臺灣博碩士論文加值系統

目的：
中醫療法盛行於亞洲地區，臺灣更為傳統醫療高度利用的國家，在特殊的職業環境下，中醫師的健康狀態與醫療照護品質有極大的相關。然而，過去國內外有關醫事人員之文獻，大多以西醫師職業族群的健康狀態為主，鮮少著墨於中醫師的研究。有鑑於此，本研究主要目的在分析探討中醫師世代的死亡率型態以及癌症發生率。

材料與方法：
利用行政院衛生署中醫師證照登記資料庫，獲得領有中醫師執照之中醫師，納入 1985年時滿25歲之中醫師並排除1985年超過85歲者，與行政院衛生署死因登記檔以及行政院衛生署國民健康局癌症登記資料庫串聯，取得1985-2005年中醫師死亡資料與1985-2004年中醫師癌症資料，並以同期間之全國一般人口做為研究結果之參考族群，進而計算各死因、主要死因與依國人十大死因分類之間接標準化死亡率以及各癌症、主要癌症與依國人十大癌症分類之間接標準化癌症發生率，探討中醫師與國人在癌症發生率及死亡率之差異，並進一步了解其成因為何。

結果：
本研究總共包含7,675位中醫師，其中男性中醫師6,345人﹙82.7%﹚，女性中醫師1,330人﹙17.3%﹚，1985年至2004年共269人罹癌﹙男性中醫師254人，女性中醫師15人﹚，1985年至2005年共796人死亡﹙男性中醫師775人，女性中醫師21人﹚，由追蹤開始年份計算之平均世代年齡約為33.91 ± 14.89歲﹙男性中醫師為35.18 ± 15.77歲，女性中醫師為27.89 ± 6.77歲﹚，由於女性中醫師罹癌個案數與死亡個案數稀少，故在進一步分析時將之予以排除。在各死因死亡率部份，中醫師全死因SMR為0.68﹙95%CI = 0.63-0.73﹚，男性中醫師全死因SMR為0.61﹙95%CI = 0.57-0.65﹚，大多數死因顯著低於國人與男性國人，除腎炎、腎徵候群及腎性病變之外﹙中醫師SMR = 1.22，95%CI = 0.88-1.64；男性中醫師SMR = 1.13，95%CI = 0.81-1.53﹚。在癌症發生率部份，中醫師全癌症SIR為0.80﹙95%CI = 0.71-0.90﹚，男性中醫師全癌症SIR為0.80﹙95%CI = 0.71-0.91﹚，大部份SIR低於一般族群，但在肝及肝內膽管惡性腫瘤﹙中醫師SIR = 1.51，95%CI = 1.16-1.92；男性中醫師SIR = 1.12，95%CI = 0.86-1.42﹚與膀胱惡性腫瘤卻有高於有國人的現象﹙中醫師SIR = 2.59，95%CI = 1.67-3.82；男性中醫師SIR = 1.84，95%CI = 1.18-2.73﹚。

結論：
本研究結果顯示中醫師與男性中醫師在全死因SMR、全癌症SIR皆顯著低於臺灣一般國人，可能成因與醫師的職業特性有關。醫師擁有豐富的醫學知識且為高社經地位族群，對於自身健康情形警覺性較高，易達到早期發現早期治療之效果，因此醫師的身體健康狀態較一般民眾良好。然而在肝癌、泌尿系統癌症SIR與泌尿系統疾病SMR有高於一般國人的現象，此危險因子可能與中醫師職業暴露有關，例如中草藥重金屬污染、藥源性疾病以及醫療業務相關因素等等，這可能為此職業世代的特殊職業疾病，值得我們加以重視，並進一步深入研究其相關危險因子。

Objectives:
Medication by Chinese medical physicians is very popular in Asia, including Taiwan. Under special occupational setting, health status of Chinese medical physicians is critical to the quality of medical care. However, there were very few investigations focused on Chinese medical physicians. The aims of this study were apted to understand the mortality and cancer incidence among Chinese medical physicians.

Method:
The data utilized in this study were obtained from The Medical Personnel Register System of Department of Health, Taiwan. Only Chinese medical physicians who older than 25 years in 1985 were recruited as study cohort while Chinese medical physicians who older than 85 years were excluded. The health records of Chinese medical physicians were obtained by linkage from death register system 1985-2005 and cancer register system 1985-2004, Bureau of Health Promotion, Department of Health, Taiwan. Data of general population were treated as reference group. The overall causes of death, leading causes of death and standardized mortality rate (SMR) and standardized incidence rate (SIR) were calculated.

Result:
A total of 7,675 Chinese medicine physicians were recruited in this study, including 6,345 (82.7%) males and 1,330 (17.3%) females. Two hundred and sixty nine physicians were registered as cancer cases (254 males and 15 females) during 1985-2004. A number of 796 physicians (755 males and 21 females) were decreased during 1985-2005. The mean age for Chinese medicine physicians was 33.91 ± 14.89 years old (male physicians was 35.18 ± 15.77 years and female physicians was 27.89 ± 6.77 years). Due to small sample size, female physicians were excluded from statistical analyses. The overall death causes SMR was 0.68 (95%CI = 0.63-0.73) for Chinese medicine physicians and 0.61 (95%CI = 0.57-0.65) for male physicians. With the comparison of general population, the SMRs of all death causes in this study were significantly less than 100, except nephritis, nephrotic syndrome and nephrosis (Chinese medicine physicians SMR = 1.22，95%CI = 0.88-1.64，male physicians SMR = 1.13，95%CI = 0.81-1.53). The overall cancer SIR was 0.80 (95%CI = 0.71-0.90) for Chinese medicine physicians and 0.80 (95%CI = 0.71-0.91) for male physicians. In this study, most cancer SIR were lower than general population, however, malignant neoplasm of liver and intrahepatic bile ducts (Chinese medicine physicians SIR = 1.51，95%CI = 1.16-1.92; male physicians SIR = 1.12，95%CI = 0.86-1.42 ) and malignant neoplasm of bladder (Chinese medicine physicians SIR = 2.59，95%CI = 1.67-3.82; male physicians SIR = 1.84，95%CI = 1.18-2.73 ) were higher than general population.

Conclusion:
It showed that overall SIR and overall SMR in Chinese medicine physicians were lower than general population. It suggested that the beneficial effect may be associated with job characteristics of qualified physicians. Physicians are health knowledgeable, are at high socioeconomic rank, and can self-perceive themselves with health status, therefore they will healthy than general population. However, the SIRs in urinary system and liver caner and SMR in urinary system diseases were higher than reference group. It maybe associated with their job exposure, such as heavy metal contamination in herbal, drug induced diseases and medicine factors. It needs to investigate the risk factors of specific diseases mention above for these practitioners.

目 錄
第一章 前言 1
第一節 研究動機 1
第二節 研究目的 5
第二章 文獻探討 6
第一節 醫師的特性 6
第二節 醫師的健康狀態、罹病情形及死亡概況 8
一、醫師的身心健康狀態 8
二、醫師的罹病情形 15
三、醫師的死亡概況 17
第三節 傳統醫療利用的現況 22
一、世界各國傳統醫療利用情形 22
二、臺灣目前傳統醫療利用情形 22
第四節 臺灣中醫師的制度、特性與人力現況 24
一、臺灣中醫師考試制度 24
二、臺灣中醫師特性 24
三、臺灣中醫師人力現況 25
第五節 中醫師的潛在暴露與危害 27
一、工作負荷量與工作壓力 27
二、中藥材暴露與危害 27
第三章 研究方法與進行步驟 30
第一節 研究族群之選取 30
第二節 研究方法 31
一、中醫師世代基本人口統計 31
二、死因資料分析 31
三、癌症發生率分析 35
四、統計軟體與方法 38
第三節 研究流程 39
第四章 結果 40
第一節 中醫師族群基本描述 40
第二節 中醫師死因分析結果 42
第三節 中醫師癌症分析結果 45
第五章 討論 48
第一節 中醫師死亡率之探討 48
第二節 中醫師高發生率癌症成因之探討 51
一、中草藥重金屬污染 51
二、藥源性疾病 54
三、醫療業務相關因素 56
四、其他可能因子 57
第三節 研究優點與研究限制 59
一、研究優點 59
二、研究限制 59
第六章 結論與建議 61
第一節 結論 61
第二節 建議 62
第七章 參考文獻 63


表 目 錄
表1. 中醫師世代基本人口統計學描述 76
表2. 中醫師世代癌症組與非癌症組年齡之分析 77
表3. 中醫師各死因死亡人數之分布 78
表4. 依中醫師主要死因與國人十大死因分類之人數分布 79
表5. 中醫師與國人各死因平均死亡年齡之分佈 80
表6. 依中醫師主要死因與國人十大死因分類之平均死亡年齡分佈 81
表7. 中醫師各死因間接標準化死亡率 82
表8. 依中醫師主要死因與國人十大死因分類之間接標準化死亡率 83
表9. 中醫師主要死因年齡分層間接標準化死亡比 84
表9 (續). 中醫師主要死因年齡分層間接標準化死亡比 84
表10. 男性中醫師主要死因年齡分層間接標準化死亡比 85
表10 (續). 男性中醫師主要死因年齡分層間接標準化死亡比 85
表11. 中醫師依國人十大死因分類之年齡分層間接標準化死亡比 86
表11 (續). 中醫師依國人十大死因分類之年齡分層間接標準化死亡比 86
表12. 男性中醫師依男性國人十大死因分類之年齡分層間接標準化死亡比 87
表12 (續). 男性中醫師依男性國人十大死因分類之年齡分層間接標準化死亡比 87
表13. 中醫師癌症發生人數之分布 88
表14. 中醫師癌症間接標準化發生率 89
表15. 中醫師癌症間接標準化發生率 (以單一ICD-9碼區分) 90
表16. 中醫師主要癌症間接標準化發生率 91
表17. 中醫師依國人與男性國人十大癌症分類之間接標準化發生率 92
表18. 中醫師癌症年齡分層間接標準化發生率 93
表18 (續). 中醫師癌症年齡分層間接標準化發生率 93
表19. 男性中醫師各癌症年齡分層間接標準化發生率 94
表19 (續). 男性中醫師各癌症年齡分層間接標準化發生率 94
表20. 中醫師主要癌症年齡分層間接標準化死亡比 95
表20 (續). 中醫師主要癌症年齡分層間接標準化死亡比 95
表21. 男性中醫師主要癌症年齡分層間接標準化死亡比 96
表21 (續). 男性中醫師主要癌症年齡分層間接標準化死亡比 96
表22. 中醫師依國人十大癌症分類之年齡分層間接標準化發生率 97
表22 (續). 中醫師依國人十大癌症分類之年齡分層間接標準化發生率 97
表23. 男性中醫師依男性國人十大癌症分類之年齡分層間接標準化發生率 98
表23 (續). 男性中醫師依國人十大癌症分類之年齡分層間接標準化發生率 98

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