩種疾病的自我認知、治療及控制率的改變。結果：初步研究樣本共9,017個曾參加至少一次健檢的老人中，符合高血壓定義的盛行率為58.1%、自我認知率為79.6%、治療率為76.6%、控制率則是48.9%；符合糖尿病定義的盛行率為17.4%、自我認知率為78.7%、治療率為74.3%、控制率則是47.3%。而針對5,209位參加至少兩次健檢的次族群，於第一次健檢中符合高血壓定義但無自我認知的648位老人，在第二次檢查時的自我認知率則有17.6%；符合高血壓定義但未接受治療的749位老人，在第二次檢查時則有23.1%已接受治療；未達控制標準的963位老人中，在第二次健檢能達到目標的則達到49.6%。糖尿病的部分，對於第一次健檢中符合糖尿病定義但無自我認知的183位老人，在第二次檢查時的自我認知率則有32.8%；符合糖尿病定義但未接受治療的220位老人，在第二次檢查時則有38.6%已開始接受治療；未達控制標準的307位老人中在第二次健檢能達標的則達35.8%。結論：針對65歲以上老人安排每年乙次之健康檢查，在後續追蹤的統計數據中發現，的確能有效加強長者族群對於高血壓及糖尿病的自我認知率、治療率、甚至控制率，希望後續的追蹤研究能進一步呈現長期降低心血管、腦血管傷害和腎臟疾病的效果。 Background: According to the statement of the Ministry of Health and Welfare in 2016, diabetes mellitus and hypertension were the 5th and 8th among the top ten leading causes of death. We assessed the prevalence, awareness, treatment and control rates of the senior citizens who participated in health checkups in Taipei City to analyze the benefit these health checkups can provide. Methods: This is a retrospective cohort study. We studied changes in the prevalence of hypertension and diabetes mellitus of the senior citizens who participated in the annual elderly health checkups held in Taipei City Hospital Renai Branch from 2008 to 2014. We also followed up the changes in awareness, treatment, and control rates of these two diseases in the subgroup of participants who participated in the health checkup for two or more times. Results: Among the study group of 9,017 cases who participated in health checkups at least once, the prevalence, awareness, treatment, and control rates for hypertension were 58.1%, 79.6%, 76.6%, and 48.9%, respectively, while those for diabetes were 17.4%, 78.7%, 74.3%, and 47.3%, respectively. Furthermore, among the subgroup of 5,209 cases who underwent the follow-up health checkups, we observed 17.6% awareness in the 648 cases who were unaware of hypertension in the first checkup, 23.1% treatment rate in the 749 cases diagnosed with hypertension but without treatment in the first checkup, and 49.6% control rate in the 963 cases who had not reached treatment goal in the first checkup. Meanwhile for diabetes mellitus, we observed 32.8% awareness in the 183 cases who were unaware of diabetes in the first checkup, 38.6% treatment rate in the 220 cases diagnosed with diabetes but without treatment in the first checkup, and 35.8% control rate in the 307 cases who had not reached treatment goal in first checkup. Conclusion: The annual health checkup for elderly aged 65 and over does increase the awareness, treatment and control rates of hypertension and diabetes mellitus effectively. We hope in future follow up studies, we could demonstrate the long-term impact on reducing cardiovascular and cerebrovascular damage and kidney disease.