31卷6期

• Link 公衛今與昔 Public Health Now and Then
• 大擘劃家陳拱北教授A Great Planner of Taiwan Public Health History: Dr. Kung-Pei Chen
• 翁瑞宏
  Rhay-Hung Weng
• 無none
  無none
• 無none
  無none
• 499 - 501
• 10.6288/TJPH2012-31-06-01

• Link 公衛論壇 Public Health Forum
• 進口美國牛肉的科學、法律以及政治爭議：牛海綿狀腦病的討論Scientific, legal, and political debates about omporting US beef: adiscussion about Bovine Spongiform Encephalopathy.
• 廖舜右、張照勤
  Shun-Yo Liao, Chao-Chin Chang
• 無
  none
• 無
  none
• 502 - 511
• 10.6288/TJPH2012-31-06-02

• Link 綜論 Review Article
• 極端高溫健康預警系統之國際文獻回顧A Literature Review of Action Plans for the Impact of Heat Waves on Health
• 林于凱、林沛練、李明旭、黃鈴雅、宋鴻樟、王玉純
  Yu-Kai Lin, Pay-Liam Lin, Ming-Hsu Li, Ling-Ya Huang, Fung-Chang Sung, Yu-Chun Wang
• 熱浪 ； 溫度 ； 死亡 ； 預警系統
  heat wave ; temperature ; mortality ; warning system
• 國內外研究顯示極端高溫及其連續數日事件顯著增加健康風險，本研究彙整2004-2012年間關鍵字為氣象、事件、高溫、預警及死亡等之國際主要文獻與報告，統整各國高溫預警準則及預警系統之架構，以作為本國未來相關系統建置之參考依據。都會區是氣象-健康預警系統之基本空間單位。建立預警系統前，需先了解溫度與敏感族群健康之相關性。目前熱預警系統定義之高敏感性族群以糖尿病、無行為能力者、藥癮酒癮者、腎臟疾病及腦血管、心肺疾病等慢性病病患為主。熱預警計畫由政府衛生單位、氣象單位及專家學者共同界定地區氣象預警項目及規範，氣象單位負責氣象預報並發布預警工作，衛生單位則負責熱應變計畫工作（如：建議敏感性族群提升個人主動防護及行為措施）及風險溝通工作。各地區採用之溫度指標及應變項目略有不同，宜因地制宜。研究證實熱預警系統建置可有效降低熱相關死亡及就醫。因此，在全球暖化趨勢下，我們應即早規劃適用本國之高溫預警應變系統。
  Many studies have associated episodes of extremely high temperature and prolonged heat waves with increased risks in terms of mortality and morbidity. This study investigated the various health warning systems regarding heat waves that had been proposed by Western countries and reviewed worldwide publications and reports available from 2004 to 2012. Temperature-health associations should be identified before establishing a heat wave warning system. Patients with diabetes mellitus, renal diseases, disabilities, and chronic cardiopulmonary diseases are highly vulnerable to extremely high temperatures. A national weather system is expected to disseminate the heat warning accurately and in a timely fashion. The regional health authority is the lead agency responsible for public health responses to heat and the communication of risks to the public. Application of the temperature index and responses to heat wave warnings vary among areas depending on weather conditions and socio-demographic status. Based on our evaluation, a heat wave warning system would be expected to significantly reduce the impact on health from extremely high temperatures. Studies of temperature-health associations and heat wave warning systems should be established in Taiwan to mitigate the impact of global warming.
• 512 - 522
• 10.6288/TJPH2012-31-06-03

• Link 原著 Original Article
• 含酒精提神飲料的職業安全健康危害：現況問題與政策因應Effects of alcoholic energy drinks on occupational safety and health: current conditions and intervention policies
• 鄭婉汝、鄭雅文
  Wan-Ju Cheng, Ya-Wen Cheng
• 含酒精提神飲料 ； 職業安全 ； 職業健康 ； 政策
  alcoholic energy drinks ; occupational safety ; occupational health ; policy
• 含酒精提神飲料的飲用是台灣勞力工作者特有的職場文化。國外已有不少研究報告指出，酒精與提神飲料併用會增加安全與健康上的風險，但國內有關此類飲品健康危害的本土學術研究卻仍相當不足。本研究採文獻分析法，回顧國際與台灣有關含酒精提神飲料的實證研究各51篇及8篇，以瞭解此類飲料的盛行狀況、飲用行為與其安全健康危害。結果發現，西方國家大多以大學生為主要飲用族群，台灣則以勞力職業族群為主，特別是在營建業勞工中，約20%有飲用習慣。含酒精提神飲料的飲用，與工作傷害、危險行為及酒癮等問題有正相關，但台灣仍缺乏追蹤性研究以證實其因果關係。回顧近十年來國際間有關含酒精提神飲料政策之發展趨勢，可發現大多數國家的管理政策傾向於全面禁止其銷售。反觀台灣，雖然近年來衛生主管單位陸續提出管理與標示政策，但顯然仍有不足，亟需大幅改進。
  The consumption of alcoholic energy drinks is a unique feature among manual workers in Taiwan. Growing evidence indicates that mixing energy drinks with alcohol increases safety and health risks; however, the situation in Taiwan has not been well understood. We conducted a systematic review to understand the prevalence, drinking behaviors, and the risks associated with alcoholic energy drinks. A total of 51 international studies and 8 Taiwanese studies were reviewed. Results showed that alcoholic energy drinks were popular among college students in Western countries, while in Taiwan such drinks were consumed mostly by manual workers, especially by construction workers, 20% of whom were habitual drinkers. The consumption of alcoholic energy drinks was found to correlate with the occurrence of occupational injuries, risky behaviors, and alcohol dependence, yet the causal relationships should be confirmed by longitudinal studies. Governmental policies in selected countries concerned about alcoholic energy drinks are moving towards a complete ban on the sale of such drinks. In Taiwan, recently issued regulations on the sale and labeling of alcoholic energy drinks are insufficient and should be improved.
• 523 - 534
• 10.6288/TJPH2012-31-06-04

• Link 原著 Original Article
• 台灣18歲以下未成年人交通事故住院發生率與醫療資源耗用之相關因素Incidence of and factors associated with medical costs of traffic injury-related hospitalization of children in Taiwan
• 張筑禎、林蕙欣、林志銘
  Chu-Chen Chang, Hui-Hsin Lin, Chih-Ming Lin
• 交通事故 ； 發生率 ； 住院天數 ； 醫療費用 ； 未成年人
  Traffic accidents ; Incidence ; Length of stay ; Medical expense ; Children
• 目標：分析台灣18歲以下未成年族群因交通事故住院之發生率，並探討個人、疾病及醫院因素與醫療資源耗用之相關性。方法：採用國家衛生研究院建置的2007-2009年健康保險住院醫療費用資料檔，依外因分類碼擷取診斷欄位為交通事故且年齡低於18歲之住院傷患，總計樣本19,781人。我們估計全國未成年人口交通事故住院發生率，並以對數轉換後之住院天數與醫療費用為結果變項，以多變項迴歸研析其與年齡、性別、醫院層級、手術處置與共病數等潛在相關因子之相關性。結果：台灣未成年人在這3年因交通事故導致19,781筆住院總計1,117.7千人日，醫療費用7.1億元。平均年住院發生率為105.9/105，平均住院天數與醫療費用分別為5.65天與35,903.5元。15-17歲男孩有最高之住院發生率(445.5/105)與醫療費用(41,029.2元)。年齡較大、女性、手術處置、高醫院層級與多共病數顯著增加住院天數。然而在調整住院天數後，除手術處置與高醫院層級外，男性、嬰兒與單純性傷害反而是造成醫療費用增加的因子。結論：台灣未成年人交通事故傷害耗用具體之健康照護資源，每年花費的住院醫療支出達2.37億元，且有許多相關因子值得後續研究。
  Objectives: To study traffic injury-related hospitalization of children under 18 years of age in terms of incidence and factors related to medical costs. Methods: The 2007-2009 National Health Insurance Research Database was used to identify a total of 19,781 children under 18 years of age who were hospitalized with an external cause (E code) of traffic injury. The incidence of traffic injury-related hospitalization among children was estimated. The associations between potentially significant covariates (age, gender, accreditation level of hospital, surgical intervention, number of comorbid conditions) and log-transferred hospitalization cost and length of stays (LOSs) were examined with multivariate regression analysis. Results: The 19,781 traffic injury-related hospitalizations among children under 18 years of age from 2007 to 2009, resulted in more than 710 million NTD in inpatient charges and 1117.7 thousand person-days of hospitalization. The annual incidence rate of hospitalization was 105.9/105. Mean (SD) LOSs and hospital charges were 5.65 (6.57) days and 35 903.5 (77 358.0) NTD, respectively. Male adolescents aged 15 through 17 had the highest hospitalization rates (445.5 per 100 000) and medical cost (41029.2 NTD). Older age, being female, having a higher number of comorbid conditions, surgical intervention and a higher hospital accreditation level were significantly associated with longer LOSs. In addition to surgical intervention and accreditation level of the hospital, those who were male, infants, or without other comorbid conditions tended to incur higher hospital charges after adjustment for LOSs. Conclusions: Traffic injuries among children incur a substantial health care burden, with an annual cost for hospital care exceeding 237 million NTD. Many related factors are worthy of further study.
• 535 - 543
• 10.6288/TJPH2012-31-06-05

• Link 評論 Commentary
• 評論：台灣18歲以下未成年人交通事故住院發生率與醫療資源耗用之相關因素Commentary:Incidence of and factors associated with medical costs of traffic injury-related hospitalization of children in Taiwan
• 白璐
  Lu Pai
• 無
  none
• 無
  none
• ?
• 10.6288/TJPH2012-31-06-11

• Link 原著 Original Article
• 高估或低估？自我評核與評鑑委員評核結果的一致性探討：以2009年護理之家評鑑資料庫為例Higher or Lower? Agreement between Self-evaluation and External Evaluation Regarding the Outcome of Nursing Home Accreditation: An Analysis of the 2009 Nursing Home Accreditation Survey
• 梁亞文、蔡淑鳳、鄭瑛琳、林育秀
  Yia-Wun Liang, Shwu-Feng Tsay, Ying-Lin Cheng, Yu-Hsiu Lin
• 護理之家 ； 評鑑 ； 一致性 ； Kappa檢定
  Nursing home ; accreditation ; agreement ; Kappa test
• 目標：本研究旨在瞭解首次台灣一般護理之家評鑑自評結果及委評結果之一致性，並探討影響一致性之相關因素，做為主管機關未來修訂評鑑實施方式及內容與經營管理者準備評鑑工作參考。方法：本研究為一橫斷式研究，以2009年「台灣護理之家評鑑資訊網資料庫」中之351家一般護理之家為研究對象，進行次級資料分析。採一致性百分比與Kappa檢定分析受評護理之家自評與委評於評鑑結果之一致性，並以邏輯斯迴歸探討影響自評結果與委評結果一致性之因素。結果：評鑑基準五大面向與總評結果之自評結果與委評結果Kappa值介於0.086-0.291，一致性百分比介於40.17%-65.53%。護理之家開業年數、負責人角色為合夥股東型態者顯著增加自評結果與委評結果的一致性；所在區域為南區及高屏區的護理之家其自評結果與委評結果一致性顯著低於東區的護理之家。結論：整體而言，kappa值介於輕微至尚可之間，顯示護理之家自評者與評鑑委員對於評鑑項目達成認知的一致性不高。建議主管機關未來修訂評鑑指標應力求清晰明確，並舉辦評鑑後論壇，探討當年度評鑑自評結果與委評結果不一致之可能原因及改善方案；機構自評者應多參加評鑑前說明會與評鑑後論壇，透過標竿學習，提昇自評結果與委評結果的一致性。
  Objectives: This study examined the agreement between self-evaluation and external evaluation regarding the outcome of nursing home accreditation and factors related to that agreement. Methods: This was a cross-sectional study using data from the 2009 Taiwan Nursing Home Accreditation Survey. A total of 351 nursing homes were included. Percentage agreement and Kappa tests were used to measure the agreement between self-evaluation and external evaluation. Multivariate logistic regression was used to identify factors associated with agreement. Results: The Kappa ranged from 0.086 to 0.291, and the percentage of agreement from 40.17% to 65.53%. After controlling for other variables, multivariate logistic regression showed that years of nursing home operation (OR=1.078, 95% C.I.=1.006-1.156), the owner's role (OR=2.540, 95% C.I.=1.062-6.077), and region of the nursing home's location (OR=0.262, 95% C.I.=0.075-0.913; OR=0.197, 95% C.I.=0.055-0.705) were significantly associated with agreement. Conclusions: As a whole, agreement between self-evaluation and external-evaluation regarding the outcome of nursing home accreditation was only slight to fair. A clear and specific accreditation index and the use of benchmarks to encourage nursing home employees to identify best practices are suggested as ways to promote agreement between self-evaluation and external-evaluation. Additional training of self-evaluators and external-evaluators may be useful in increasing the rates of agreement between these groups.
• 545 - 555
• 10.6288/TJPH2012-31-06-06

• Link 原著 Original Article
• 醫師的安眠藥物處方行為之初探：一項質性研究A preliminary investigation of hypnotic prescribing behavior by physicians: a qualitative study
• 郭淑珍、 陳怡君、 楊雪華
  Shu-Chen Kuo, Yi-Chun Chen, Hsieh-Hua Yang
• 安眠藥物 ； 處方行為 ； 醫師 ； 失眠
  hypnotics ; prescribing ; physician ; insomnia
• 目標：台灣過去有關安眠藥物使用的研究，大多是對處方內容作分析，較難瞭解醫師臨床處方之考量。本研究透過深度訪談，探索醫師的安眠藥物處方行為。方法：研究對象經由從事醫療工作的朋友引見，以質性深度訪談，訪問17位有開立安眠藥物處方的執業醫師；資料的分析採用編輯式分析法。結果：影響醫師是否處方安眠藥物之考量因素包括有：醫師的專業科別、病人期待藥物的效果、恢復及維持病人的社會功能、建立和鞏固醫病關係；受訪醫師雖表示不見得會順應病人對藥物的要求，然而醫病之間的長久熟識，可能使得醫師較難抗拒病人對於藥物需求的習慣性期待。在藥物選擇上，病人過去用藥史，如果曾經使用安眠藥物，受訪醫師會處方原來的藥物給病人繼續服用；如果是首次藥物使用者，醫師大多處方非苯二氮平類的安眠藥物；對於非苯二氮平類藥物的信心，使得醫師易忽略使用這類藥物的風險。醫師對於處方訊息的告知，最常透露的是藥物名稱、服藥時間等；醫師認為病人可能不想獲得太多訊息，因此對於藥物各種作用的詳細說明、持續用藥追蹤諮詢與評估等，並未確實執行。大部分受訪醫師對於非藥物治療失眠方式所知有限，又因健保給付制度的影響，治療失眠仍以藥物為主。結論：醫療專業特質、社會規範、醫病互動以及保險支付制度對於醫師處方行為皆有影響，相關政府單位如能規劃論質計酬的支付方式，提供多元的治療選項，同時在醫師的繼續教育中，安排非藥物治療方式訓練，使得醫師可以擬定適合治療計畫，減低非必要的藥物使用。
  Objectives: In Taiwan, the bulk of studies about hypnotics have focused on the content of prescriptions, with relatively less emphasis on the physician's clinical considerations. The objective of this study was to explore hypnotic prescribing behavior by physicians. Methods: Referred by friends engaged in medical work, 17 physicians who prescribed hypnotics consented to in-depth interviews. Data were subject to editing style analysis. Results: Factors influencing hypnotic prescribing behavior included physician specialization, patient expectation of drug effects, maintenance of social functioning of the patient, and the doctor-patient relationship. The physician might not want to respond to a patient's request, but the long-term doctor-patient relationship might still influence prescription behavior and the physician would prescribe the same drug again. If the patient were a first-time user, the physician would prescribe benzodiazepine receptor agonists. Because of confidence in non-benzodiazepine drugs, physicians would ignore the risk of using these drugs. Some physicians believed that patients did not want to get too many messages, and told their patients only the name of the medication and the time of ingestion, but not a detailed description of the effects or the need for continuous follow-up evaluation and consultation. Other than their impact on the health care payment system, most of the physicians had limited knowledge about non-pharmaceutical treatments for insomnia. As a result, the treatment of insomnia still heavily relies on prescription medications. Conclusions: Based on the results, we suggest that the government might adopt pay for performance to cover the cost of alternative medical treatments. To reduce the unnecessary use of hypnotics, physicians are encouraged to learn about other non-pharmaceutical techniques during continuing medication education, apply these techniques in clinical settings, and create proper treatment plans for patients with insomnia.
• 556 - 569
• 10.6288/TJPH2012-31-06-07

• Link 原著 Original Article
• 台灣民眾有類流感症狀時戴口罩之行為意圖及其相關因素探討：H1N1新型流感大流行與後大流行期間之比較The Prevalence of and Factors Associated with Intention to Wear a Face Mask during an Influenza-like Illness: A Comparison between the Influenza A/H1N1 Pandemic and the Post-pandemic Phase
• 莊淑如、黃俊豪
  Shu-Ru Jhuang, Jiun-Hau Huang
• H1N1新型流感 ； 大流行 ； 後大流行 ； 戴口罩意圖 ； 健康信念
  influenza A/H1N1 ; pandemic ; post-pandemic ; intention to wear a face mask ; health beliefs
• 目標：比較新型流感大流行與後大流行期間，台灣民眾有類流感症狀時戴口罩之行為意圖與相關健康信念之差異，並探討不同流行期間民眾健康信念與其戴口罩行為意圖之關係。方法：於2009年及2010年10月，分別依縣市進行分層隨機抽樣，採用電腦輔助電話訪問進行全國調查，訪問年滿15歲之民眾以蒐集健康信念及戴口罩之行為意圖等資訊，分析樣本分別為1,079人及1,067人，電訪完成率分別為68.5%及66.0%。結果：民眾有戴口罩之行為意圖的盛行率，於大流行與後大流行期間分別為95.9%及93.7%。大流行期間，自覺戴口罩非常有效（AOR=4.88）、自覺戴口罩不太困難（AOR=9.23）或一點也不困難（AOR=25.29）及近期無類流感症狀者（AOR=3.55），較傾向戴口罩。反觀後大流行期間，認為疫情有點可能持續擴大（AOR=3.07）、自覺戴口罩有點有效（AOR=5.29）或非常有效（AOR=9.61）及自覺戴口罩不太困難（AOR=10.09）或一點也不困難者（AOR=14.55），較傾向戴口罩。結論：未來針對民眾採取疾病預防行為之衛教計畫，可強調採取該行為之效果，並降低採取該行為可能之障礙。於大流行期間，無需過度強調疫情嚴重度，然於後大流行期間，則需定期提供疫情資訊，使民眾持續採取預防行為。
  Objectives: This study investigated and compared intention to wear a face mask during an influenza-like illness (ILI) and associated factors in the general Taiwanese population during the phase-6 influenza A/H1N1 pandemic (pH1N1) and the post-pandemic phase. Methods: Two national surveys using the computer-assisted telephone interview method were conducted in Taiwan during October in 2009 and 2010. Stratified random sampling by region was used to select these two national samples of participants aged 15 years or older. Participants were asked about their intention to wear a face mask during an ILI and their related health beliefs. The final samples consisted of 1,079 and 1,067 participants, resulting in response rates of 68.5% and 66.0%, respectively. Results: Nearly 96% of the participants intended to wear a face mask when having an ILI during the pandemic phase, whereas only 93.7% intended to do so during the post-pandemic phase. Multivariate logistic regression indicated that factors associated with intention to wear a face mask and the strengths of these associations were different during these two phases. During the pandemic phase, participants who considered wearing face masks to be very effective in preventing pH1N1 [adjusted odds ratio (AOR) =4.88], who considered wearing face masks to be not very difficult (AOR=9.23) or not at all difficult (AOR=25.29), and who did not have influenza-like symptoms during the previous month (AOR=3.55) were more inclined toward wearing face masks. By contrast, during the post-pandemic phase, participants who perceived that the pH1N1 outbreak would expand (AOR=3.07), who considered wearing face masks to be effective (AOR=5.29) or very effective (AOR=9.61), and who considered wearing face masks to be not very difficult (AOR=10.09) or not at all difficult (AOR=14.55) were more inclined to wear them. Conclusions: These findings suggest that future health education campaigns should emphasize evidence-based information regarding the effectiveness of the recommended preventive behavior, while perceived barriers should be better understood, addressed, and hence minimized. The seriousness of the disease should not be overplayed during the pandemic phase; however, communication campaigns in the post-pandemic phase should provide regular updates about the outbreak to keep the public alert in order to maintain good preventive health behavior practices.
• 570 - 580
• 10.6288/TJPH2012-31-06-08

• Link 原著 Original Article
• 促進小學生健康飲食行為之研究：整合跨理論模式及問題導向學習模式Integrating the Transtheoretical Model and Problem-based Learning Strategies to Improve Students' Dietary Behaviors
• 邱詩揚、陳富莉、劉潔心
  Shy-Yang Chiou, Fu-Li Chen, Chieh-Hsing Liu
• 健康飲食 ； 飲食行為 ； 跨理論模式 ； 問題導向學習模式 ； 小學生
  healthy eating ; dietary behavior ; Transtheoretical Model ; Problem-based Learning ; elementary students
• 目標：本研究旨在探討「整合跨理論模式及問題導向學習模式之教學模組」促進學生健康飲食行為之效果，期能發展國小融入式健康飲食教學模組以增進學生的飲食與健康問題覺識、飲食認知、預期結果評價、增強管理技巧、社會支持、自我效能及健康飲食行為。方法：本研究採「不相等實驗組、控制組實驗設計」，立意選取宜蘭縣內一所國小為實驗學校，一所國小為對照學校，並分別於該校選取五年級的學生為研究對象。本研究之評量包括形成評量、過程評量及成效評量，並以前後測問卷調查收集量性之成效評量資料。結果：研究結果顯示教學介入可有效增進國小學童的「飲食與健康問題覺識」、「飲食議題認知」、「增強管理技巧」、「自我效能」及「健康飲食行為」，且在一個月後仍能維持增進「健康飲食行為」的延宕效果。結論：研究結果可作為未來推動國小健康飲食及教師在職訓練之參考。
  Objectives: The purpose of this study was to evaluate the effects of a teaching module about healthy dietary behaviors based on the Transtheoretical Model and Problem-based Learning on elementary school students in Taiwan. This module was expected to increase students' awareness about dietary and health issues, dietary knowledge, outcome expectancy, reinforcement and management skills, social support, self-efficacy, and healthy dietary behaviors. Methods: A nonequivalent experimental-control group design was used with 5th grade classes from two elementary schools in Ilan County. The experimental group received instruction in healthy eating during the intervention period, while the control group received no intervention during the same period. Evaluations of formation, process, and outcome were done with questionnaire surveys to collect quantitative data. A closed-ended pretest-posttest questionnaire and another closed-ended follow-up test questionnaire were used to evaluate the outcome effects. Results: The results supported the hypothesis that this module could produce a positive increase in students' awareness about dietary and health issues, dietary knowledge, reinforcement and management skills, self-efficacy, and healthy dietary behaviors. A follow-up test provided support for continued educational effects on students' healthy dietary behaviors. Conclusions: The results of this study provide a new perspective for future research and teacher training with regard to healthy eating in elementary schools.
• 581 - 596
• 10.6288/TJPH2012-31-06-09

• Link 實務 Public Health Practice
• 影響台灣不同世代老人存活相關因子探討Factors Related to Survival Rates of the Elderly in Different Cohorts in Taiwan
• 林正祥、劉士嘉
  Cheng-Hsiang Lin, Shih-Chia Liu
• 老人健康調查 ； 存活狀況 ； Cox模式 ； 脆弱模式
  survey of health and living status of the elderly ; survival rates ; Cox proportional hazard model ; frailty model
• 探討台灣不同世代老人存活趨勢變化差異及影響老年人口存活相關因子。方法：本研究利用國民健康局「台灣地區中老年人身心社會狀況長期追蹤研究調查」自1989年至2007年之六次訪查資料，以Cox脆弱加權模式分析探討老年人口存活相關因素並比較不同出生A、B世代（1915-1929、1929-1943）分別於1989-1993年及2003-2007年存活趨勢變化差異。結果：就兩世代樣本特性言，以性別及族群差異較大，其他影響世代存活相關因子間差異，A世代抽菸人數與體能、自評健康狀況及自認經濟狀況好者較B世代為多，顯現世代間之健康行為及其對身心狀況的感受亦有所差異；罹患糖尿病與高血壓的比例B世代較A世代為多，具呼吸疾病的比例則以A世代老人較高。其餘疾病如中風、心臟疾病及胃潰瘍或胃病等差異不大。另經統計模式選擇結果發現年齡、住地類型、自評健康、體能狀況、有無糖尿病及抽菸為影響台灣不同世代老人存活趨勢變化差異之重要指標。結論：在不同世代存活4年趨勢變化差異上，較為年輕B世代老人，由於經濟情況的改善及全民健保的實施，相較於A世代老人，生活條件較好並享有較為優質的醫療照顧；經相關變項調整後，B世代死亡風險為A世代的0.601倍；兩世代老人的存活情況，受性別、族群、嚼檳榔及社團參與的影響不大，糖尿病則為影響不同世代60-74歲老人存活之主要慢性疾病，然未來時日增長，增加較多調查數據時，情況亦可能有所變化，有待進一步探討。
  Objectives: To investigate the factors related to the survival rates of the elderly in two different cohorts in Taiwan. Methods: Data derived from six waves of the survey of Health and Living Status of the Elderly in Taiwan from 1989 to 2007 were used to compare the survival rates of the elderly during 1989-1993 and 2003-2007 between two different birth cohorts (1915-1929-Cohort A and 1929-1943-Cohort B). The weighted Cox frailty model with time-dependent covariates was used for data analysis. Results: There were differences in gender and ethnicity between two cohorts. The rates of smoking, good physical condition, self-rated health and economic situation were higher in cohort A than in cohort B. The rates of diabetes and hypertension were higher in cohort B than in cohort A. Conversely, the rate of respiratory system diseases was higher in cohort A. For other chronic diseases, e.g. stroke, heart disease, gastric ulcers, and stomach ailments, there were slight difference between the two cohorts. Based on Cox model selection, age, residential location, self-rated health, physical function, diabetes, and smoking were significant factors related to the survival of the elderly in both cohorts. Conclusions: By the results of Cox frailty model, four-year survival rates differ a lot between cohort A and cohort B. This difference might be due to improved economic conditions and the implementation of national health insurance, which resulted in a better living standard and medical care for the elderly in cohort B compared to cohort A. In addition, after adjusting for related covariates, the risk ratio of cohort B to cohort A was about 0.601. Gender, ethnicity, chewing betel nut, and social activity were insignificant for both cohorts. Diabetes was the main disease related to survival for both cohorts. Some factors may become significant if more data is included in a future study. This issue requires further investigation.
• 597 - 611
• 10.6288/TJPH2012-31-06-10