12卷4期

• Link 原著 Original Article
• 引言Forward
• 王榮德
  Jung-Der Wang
• 無
  none
• 無
  none
• 325 - 325
• 10.6288/JNPHARC1993-12-04-01

• Link 原著 Original Article
• 用流行病學方法研究毒性化學物質所引起之疾病Use of Epidemiologic Methods in Studying Diseases Caused by Toxic Chemicals
• 王榮德
  Jung-Der Wang
• 流行病學 ； 雙啶 ； 鉛中毒 ； 皮膚癌
  epidemiologic method ; bipyridyl ; lead poisoning ; skin cancer
• 流行病學方法原用於研究人類疾病及其決定因子，特別是病因。由於臺灣未有一個類似「物質安全資料表」的危害通識系統，臨床醫師甚難診斷毒化物所引起之病。我們使用流行病學方法基本原則－猜測與否證，運用推翻假說的方式在過去10年間診出10種職業病。本文中以找出某種職業性皮膚癌之病因雙啶及異構物做例子來說明此方法，此外，流行病學方法也可以幫助我們找出早期診斷之標準與預估可能的健康危害。最近我們發現某鉛回收廠有31位（約50%）工人鉛中毒，且其旁之幼稚園小孩鉛吸收增加而智商下降，搬離工廠二年後才恢復。以上敘述二例子作為流行病學方法研究環境毒物之示範。
  Epidemiologic methods are primarily used for the study of the determinants and occurrence of human illnesses. They have also been applied widely for the discovery of etiologic agents. Because we did not implemented a system of hazard communication e.q. material safety data sheet (MSDS) in Taiwan before 1991, it has been relatively difficult for clinicians to recognize diseases caused by toxic chemicals. By carefully falsifying alternative hypotheses, we have documented 10 kinds of diseases caused by industrial toxic chemicals during 1 983-1992 through the application of epidemiologic methods, which can be considered as a game of conjectures and refutations. We shall share this experience on the documentation of bipyridyl and its isomers as the cause of occupational skin cancer. Epidemiologic methods can also be used to set up early diagnostic criteria and to quantitatively assess the health risk of potential hazards. We have recently found 31 cases (48% of all examined workers) of lead poisoning in a lead recycling factory, and found both an increased lead absorption and a decreased intelligence quotient (IQ) of kindergarten children nearby the factory. Their blood leads decreased and IQ improved significantly after being moved 2 kilometers away from the factory for 2.5 years. These two examples illustrate how the epidemiologic methods can be used on the study and prevention of diseases caused by toxic chemicals.
• 326 - 334
• 10.6288/JNPHARC1993-12-04-02

• Link 原著 Original Article
• 台灣職業醫學五十年之回顧Occupational Hepatic, Renal, Neurological, Hematologic, Dermatologic, Cardiovascular and Musculoskeletal Diseases in Taiwan
• 劉紹興、顧天倫、徐尚為、陳明宏、林春蓮、 陳麗美
  Saou-Hsing Liou, Tyan-Luen Gu, Shang-Wei Hsu, Ming-Hon Chen, Chuan-Lian Lin, Li-Mei Chen
• 職業病 ； 毒性化學物質 ； 職業史
  occupational diseases ; toxic chemicals ; occupational history
• 工業化的結果造成工業界大量使用有毒物質。這些有毒物質沒有標示正確的成分，加上雇主和勞工缺乏正確使用的知識，勞工可能經由呼吸道，腸胃這或皮膚吸收有毒物質而造成各種器官系統疾病。向於台灣職業病醫師的不足，過去被診斷的病例不多；本文收集近五十年報告的職業疾病，藉此提醒各科醫師把職業因素列入鑑別診斷。中毒性肝炎是最常見的職業性肝臟疾病，被報告的肝臟毒物包括四氯乙烷、四氯化碳、二甲基甲醯胺和氯仿。另外，氯乙烯和油漆或黏膠中的混合有機溶劑亦被發現會造成肝功能異常。肝臟毒物也是腎臟毒物；除此之外，重金屬如鎘、汞亦被發現造成腎功能異常。周邊神經毒物被報告者有正己烷，鉛和二硫化碳。機械性的壓迫如射擊或重覆動作亦會造成周邊神經病變。硫化氫，一氧化碳，錳和有機溶濟則被發現造成中樞神經病變。職業性血液疾病中較常見的是苯造成的再生不良性貧血；鉛也是造成貧血的毒物之一。另外，Aniline染料會造成變性血紅素症。職業性皮膚疾病，是次常見的職業病，但台灣被診斷的職業性皮膚病例不多。肌肉骨骼關節病變是第一常見的職業疾病，但缺乏系統性的調查其發生情形，僅有的報告也衹是小型工業而己。心臟血管疾病一般不被認為與職業有關，但噪音被發現與血壓增高有關。這些報告的病例數目可能嚴重低估台灣職業病的嚴重程度；要正確診斷職業病就是詢問職業史，臨床醫師多花一兩分鐘詢問工作史可能就會香現許多的職業病例。
  With industrialization, many toxic substance was used in various kinds of industries. Without knowledge of the contents and improper handling of these toxic chemicals may lead to occupational diseases through the routes of respiratory, gastrointestinal tracts or skin. The occupational diseases have seldom been recognized in Taiwan on account of shortage of occupational physicians. This article is to collect the occupational diseases reported in Taiwan in order to provide the information in recognizing occupational diseases. Toxic hepatitis is the most common occupational liver diseases. The causing agents which have been documented in Taiwan included tetrachioroethane, carbon tetrachloride, dimethyl formamide and chloroform. Vinyl chloride monomer and mixed organic solvents used in paint or glue were found to cause hepatic dysfunctions. Hepatic toxins may also cause renal damage. Heavy metals, e.g. cadmium and mercury were found to be renal toxins. n-Hexane, lead and carbon disulfide have been documented to cause polyneuropathy. Mechanical compression induced by target shooting and repetitive movement may lead to peripheral neuropathy. Hydrogen sulfide, carbon monoxide, manganese and organic solvents have found to cause central neuropathy. Benzene induced aplastic anemia was the well known occupational hematologic diseases. Lead poisoning may also be manifested with anemia. Methemoglobinemia induced by aniline have been found in dye workers. Contact dematitis is usually the second common and musculoskeletal disorder is the first common occupational diseases. However, few of these two diseases were reported to be associated with occupations. Cardiovascular diseases are too common to be considered as occupational diseases. But, noise exposure has been found to be related to hypertension. The number of occupational diseases currently recognized in Taiwan is considered to be seriously underestimated. All the physicians should bear in mind that a few minutes of questioning about occupational history will often reveal a large number of occupational illnesses.
• 335 - 353
• 10.6288/JNPHARC1993-12-04-03

• Link 原著 Original Article
• 1985-1990年職災殘廢累積發生率及原因之分析Determinants and Trends of Occupational Disability Rates in Taiwan during 1985-1990
• 劉益宏、王榮德
  Yi-Hung Liu, Jung-Der Wang
• 職業傷害 ； 累積發生率 ； 職災殘廢
  Occupational injury ; Cumulative incidence rate ; Occupational disability
• 勞工職業傷害事件的發生率極高，本文目的在於探討歷年職災殘廢的原因、累積發生率及其變遞。所分析的對象係1985-1990年間，發生職災殘廢尚勞工保險局核付殘廢給付的34416名勞工。平均每年有5736位勞工發生職災殘廢；其中75.1%屬於製造業，7.3%礦業，5.1%為營造業。其平均年齡為35.6±13.0歲。由於被夾、被壓、被捲所致者佔75.2%，由於被刺、割、擦傷者佔9.1%，而物體飛落倒塌與交通意外事故分別佔4.8%及4.1%。男性勞工職災殘廢千人發生率，1985年為1.95，至1990年降為1.08；其15-65歲累積發生率，則從1985年之0.118降至1990年之0.063。男性勞工之今生率，約四倍於女性勞工。男性勞工之年齡別殘廢發生率，以16-20歲最高；女性則是40-55歲之間最危險。肇事之媒介物以一般動力機械最多，尤以金屬沖床發生頻率最高。殘廢嚴重程度屬於重度者佔2.3%，中度佔16.5%，其餘81.2%則屬輕度殘廢。各業別之職災殘廢累積發生率，以礦、土石採取業最高，製造業及營造業居次。除了礦、土石採取業及運輸倉儲業外，其餘各單一行職業之職災殘發生率歷年來改善有限。勞工職災殘廢率雖然六年內約下降一半，但工人數最多的製造業，其15-65歲累積發生率，男工只由1985年之0.136降至1990年之0.092，女工由0.046降至0.028，由於這期間所增加的勞工，以職災殘廢率較低的商業與服務業為主；因此勞力市場中，低危險性勞工人。比例之增加應為整體職災殘廢率下降的主因之一。未來預防職業傷害，應著重於職災殘廢發生率偏高之行職業勞工；尤以年輕缺乏職業訓練之男工或操作衝壓機械之製造業勞工最需加強傷害管制。
  To explore the nature of work-related injuries, we collected and analyzed 34,416 records of occupational disabilities from the Labor Insurance Bureau of Taiwan. The study period ranged from January 1985 till August 1991. Sex-, year- and age-specific incidence rates and cumulative incidence rates of occupational disability were calculated. About fifty hundred workers are physically handicapped due to occupational injuries each year. Of these workers, 75.1% belong to manufacturing industry, and 7.3% were from mining and quarrying industry; 5.1% were of construction industry. The rate ratio of male workers to female workers is about 4:1. Average age (±standard deviation) of disabled workers is 35.6±13.0. Most of these events are caused by crushing (75.2%) and stabbing (9.1%). The incidence rates have steadily declined after adjustment for age and gender since 1985. The cumulative incidence rate of 15-65 year of age among male workers in 1985 and 1990 are 0.118 and 0.063, respectively. After stratification by type of industry, we found that other than mining, quarrying, and transportation, most industries did not show a marked decline. Instead, the decrease of disability rates in the past years can be partially attributed to the increased enrollment of labor insurance among low risk workers in service and commerce industries. Male workers of 16-20 years old and female workers of 40-55 years of age have the highest disability rate. Mechanical injuries (70.5%), especially those caused by press machines, were the most common etiology. 81% of disabled workers were physically able to return to work, Among the high risk occupations were: press machine operators, workers of mining and quarrying, workers of manufacturing and construction industries. We recommend that effective control measures should be developed on them.
• 354 - 367
• 10.6288/JNPHARC1993-12-04-04

• Link 原著 Original Article
• 機動車交通事故之死亡率、潛在生命年數損失及其貨幣價值The Mortality Rate, Years of Potential Life Lost and Its Monetary Value of Deaths Caused by Motor Vehicle Accidents
• 陳立慧、林茂榮、王榮德
  Li-Hui Chen, Mau-Roung Lin, Jung-Der Wang
• 機動車意外事故 ； 潛在生命年數損失 ； 經濟損失
  Motor Vehicle Accidents ; YPLL Years of Potential Life Lost ; Cost
• 本研究乃利用行政院衛生署、臺灣省衛生處、及內政部之生命及人口統計資料與行政院主計處和經濟建設委員會合編之臺灣地區人力運用調查報告中之性別、年齡別國民平均薪資所得，計算1972至1990年間，因惡性贅瘤、腦血管疾病及機動車交通事故所造成之死亡率、潛在生命及薪資損失。結果發現過去19年來，機動車交通事故造成之累積死亡率有逐年上升之趨勢、1972、1981、1990年之終生累積死亡率各為1.51%，2.97%，及3.28%。潛在生命年數損失(years of Potential life lost; YPLL)上，機動車交通事故在1972、1981、1990年的損失各為每千人5.82，12.14，及13.50年，損失年數比惡性贅瘤稍低，但卻高淤腦血管疾病。在潛在工作年數(working years of potential life lost; WYPLL)及價值年數損失(valued years of potential life lost; VYPLL)計量中，損失最多的約為機動車交通事故。而潛在薪資所得損失上，1990年時，機動車交通事故、惡性贅瘤及腦血管疾病死亡所造成的損失，分別為183、173、及63億元。以上只是死亡的部分，尚未計算醫療及其它種種無形損失如果再加上受傷的部分則損失更為龐大。參照警政署的資料，發現車禍後24小時內死亡之比率持續下降，從1972年的91%降到1989年的52%：但本研究之結果，終生累積死亡率則有持續上升的趨勢，顯示只改善院內急放醫療服務、無法實際降低死亡率，未來更須從預防及改善院外急救服務著手。吾人建議政府應多分配資源於機動車交通事故之防治，以減少社會損失。
  The objectives of this paper are to measure the mortality rates, years of potential life lost (YPLL's) and the loss of income from the death of motor vehicle accidents during 1972-1990, and to compare with those from malignant neoplasms and cerebrovascular disease (CVA). Data of demography (sex-, age-, specific population) and mortality were obtained from vital statistics, while income data were abstracted from the National Statistical Department and adjusted for annual productivity increase rate, discount rate, labor force participation rate, and unemployment rate. The result show that the time trend of cumulative mortality rate (CMR) from motor vehicle accidents has steadily increased during the last 19 years. The CMR before age 75 are 1.5 1%, 2.97%, and 3.28% in 1972, 1981, and 1990. The YPLL's from motor vehicle accidents are less than those from malignant neoplasms but greater than those from CVA. However, the WYPLL's (working years of potential life lost) and VYPLL's (valued years of potential life lost) from motor vehicle accidents are greater than those from the other two causes of death. The time trend of these YPLLs, WYPLLs, and VYPLL's from motor vehicle accidents have also increased during this period. The YPLL per 1,000 population are 5.82, 12.14, and 13.50 years in 1972, 1981, and 1990. The loss of wage income in 1990 from motor vehicle accidents, malignant neoplasms and CVA are estimated to be NT$18.3, 17.3 and 6.3 billions; but the numbers do not include the costs of medical and other impact of the family and society. We have also found that the first 24 hour mortality rates of motor vehicle accidents have decreased from 91% in 1972 down to 52% in 1989, which indicates an improvement of post-hospital emergency care. We conclude that our society should allocate more resource on the prevention of motor vehicle accidents and future research and policy should focus more on pre-hospital care and preventive strategy as well.
• 368 - 379
• 10.6288/JNPHARC1993-12-04-05

• Link 原著 Original Article
• 1971-1990年間臺灣地區火災事故累積死亡率及潛在生命年數損失之變化Cumulative Mortality Rate and Years of Potential Life Loss Due to Fire in Taiwan during 1971-1990
• 莊昭華、劉益宏、王榮德
  Chao-Hua Chuang, Yi-Hung Liu, Jung-Der Wang
• 火災 ； 潛在生命年數損失
  Fire ; YPLL years of potential life lost
• 以死亡率來估計一個社會的健康狀況，乃將不同年齡之死亡者，視為對社會有相同之衝擊，而潛在生命損失則考慮在不同年齡死亡時，社會所損失之人年數，可較準確的估計某死因所帶給社會之衝擊。本文之目的在探討20年來，臺灣地區因火災意外事故死亡之累積死亡率、潛在生命年數損失和其生產力損失之趨勢。本文乃利用行政院衛生署之生命統計資料，計算1971-90年間，臺灣地區因火災意外事故死亡之潛在生命年數損失、潛在價值年數損失及潛在工作年數損失。除此之外，尚利用標準化潛在工作年數損失及按1986年消費者物價指數調整過之受僱員工每人每月平均薪資所得兩者相乘，求出歷年之薪資損失。結果中顯示在過去20年來，臺灣地區因火災意外事故死亡之人數增為3倍，0-74歲之累積死亡率增為2倍左右。1990年因火災意外事故致死者，其潛在生命年數損失為17,825人年，潛在價值年數損失為5,377人年，潛在工作年數損失為11,481人年，薪資所得損失為2.5億元。由火災意外事故致死的各項標準化潛在生命年數損失及薪資損失來看，有逐漸增加之趨勢。以上尚未將因火災意外事故之財物損失及未致死者之醫療、所得損失，和因火災意外所造成之社會、家庭變化之損失估算在內，否則因火災意外所引起之損失會更加龐大。吾人實應多用心於火災之防治，以減少社會、家庭及個人之損失。
  Mortality rates have been a major index of health status in a community for decades. They describe the number and rates of death due to different causes in a population, but were unable to represent the total social impact resulting from this cause. YPLL (years of potential life lost), in contrast, is presented as an index that focuses more on the social and economic consequences of mortality. The purpose of this study is to determine the 20-year time trends and economic loss of cumulative mortality rates and YPLL's due to fire. We calculated the YPLL, WYPLL (working years of potential life lost), VYPLL (valued years of potential life 1os of fire mortality during the 1971-90 period in Taiwan. Besides, we also computed the human capital loss by multiplying the WYPLL with the salary (adjusted for consumer price index) of the particular calendar year. The results showed that the number of death and cumulative mortality rates (0-74) due to fire increased to 3, and 2times, respectively, during the last 20 years. YPLL's of the death caused by fire also increased to about more than 2 times. In 1990 alone, YPLL, WYPLL, and VYPLL due to fire accidents are 17, 825, 11, 481, 5, 377 person years respectively. The human capital loss is estimated to be NT$ 0.25 billion by income alone, if counting the loss of the psychological influence and finance of the family and society, the impact of fire will become even greater and deserve future studies. We conclude that our health policy should also focus on the prevention of fire accidental events to minimize the damage of individuals and society.
• 380 - 391
• 10.6288/JNPHARC1993-12-04-06

• Link 原著 Original Article
• 1974-1990年間臺灣地區中毒累積死亡率及潛在生命年數損失之趨勢1974-1990?????????????????????????
• 趙文霙、劉益宏、王榮德
  Wen-Ying Chao, Yi-Hung Liu, Jung-Der Wang
• 中毒 ； 潛在生命年數損失 ； 潛在工作年數損失
  Poison ; YPLL Years of Potential Life Lost ; WYPLL Work Years of Potential Life Lost
• 臺灣地區化學工業發達，化學品之使用廣泛，每年平均約有1600人因中毒而死亡，本研究的目的，乃利用行政院衛生署之生命統計資料，分析1974年至1990年間，因為中毒死亡所造成的粗死亡率、標準化死亡率及累積死亡率的變化趨勢，並以潛在生命年數損失之計算方法來估算生產力的損失。分析結果發現1974-1990年間，國人由於中毒死亡之死亡率，男性略高於女性，平均約為萬分之一。其0-74歲之累積死亡率，則約為百分之一，在五項中毒死因中，毒物咬傷致死者已大量減少，可能是近年都市擴大，減少毒物樓習地，且毒蛇血清也已充分發明及使用。「以固體及液體物質或以家用瓦斯或其他氣體及蒸氣自殺或自為中毒」所造成的潛在生命損失年數為所有中毒死亡死因中最高者，但有逐年下降之趨勢；在「以團體及液體物質或以家用瓦斯或其他氣體及蒸氣意外中毒」此項死因中，男性所造成的潛在生命年數損失一直無下降，而女性在近年則逐年下降；而男性及女性在「藥品、藥物及生物製劑之意外中毒」的死因中，所致之潛在生命年數損失於1990年反而增加。中毒死亡所致之潛在生命損失，每年達6萬人年左右，而每年所損失的薪資額高達71億元。推測其原因，可能是職業與環境上各種新化學藥劑的接觸，又缺乏物質安全資料表，在意外中毒時搶救不及；但醫藥發達，使因意外及蓄意自殺而死亡的人數逐年減少。我們建議上述原因應儘快改善，以減少社會的損失。
  Because chemicals and pesticides are widely used in Taiwan, there are about one thousand and six hundred deaths due to poisoning each year. The purpose of this study is, using the published vital statistics by health administration of Taiwan government, to determine the time trend of crude, standardized, and cumulative mortality rates and years of potential life loss (YPLL) due to poisoning during 1974-1990 in Taiwan. The annual mortality rate was around 1×10^(-4) during this period. The mortality rate of male was slightly higher than that of female. The cumulative mortality rate of 0-74 years of age was about 0.01. Among the five main causes of death due to poisoning, snake or insect bits have a major decrease. The YPLL due to poisoning or suicide caused by solid, liquid or vaporized chemical or gas is the highest. However, the deaths due to this cause also showed a tendency of decline. The tendency was prominent in female but not in male. Deaths and YPLL due to unintentional poisoning of drugs or biomedical substances were increased in 1990. The annual YPLL due to poisoning was about sixty thousand person-year. The salary loss equivalent to the YPLL was seven billion and one hunhard million New Taiwan dollars each year. Thus the prevention of poisoning is an important issue and more effort should be done on it.
• 392 - 404
• 10.6288/JNPHARC1993-12-04-07

• Link 原著 Original Article
• 1974-90年間臺灣地區老年人口意外災害死亡率及潛在生命損失之分析Trends in Mortality Rates and Years of Potential Life Lost Due to Elderly Accidents in Taiwan from 1974 to 1990
• 邱淑媞、曹昭懿、王榮德
  Shu-Ti Chiou, Jau-Yih Tsauo, Jung-Der Wang
• 意外災害死亡 ； 老化 ； 累積死亡率 ； 潛在生命損失 ； 標準化潛在生命損失
  Accidental deaths ; Aging ; Cumulative mortality rate ; Years of potential life lost YPLL ; Standardized YPLL
• 隨著老年人口之增加，老人之醫療照護問題日益重要。意外災害是六十五歲以上老人之第六大死因，也是老人醫療照護的重要問題之一。本研究分析自1974年至1990年問臺灣地區意外災害之死亡資料，以粗死亡率、65-84歲之累積死亡率及標?化潛在生命損失等三種指標，作性別、年齡別、死因別與年代別之比較，並與腦血管疾病、惡性腫瘤、及心臟病之長期趨勢對照。結果發現，老人意外災害之死亡率，隨年齡之增加而升高；男多於女；以事故種類來看，男女之排行依序為：機動車交通事故、意外墜落、意外中毒及溺水、火災。各事故除溺水外，其餘在男女兩性均大致呈上升之長期趨勢。與腦血管疾病、惡性腫瘤及心臟病比較，意外災害之死亡率雖較低，但其近年來上升比例最大；惡性腫瘤在老人之死亡率亦呈上升趨勢，心臟病之變化不明顯，而腦血管疾病則逐年降低。以上結果，用前述三種死亡指標比較，所得之結論相同。
  Problems in geriatric health care delivery are becoming more and more important as the elderly population of our country grows. Accident is the sixth commonest cause of death among people aged 65 and over. We analyzed mortality data of accidents in Taiwan from 1974 to 1990. Crude and cumulative mortality rates (65-84 years) and the standardized years of potential life lost (SYPLL) were calculated for comparisons between sexes, and among five major causes of accidents. The time trend of all-cause accident was also compared with those of cerebrovascular diseases (CVD), malignancies, and heart diseases (HD). The result showed a consistent trend that the older the age, the higher the mortality rate due to accidents. Males are more likely to die of any of the 5 major causes of accidents than females. The rankings of mortality rates for 5 major accidents are as follows: motor vehicle accidents, accidental falling, accidental poisoning, drowning and submersion, fire and flames. All these accidents showed an increasing secular trend in both sexes, except drowning and submersion. Although the cumulative mortality rates and SYPLL's caused by accidents during 1974-90 are generally lower than those of CVD, malignancies, and HD, the rate of increase in these two indicies caused by accidents are the highest. We conclude that appropriate preventive programs should be implemented for such accidents among elderly in the future.
• 405 - 420
• 10.6288/JNPHARC1993-12-04-08

• Link 原著 Original Article
• 1964-1990年間台灣地區兒童意外事故死亡趨勢及潛在生命損失分析Mortality Trend and Years of Potential Life Loss (YPLL) of Accidents in Children in Taiwan during 1964-1990
• 吳明玲、季瑋珠、王榮德
  Ming-Ling Wu, Wei-Chu Chie, Lung-Der Wang
• 意外事故 ； 潛在生命年數損失
  Accidents ; YPLL
• 意外事故死亡，為兒童期第一大死因，由於意外事故導致死亡的1-19歲兒童每年約在二千五百人左右。本文以1964年至1990年的死因資料為基礎作分析，探討兒童事故死亡的重要性及長期趨勢，並計算其死亡率及潛在生命損失(YPLL)。結果發現自1964年至1990年，1-19歲兒童總死亡率幾呈直線下降趨勢，而意外事故死亡率則保持穩定，使得意外事故占總死亡比例呈直線上升趨勢，由19%升高至60%。最近五年兒童意外死亡的潛在生命損失，平約每年高達16.5萬人年，性比（男／女）＝2.0。1990年最常見的五項死因依序為機動車事故(51%)、溺水(25%)、火災(4.7%)、中毒(3.2%)、墜落(3.2%)；意外事故累積死亡率，男性為0.95%，女性為0.41%。依年齡層區分，各年齡層的前二死因、潛在生命損失及其性比如下：1-4歲－(1)溺水(41%)，1.4萬人年，性比＝2.3，(2)機動車事故(34%)，1.2萬人年，性比＝1.0；5-9歲－(1)溺水(38%)，0.9萬人年，性比＝2.8，(2)機動車事故(35%)。0.8萬人年，性比＝1.0；10-14歲－(1)機動車事故(46%)，1.2萬人年，性比＝1.8，(2)溺水(39%)，1.0萬人年，性比＝3.5；15-19歲－(1)機動車事故(68%)。4.7萬人年，性比＝3.2；(2)溺水(13%)，0.9萬人年，性比＝6.6。顯示兒童意外事故死亡已帶給社會及家庭巨大損失，且長期趨勢顯示意外事故的重要性逐年增加；由於我國兒童意外死亡率明顯高於已開發國家，因此建議政府及國人共同研擬兒童傷害事故防治計畫，以有效減少意外事故，達到維護兒童健康的目的。
  The aims of the study were to analyze the mortality trend and the years of potential life loss (YPLL) of children's accidents (age 1-19) in Taiwan during 1964-90. We abstract mortality and population data (1964-90) from Health and Vital Statistics, R.O, C. Age-, sex- specific mortality rate, cumulative mortality rate, proportionate mortality rate and YPLL were calculated to analyze the mortality trend of children's accidents and its influence. Accidents is the leading cause of death in children, which causes about 2500 children's death each year. The proportionate mortality rate due to accidental death increases from 19% to 60% during 1964-90. The average annual YPLL is 165,000 personyear during the past five years, MIF (male/female ratio)=2.0. In 1990, the cumulative mortality rate is 0.95% (M), 0.41% (F). The five leading cause of children's accidents were motorvehicle accidents (MVA), drowning, fires, poisoning and falls, each consisting of 51%, 25%, 4.7%, 3.2%, 3.2% of all accidents in 1990, respectively. According to age group, the two leading cause of death (proportionate mortality rate in parenthesis), its YPLL and sex ratio are as follows: age 1-4: (1) drowning, (41%), 14456 person-year, M/F=2.3, (2) MVA (34%), 12018 person-year, M/F=1.0; age 5-9: (1) drowning (38%), 9152 person-year, M/F=2.8, (2) MVA (35%), 8483 person-year, M/F=1.0; age 10-14: (1) MVA (46%), 12148 person- year, M/F=1.8, (2)drowning (39%), 10243 person-year, M/F=3.5; age 15-19: (1) MVA (68%), 46857 person-year, MJF=3.2, (2) drowning (13%), 9033 person-year, MJF=6.6. Children's accident is an important issue in Taiwan. MVA and drowning have been the highest death risk, which account for three quarters of all accidents. We therefore recommend that more resources and attention need to be drawn on the research and prevention of children's accidents, especially on MVA and drowning.
• 421 - 434
• 10.6288/JNPHARC1993-12-04-09