| Summary: | 碩士 === 國立陽明大學 === 衛生福利研究所 === 96 === Objectives: The aim of this study is to explore the correlations of metabolic syndrome and cardiovascular disease and diabetes morbidity outcome. The research also analyzes the relationship between metabolic syndrome and its major risk factors on medical care utilization in Taiwan.
Materials and Methods: This study is a long-term follow-up cohort study. The data came from Taiwanese Survey on Prevalence of Hyperglycemia, Hyperlipidemia and Hypertension (TwSHHH). A total of 4,710 individuals were used in the analysis after excluding those who lacked information and had diagnosis of cardiovascular disease and diabetes at baseline. Subjects were followed up for cardiovascular disease and diabetes morbidity and mortality from 2002 to 2006 by linking their data to the National Health Insurance Research database and National Death Register, and their medical care utilizations were analyzed. In this study, classification of metabolic syndrome is based on the modified NCEP ATP III criteria for Asians. The statistical design includes description statistics, multiple logistic regression analyses, Cox proportional hazard model and multiple regression analyses.
Results: After adjustment for age, sex, race, education, income, life style and cormobidity, the hazard ratio of developing cardiovascular disease, coronary heart disease（CHD） and diabetes for those with metabolic syndromes are 1.67（95%CI: 1.44-1.94, p<0.001), 1.52（95%CI:1.26-1.85, p<0.001）and 2.69（95%CI: 2.23-3.25, p<0.001）respectively, compared with those without such syndromes. The result also revealed that subjects with metabolic syndrome are at significant greater risk of cardiovascular disease mortality（adjusted HR=5.02, 95%CI:1.38-18.25，p=0.014）and diabetes mortality（adjusted HR=7.88, 95%CI:1.49-41.76，p=0.015）than those without metabolic syndrome. As numbers of risk factors from metabolic syndrome increased, the risk of cardiovascular disease and diabetes morbidity also increased. Under different disease severities, frequency of outpatient visits and total medical expenditure are significantly higher among subjects with metabolic syndrome than those without. As numbers of risk factors from metabolic syndrome increased, the cost of outpatient visit and admission also increased. Hypertension and elevated triglyceride are two significant predictors for outpatient visit and medical expenditure among the metabolic syndromes.
Conclusion: People with metabolic syndrome are at increased risk of cardiovascular disease and diabetes morbidity and mortality than those without. Metabolic syndrome can be used as a multiple dimension risk factor assessment tool for clinicians to identify people with high risk of developing cardiovascular disease and diabetes at an early stage. Policymakers should encourage preventive screening strategy to detect major risk factors of metabolic syndrome in order to lower morbidity and mortality rates in the future, as well as reduce medical resources utilization and social cost, so that the burden of the health care system can be reduced.
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