停經女性醫療利用與生活品質分析

本研究臺灣女性平均停經年齡為 48到 50歲，此階段女性會有生理與心理相關症狀，可能會常因憂鬱或各種不同症狀而找尋醫療上協助，在臨床上，停經中期的婦女甚至被視為醫療利用的重度使用者。除此之外，停經症狀對女性困擾程度因人而異，亦可能影響女性生產力與生活品質。國內外於 2002年美國婦女健康促進計畫研究結果公布後，停經相關研究多在探討婦女使用荷爾蒙療法的相關主題，然而對女性而言，停經不僅會使其聯想到是否需要服用荷爾蒙相關藥品以使症狀得到緩解，同時會衍生出相關醫療利用及生活品質等問題。本研究使用民國 90年國民健康訪問調查資料庫之問卷及其串聯之全民健康保險研究資料庫進行分析，以瞭解民國 90年間停經女性之醫療利用與生活品質概況。首先由資料分析於民國 90年之有無停經症狀女性之各變項描述性分佈。其次利用負二項迴歸分析(Negative Binomial Regression Analysis)探討兩者醫療利用的差異，並使用最小平方迴歸法 (Ordinay Linear Regression, OLS)比較兩者之生活品質差異。研究結果顯示，於女性醫療利用中，有停經症狀者對於總醫療費用、門診醫療費用、門診就醫次數、門診科別利用數皆較高，而於住院醫療費用與住院次數則無顯著差異。此外，有停經症狀者之整體生活品質、生理範疇、心理範疇生活品質皆較高，但是其社會關係、環境品質則兩者無顯著差異。因停經症狀引發之醫療利用中，女性年度與停經相關之差異成本為總醫療費用 3,707.16元、門診醫療費用 3,566.26元、門診次數 13.36次。

Health Care Utilization and Quality of Life among Menopausal Women

A retrospective case-control analysis was performed, using a unique dataset that linked the 2001 Taiwan’s National Health Interview Survey (NHIS) and the 2001 claims data of the National Health Insurance (NHI) with information on insurance claims, socio-demographic characteristics, health behaviors, health status and chronic diseases for the respondents of NHIS. Study cases were women aged 40-65 years who had menopause-related symptoms currently or before and had at least one outpatient medical record in 2001 where the primary or secondary diagnostic ICD-9-CM codes was 627 (n=296). Controls were women aged 40-65 years and without menopause-related symptoms (n=1,909). The difference in medical utilization and quality of life between cases and controls was assumed to be attributable to menopause symptoms. Negative binomial models and generalized linear regression models were performed to examine the differences in the health care utilization and quality of life between the two groups, controlling for demographic characteristics, health behaviors, health status and chronic diseases. The study group had significantly more outpatient visits, outpatient medical expenditures, visit times, total medical expenditures than the control group. In addition, the number of the type of specialty that the study group sought outpatient care from was higher than the control group. The obstetrics/gynecology department had the most uses in study group. Finally, the study group had worse quality of life in physical and psychological domains. The incremental costs of outpatient treatment were 3,566.26 NT dollars, and the total incremental costs were 3,707.16 NT dollars. The incremental outpatient visits were 13.36.