45卷1期

• Link 政策論壇 Policy Forum
• 從校園到制度：台灣青少年檳榔健康風險防制的下一步From campus to system: the next steps for betel nut health risk prevention among Taiwanese adolescents
• 王亮懿
  Liang-Yi Wang
• 無none
  無none
• 無none
  無none
• 001-004
• 10.6288/TJPH.202602_45(1).PF01

• Link 公衛論壇 Public Health Forum
• 從全球健康一體到台灣防疫一體之契機與挑戰From global one health to Taiwan’s pandemic one approach: opportunities and challenges
• 趙黛瑜
  Day-Yu Chao
• 無none
  無none
• 無none
  無none
• 005-010
• 10.6288/TJPH.202602_45(1).114103

• Link 原著 Original Article
• 初發缺血性腦中風之風險分級：動態危險因子之健保資料庫分析Risk stratification for new-onset ischemic stroke: dynamic risk factor analysis using the National Health Insurance Research Database
• 李佩儒、陳東藝、史麗珠
  Pei-Ru Li, Dong-Yi Chen, Lai-Chu See
• 缺血性腦中風、動態危險因子、台灣健保資料研究庫、負二項迴歸、分類迴歸樹
  ischemic stroke, dynamic risk factors, National Health Insurance Research Database, negative binomial regression, classification and regression tree
• 目標：採用健保資料庫與死因檔，建構初發缺血性腦中風的風險系統。方法：採用2011-2019年資料，建立2012-2019年台灣全人口的成人動態世代。涵蓋追蹤期間11個危險因子及缺血性腦中風的每日狀態。執行負二項迴歸，透過點數型風險評分演算法得出風險總分。接著利用分類迴歸樹對風險總分進行分級。結果：總追蹤14,281萬人年，初發缺血性腦中風的發生率為每十萬人年278.58例。風險總分在0至46分間，50-64歲得5分，65-79歲得9分，80歲以上得13分。心房顫動9分、心臟衰竭5分、高血壓5分、糖尿病3分、慢性腎臟疾病3分、周邊動脈阻塞疾病3分、心肌梗塞2分、冠狀動脈疾病2分、男性1分。此模型的解釋力達97.02%。經分類迴歸樹分析後，得3個風險分級：第1級（0-15分）、第2級（16-23分）和第3級（24-46分），此分級模型的解釋力達95.3%。結論：研究結果可協助民眾瞭解個人缺血性腦中風風險，進而採取預防措施。為政府機關與醫療單位提供科學依據，制定更有效的公共衛生策略與優化醫療資源的分配。
  Objectives: We developed a risk stratification tool for first-onset ischemic stroke by using data from the National Health Insurance Research Database and Cause of Death Data. Methods: A dynamic cohort of the entire Taiwanese adult population (2012–2019) was established using the aforementioned data (2011–2019). Daily data on 11 risk factors and ischemic stroke were collected. Negative binomial regression was performed to estimate regression coefficients, and a point-based risk-scoring algorithm was used to calculate a total risk score. Classification and regression tree analysis was performed using the total risk score to derive risk strata. Results: During 142.81 million person-years of follow-up, the incidence of first-onset ischemic stroke was 278.58 per 100,000 person-years. Total risk scores ranged from 0 to 46. Key contributors included age (50–64 years, 5 points; 65–79 years, 9 points; ≥80 years, 13 points), atrial fibrillation (9 points), heart failure (5 points), hypertension (5 points), diabetes (3 points), chronic kidney disease (3 points), peripheral arterial obstructive disease (3 points), myocardial infarction (2 points), coronary artery disease (2 points), and male sex (1 point). The model achieved a pseudo R2 value of 97.02%. Classification and regression tree analysis stratified the total risk score into three levels—Level 1 (0–15 points), Level 2 (16–23 points), and Level 3 (24–46 points), achieving a pseudo R2 value of 95.3%. Conclusions: Our findings may help the public accurately understand individual ischemic stroke risk, enabling them to implement preventive measures. Furthermore, the findings may support government agencies and health-care institutions in developing effective public health strategies and optimizing medical resource allocation.
• 011-026
• 10.6288/TJPH.202602_45(1).114074

• Link 原著 Original Article
• 台灣高齡機車騎士交通事故之時空樣態分析Spatiotemporal patterns of traffic collisions involving older motorcyclists in Taiwan
• 羅奕晴、張雅惠、李中一、許以霖
  Yi-Ching Lo, Ya-Hui Chang, Chung-Yi Li, I-Lin Hsu
• 高齡機車騎士、交通事故、機車、時空分布、樣態特徵
  older motorcyclist, traffic crashes, motorcycles, spatiotemporal distribution, pattern characteristics
• 目標：本研究旨在探討台灣65歲以上機車騎士交通事故的時空分布與事故類型樣態，並分析不同年齡層與性別間的差異。方法：本研究分析2014-2023年台灣警政署交通事故資料，共納入400,350人次65歲以上機車騎士。以描述性分析呈現人次與百分比，比較不同年齡層與性別之差異；並透過潛在類別分析，辨識高齡機車騎士時空環境的潛在類別，邏輯斯迴歸用於進一步分析各類別中的年齡與性別分布差異。結果：高齡機車事故主要集中於65-74歲當事者（71.25%）。男性事故佔比高於女性，此性別差距隨年齡增長更為明顯。三個潛在類別集群分別是（1）無號誌事故群、（2）有號誌路口群、（3）閃光號誌路口群。相較於有號誌路口群，75歲以上、女性與未戴安全帽的騎士，更可能歸屬於無號誌事故群與閃光號誌路口群，其中75-84歲騎士在閃光號誌路口群的勝算比達1.23倍（95% CI = 1.16-1.31）。結論：高齡機車騎士事故的類型主要由地點相關變項所區分，建議相關單位優先改善路口號誌設計與道路引導，以提升高齡者行車安全。
  Objectives: This study investigated the spatiotemporal distribution and crash type patterns of traffic collisions involving older motorcyclists (age ≥ 65 years) in Taiwan. Age- and sex-stratified analyses were performed. Methods: Traffic collision data (2014–2023) from the Taiwan Police-reported Traffic Accident Registry were analyzed. The study sample comprised 400,350 cases of traffic collisions involving older motorcyclists. Descriptive statistics (counts and percentages) were used for age- and sex-based comparisons. Latent class analysis was performed to identify underlying spatiotemporal classes, followed by logistic regression to determine age- and sex-related differences in class membership. Results: Most collisions involved riders aged 65–74 years (71.25%). The rate of collisions was higher among male riders than among female riders; this sex difference widened with increasing age. Three latent classes emerged: an unsignalized crash group (UCG), a signalized intersection group (SIG), and a flashing–signal intersection group (FSIG). Older (age ≥ 75 years), female, and non-helmet-wearing riders were more likely to be classified into the UCG and FSIG than into the SIG. Among them, riders aged 75–84 years had an adjusted odds ratio of 1.23 for classification into the FSIG (95% confidence interval: 1.16-1.31). Conclusions: The types of collisions involving older motorcyclists varied primarily by roadway location–related parameters. Relevant agencies should prioritize improvements in intersection signal design and roadway guidance to enhance the safety of older motorcycle riders.
• 027-038
• 10.6288/TJPH.202602_45(1).114073

• Link 原著 Original Article
• 公共運輸使用頻率與代謝症候群檢查結果異常相關性之多層次分析Correlation between frequency of public transportation use and abnormal metabolic syndrome screening results: a multilevel analysis
• 莊元禎、吳建遠、周燕玉、吳嘉玲、李中一、張雅惠
  Yuan-Chen Chuang, Chien-Yuan Wu, Yann-Yuh Jou, Jia-Ling Wu, Chung-Yi Li, Ya-Hui Chang
• 公共運輸、代謝症候群、身體活動、多層次分析、健康檢查
  public transportation, metabolic syndrome, physical activity, multilevel modeling, health check-up
• 目標：使用公共運輸需步行或騎車往返車站，可增加身體活動量，但其與代謝症候群之關聯仍未明。本研究探討台灣40歲以上成人公共運輸使用頻率與代謝症候群檢查異常的關聯。方法：本研究採橫斷性研究設計，結合2022年成人預防保健服務1,146,485筆健檢結果與交通部日常運具調查作為研究材料。自變項每人每週公共運輸使用時間，依五分位數分為五組。依變項為代謝症候群檢查是否異常。採二元邏輯斯迴歸分析並且結合隨機截距，調整個人層級與區位層級潛在干擾因子，並計算勝算比與95%信賴區間。結果：研究樣本中共335，187人（29.24%）檢查結果異常。與每週公共運輸使用時間極少相比，使用時間最長者代謝症候群異常勝算比顯著較低 （adjusted odds ratio（aOR）= 0.98，95% confidence interval（CI）: 0.96-0.99）。以每週使用時間增加10分鐘分析，檢查結果異常勝算比下降1%（aOR= 0.99，95% CI: 0.99–0.99）。結論：經常使用公共運輸者之代謝症候群異常風險較低，顯示公共運輸可能透過增加身體活動量具健康效益。未來可以縱貫性研究與客觀測量進一步驗證。
  Objectives: Using public transportation frequently involves physical activity such as walking or cycling to and from stations. However, the association between using public transportation and metabolic syndrome remains unclear. The present study examined the association between public transportation use and abnormal metabolic syndrome screening results in adults aged ≥ 40 years in Taiwan. Methods: This cross-sectional study evaluated 1,146,485 health examination records from the 2022 Adult Preventive Health Services Survey and data from the Ministry of Transportation’s Daily Transport Survey. The independent variable in this study was average time spent using public transportation per week per person, categorized into quintiles. The dependent variable was metabolic syndrome screening results. A binary logistic regression with random intercept was conducted to adjust for individual-level and area-level confounders, and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated. Results: In the study population, 335,187 individuals (29.24%) received a routine screening for metabolic syndrome that revealed abnormal results. Compared with the individuals who minimally used public transportation, those who frequently used it had significantly lower odds of abnormal screening results (aOR = 0.98, 95% CI: 0.96–0.99). Furthermore, each additional 10 min of weekly public transportation use was associated with a 1% reduction in the odds of abnormal screening results (aOR = 0.99, 95% CI: 0.99–0.99). Conclusions: Frequent public transportation use is associated with a substantially reduced risk of abnormal metabolic syndrome screening results, and those who use public transportation frequently likely achieve this health benefit through increased physical activity. Future longitudinal studies using objective activity-level measurements are required to validate these results.
• 039-049
• 10.6288/TJPH.202602_45(1).114072

• Link 原著 Original Article
• 衰老作為較少老年憂鬱症狀的相關因子探究：三波台灣國民健康訪問調查之人口趨勢研究Senescence as a correlate of less depressive symptoms among older adults: a population-level trend study using three waves of the Taiwan National Health Interview Survey
• 邱靜如、Andrew Alberth、梁昌璞、蘇彥竹
  Ching-Ju Chiu, Andrew Alberth, Chang-Pu Liang, Yan-Jhu Su
• 飲食、行為醫學、憂鬱症狀、老年人、健康促進
  diet, behavioral medicine, depressive symptomatology, older adults, health promotion
• 目標：探討台灣65歲以上成人在過去十年間憂鬱症狀的趨勢變化，並評估性別在風險與保護因子上的差異。方法：本研究使用台灣2005年、2009年及2013年由國家衛生研究院執行的國民健康訪問調查資料（NHIS）的數據，分析了老年人的憂鬱症狀。這三項調查均為獨立的橫斷面調查。因此，本研究採用重複橫斷面設計，旨在檢視人群層面的趨勢，而非同一群體的縱向變化。共訪談了8,832名65歲以上的老年人。我們使用邏輯迴歸分析了症狀盛行率及相關因素的趨勢和性別差異。關鍵變數包括社會人口統計因素、慢性疾病和健康行為。分析遵循NHIS數據協議，並獲得IRB批准，並豁免知情同意。結果：老年人憂鬱症狀的盛行率從20.6%下降至13.3%（卡方值 = -7.5，p < 0.05）。對男性與女性皆具保護效果的因子包括：85歲以上的高齡、規律運動與較高的社會參與程度，但這些保護因子的效果在男女之間略有差異。碳水化合物攝取過多與憂鬱症狀相關，其中男性的風險（校正後勝算比 AOR = 8.8，95%信賴區間 = 5.1-15.2）高於女性（AOR = 7.9，95% CI = 5.2-11.8）。結論：本重複橫斷面研究辨識出台灣老年人憂鬱症狀的人群層級趨勢。儘管整體盛行率隨調查波次下降，但較低的憂鬱症狀主要出現在男性85歲以上與女性75歲以上的高齡族群，較可能反映選擇性存活與生命歷程中的（U型）年齡模式，而非年齡本身具有保護效果。跨所有調查波次，高碳水化合物飲食與跌倒均持續與較高的憂鬱症狀相關，而規律運動與社會參與則為穩健的保護因子。這些發現支持在台灣進行以族群為基礎的篩檢與標的性介入，以預防晚年憂鬱。
  Objectives: To examine trends in depressive symptoms among adults aged 65+ in Taiwan over the past decade and assess gender differences in risk and protective factors. Methods: This study analyzed depressive symptoms among older adults using data from the 2005, 2009, and 2013 National Health Interview Surveys (NHIS) in Taiwan, which are three independent cross-sectional surveys. The study therefore adopted a repeated cross-sectional design to examine population-level trends rather than longitudinal changes within the same individuals. A total of 8,832 older adults (65+) were interviewed. Using logistic regression, we examined trends and gender differences in symptom prevalence and associated factors. Key variables included sociodemographic factors, chronic conditions, and health behaviors. Analyses adhered to NHIS data protocols and received IRB approval with a waiver of informed consent. Results: The prevalence of depressive symptoms among older adults declined from 20.6% to 13.3% (X2 = -7.5, p < 0.05). Protective factors for both genders included being 85+ years old, regular physical activity, and higher social participation, though these factors differed slightly between men and women. Carbohydrate-rich diets were linked to greater depressive symptoms, with a higher risk for men (AOR = 8.8, 95% CI = 5.1-15.2) compared to women (AOR = 7.9, 95% CI = 5.2-11.8). Conclusions: This repeated cross-sectional study identified population-level trends in depressive symptoms among older adults in Taiwan. Although overall prevalence declined across survey waves, lower depressive symptoms at advanced ages were mainly observed among men aged ≥ 85 and women aged ≥ 75, likely reflecting selective survival and life-course (U-shaped) patterns rather than a protective effect of aging per se. Across all waves, high-carbohydrate diets and falls were consistently associated with higher depressive symptoms, whereas regular exercise and social engagement were robust protective factors. These findings support targeted screening and population-based interventions to prevent late-life depression in Taiwan.
• 050-064
• 10.6288/TJPH.202602_45(1).114040

• Link 原著 Original Article
• 「老來伴？」：探討台灣社會及家庭脈絡下的親密暴力與孤獨感From partners to strangers: association of intimate partner violence with loneliness in later life
• 江佩璇、喬　芷
  Pei-Syuan Chiang, Chi Chiao
• 孤獨感、親密暴力、夫妻關係、中老年、代間關係
  loneliness, intimate partner violence, spousal relationship, older adults, intergenerational solidarity
• 目標：面對即將邁入超高齡社會的台灣，孤獨感成為重要議題，婚姻與家庭連結在緩解孤獨感中扮演關鍵角色，惟親密暴力可能加劇孤獨感。本研究探討中老年父母的親密暴力與孤獨感間之關聯，並納入社會與家庭相關因素進行分析。方法：使用「台灣青少年成長歷程研究」資料庫2000年及2019年調查，分析已婚狀態的中老年父母（n= 1,188），以邏輯斯迴歸模型分析親密暴力與孤獨感的關聯與變項間的影響機制。結果：在控制變項後，親密暴力對情感性孤獨的關聯依然顯著（AOR= 1.69， CI： [1.25， 2.30），對社交性孤獨仍具有一定的風險趨勢，但下降為邊緣顯著（AOR= 1.23， CI： [0.99， 1.51]）。此外，代間情感連帶與早年的家庭凝聚力有助於降低孤獨風險，低社團參與與主觀經濟壓力提升孤獨風險，中老年父母分房睡的孤獨感則顯著高於同床者。結論：即便婚配狀態穩定，親密暴力對情感性孤獨仍具顯著相關，凸顯其長期心理影響不容忽視。政策上應強化家庭情感連帶、增進社會參與，並將親密關係品質與經濟安全納入高齡福祉規劃的考量。
  Objectives: As Taiwan shifts toward becoming a super-aged society, loneliness has emerged as a pressing public health concern. Whereas marital and family ties play a key role in mitigating loneliness, intimate partner violence (IPV) may exacerbate it. This study investigated the association between IPV and loneliness among middle-aged and older parents. Relevant familial and social factors were incorporated into the analysis. Methods: Data were obtained from the 2000 and 2019 surveys of the Taiwan Youth Project. The study cohort comprised 1,188 married middle-aged and older parents. Logistic regression models were used to identify the associations of IPV with two dimensions of loneliness. In addition, the roles of familial and social factors in these associations were investigated. Results: After covariate adjustment, IPV remained significantly associated with emotional loneliness (adjusted odds ratio: 1.69; 95% confidence interval: 1.25–2.30). However, its association with social loneliness became only marginally significant (adjusted odds ratio: 1.23; 95% confidence interval: 0.99–1.51); nonetheless, the elevated risk persisted. Strong intergenerational emotional bonds and early-life family cohesion were associated with a reduced risk of loneliness, whereas low participation in social groups and high perceived financial strain were associated with an elevated risk. Notably, older parents who slept separately from their spouses reported significantly higher levels of loneliness than did those who shared a bed. Conclusions: Our findings suggest that even within long-term marital unions, IPV remains significantly associated with emotional loneliness, which highlights its relevance to psychological well-being in later life. The policy implications of this finding include a need to strengthen intergenerational emotional solidarity, promote social participation, and integrate relationship quality and financial security into aging welfare planning.
• 065-077
• 10.6288/TJPH.202602_45(1).114067

• Link 原著 Original Article
• 社會參與及社會支持對中老年人寂寞感及憂鬱情形的影響Effects of social participation and support on loneliness and depression in middle-aged and older individuals
• 李怡樺、蕭斐元、謝淑惠、譚家惠
  Yi-Hua Lee, Fei-Yuan Hsiao, Shwn-Huey Shieh, Chia-Hui (Elise) Tan
• 中老年人、寂寞感、憂鬱情形、社會參與、社會支持
  middle-aged and elderly individuals, loneliness, depression, social participation, social support
• 目標：分析我國中老年人的社會參與及社會支持對寂寞感及憂鬱情形發生的影響。方法：為回溯性世代追蹤研究，資料來源為2015與2019年中老年身心社會生活狀況長期追蹤調查資料，研究對象為50歲以上中老年人，以廣義估計方程式分析，控制基線社會人口學特質、健康情形與行為、個人經驗與居住地區特質後，分析社會參與（擔任志工經驗、社團或活動參與）及社會支持（情緒支持及訊息支持）對寂寞感與憂鬱情形發生之影響。結果：共3,967人納入分析，相較於無社會參與，有志工經驗的中老年人發生寂寞感的機率為0.81倍，參與社會團體幹部者則是0.73倍，僅參與社會團體者發生憂鬱情形的機率為0.58倍；相較於低社會支持者，中訊息與高訊息支持者其發生寂寞感的風險分別為0.80倍與0.63倍，高訊息支持者的憂鬱情形發生風險則為0.79倍。結論：社會支持有助於減少中老年人寂寞感及憂鬱情形，而社會參與則有助於降低中老年人的寂寞感發生，未來政策應考慮多元方案的介入，以增進社會支持強度。
  Objectives: This retrospective cohort study explored the effects of social participation and social support on loneliness and depression in middle-aged and older individuals. Methods: The study cohort comprised participants aged ≥50 years from the Taiwan Longitudinal Study in Aging. Generalized estimating equations were used to analyze the effects of social participation (volunteer experience and involvement in a guild or association) and social support (emotional support and informational support) on loneliness and depression. Statistical models were adjusted for baseline area characteristics. Results: This study included 3,967 participants. Individuals with volunteer experience and those serving as social group leaders had 0.81- and 0.73-fold lower risks of loneliness, respectively, than did individuals with no social participation experience. Furthermore, individuals who only participated in social groups had a 0.58-fold lower risk of depression. Individuals with middle informational support and those with high informational support had 0.80- and 0.63-fold lower risks of loneliness, respectively, than individuals with low social support. The risk of depression was 0.79-fold lower in individuals with high informational support than in those with low informational support. Conclusions: This study suggests that social support reduces loneliness and depression in middle-aged and older adults, whereas social participation reduces loneliness. Health promotion policies should incorporate pluralistic interventions aimed at enhancing social support.
• 078-095
• 10.6288/TJPH.202602_45(1).114062