台灣慢性肝病與肝硬化死亡率之年齡–年代–世代分析(1976-2005)

Age-Period-Cohort Analysis of Mortality of Chronic Liver Disease and Liver Cirrhosis in Taiwan, 1976-2005

目的：全世界的慢性肝病與肝硬化的罹病率與死亡率都在增加，慢性肝病與肝硬化仍是台灣的前十大死因。本研究擬探討台灣肝硬化死亡率的變化是否代表著短期的波動或是一個新興的長期下降趨勢。

方法：我們進行了一個年齡–年代–世代分析，以探討1976年到2005年肝硬化死亡率的趨勢。我們一共分析了103,871個年齡大於40歲的肝硬化死亡個案（75,540例男姓、28,331例女姓）。

結果：顯示這三十年當中，60歲以上者肝硬化死亡率有逐年下降趨勢，在85歲以上年齡層，男女性肝硬化死亡率分別是40歲至44歲者的是7.47倍（95%信賴區間為6.24-8.94倍）與25.0倍（95%信賴區間為15.5-40.2倍）。2001年至2005年的男性死於肝硬化的危險是1976年至1980年代的1.36倍（95%信賴區間為1.23-1.50倍），2001年至2005年女性死於肝硬化的危險是1986年至1990年代的1.42倍（95%信賴區間為1.17-1.72倍）。1936年左右出生者肝硬化死亡率最高。不同的年齡層的男女性都有不同的年齡效應，年齡在90歲至94歲者慢性肝病與肝硬化死亡率分別為30歲至34歲者之12倍與66倍。年代效應分析發現，不管男性或女性，自2004年起台灣的慢性肝病與肝硬化之死亡率皆在下降。世代分析發現，1891年至1940年出生的男性之慢性肝病與肝硬化死亡率呈現下降趨勢，但是同一出生世代女性之慢性肝病與肝硬化死亡率卻呈現上升。1950年以後的出生世代之慢性肝病與肝硬化死亡率都呈現上升趨勢。

結論：本研究結果認為，很多肝硬化的重要決定因子在出生早期就已經出現，而到之後才顯示其作用，台灣經過全國B型肝炎防治已經顯示成效，但仍有其他導致慢性肝病與肝硬化之因素需繼續努力。

 

Purpose: Globally, the morbidity and mortality of chronic liver disease and cirrhosis are increasing. Chronic liver disease and cirrhosis were the 10th leading cause of death in Taiwan. To investigate whether the recent change of liver cirrhosis mortality in Taiwan represented a short-term fluctuation or an emerging long-term decline trend.

Methods: We conducted an age-period-cohort analysis to show the trends of liver cirrhosis mortality during 1976-2005. A total of 103,871 mortality cases (75,540 males and 28,331 females) of liver cirrhosis, aged ≥ 40 were used in the analysis.

Results: The results revealed a decreasing secular trend in liver cirrhosis mortality over the last three decades on those aged 60 and above. In the age group of 85+, the mortality rate is 7.47 (95% CI: 6.24-8.94) and 25.0 (95% CI: 15.5-40.2) times that of the youngest age group (40-44), for males and females, respectively. The relative risk of dying from liver cirrhosis in 2001-2005 is 1.36 (95% CI: 1.23-1.50) times for males compared to the 1976-1980 time periods, and 1.42 (95% CI: 1.17-1.72) times for females compared to the 1986-1990 time periods. Those born around 1936 had the highest risk of dying from liver cirrhosis. The age effects showed differential age gradients between two sexes. The mortality rates for chronic liver disease and cirrhosis in the oldest age group of 90-94 were 12 and 66 times greater than in the youngest age group of 30-34 for men and women, respectively. The period effects showed that the mortality rates for chronic liver disease and cirrhosis were declining from 2004 for both sexes. For the birth-cohort effect, the mortality rates of chronic liver disease and cirrhosis were decreasing in men but increasing in women from 1891 to 1940 birth cohort, and both sexes all increase after 1950 birth cohort.

Conclusion: These findings imply that some important determinants of liver cirrhosis might occur early in life and operated their effects some time later. There was some effect after national hepatitis B prevention project in Taiwan, but still need some effort to control other factors that induce chronic liver disease and cirrhosis.