| Summary: | 碩士 === 慈濟大學 === 公共衛生研究所 === 96 === Heart disease was the second leading cause of death in 2004 in Taiwan. Coronary Heart Disease (CHD) was the major cause among the heart diseases. Chin-Shan Cardiovascular Study was the only longitudinal study to investigate the CHD incidence in Taiwan. However, Chin-Shan Study did not examine the incidence across different types of CHD, and it merely covered a very local population. The present study is to investigate the morbidity rates and medical uses of various types of CHD among 30-100 year-old adults in Taiwan from 2000 to 2004.
Our data were collected from Department of Health and National Health Research Institute in Taiwan. The first data source was used to investigate the mortality trend of CHD from 1991~2004. Linear regression analysis was employed to examine whether there was a change in the mortality trend after 2000. The second data source was used to investigate the incidences and medical uses of various types of CHD from 2000 to 2004. Poisson regression analysis was used to estimate gender- and age-specific incidences and their relative risks for acute and chronic CHD, respectively. Modified Poisson regression analysis was conducted to study the trends and the determinants of uses in angiography and angioplasty.
During 1991 and 2004, the CHD standardized mortality decreased; for male, the mortality decreased from 15.1 to 9.7 per 10,000 person-years, and for female, the rate declined from 12.1 to 5.8. However, the declined trend lessened in 2000, and did not change significantly after 2000. There was no significant change in the trend of CHD incidence during 2000 and 2004. For male, annual incidences of CHD, acute myocardial infarction (AMI), other acute and subacute coronary symptoms (OACS), and chronic CHD (CCHD) were 55.2, 11.8, 6.9, and 36.5 per 10,000 persons, respectively. For female, the annual incidences of CHD, AMI, OACS, and CCHD were 39.1, 5.4, 4.3, and 29.5 per 10,000 persons, respectively. There were gender differences in the age-trend of AMI incidences, and no gender differences in the other types of CHD. AMI incidence for males younger than 70 years-old was significantly higher than that in females, relative risk (RR) ranging from 2.7~8.0. There was no gender difference in AMI incidences for subjects older than 70 years-old. The uses of angiography and angioplasty were increased yearly by 9%, and 15%, respectively. Male-to-female ratios for the uses of angiography and angioplasty were 1.2 and 1.7, respectively. Medical expenses were also significantly increased by 7% every year.
From 2000 to 2004, there were no changes in the trends of CHD mortality and incidence. However, the age-trend incidence and medical uses of acute CHD were very different from those of chronic CHD. This suggested that the incidence rates of CCHD could be over-estimated in this study. Although the trend of uses in angiography and angioplasty were significantly increased, and thus the total medical expenses were also increased, there was no reduction in the CHD mortality. Therefore, the appropriateness of the medical uses in CHD, and the underlying reasons of the gender differences in the uses merit further investigation.
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