Trend, medical resources utilization and survival of thalassemia major suffer from anxiety or depression disorders

碩士 === 高雄醫學大學 === 醫務管理暨醫療資訊學系碩士在職專班 === 103 === Objective: Thalassemia is the most common hereditary disease: α-Thalassemia is found in 4% of Taiwan’s overall population while β-Thalassemia is present in 1.1% of the population. Current treatment of this disease not only impacts society’s resources,...

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Main Authors: Yea-Yan Lau, 劉雅燕
Other Authors: Hon-Yi Shi
Format: Others
Language:zh-TW
Published: 2015
Online Access:http://ndltd.ncl.edu.tw/handle/6d3nq4
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description 碩士 === 高雄醫學大學 === 醫務管理暨醫療資訊學系碩士在職專班 === 103 === Objective: Thalassemia is the most common hereditary disease: α-Thalassemia is found in 4% of Taiwan’s overall population while β-Thalassemia is present in 1.1% of the population. Current treatment of this disease not only impacts society’s resources, but also affects the mental and well-being of a family. Therefore, the purpose of this study is comprised of the following three areas: 1.To investigate the trend and correlation factors associated with thalassemia; 2.To investigate the relationship between anxiety or depressive disorders with regards to thalsse-mia; 3.To investigate the relationship between anxiety or depressive disorders associated with tha-lassemia and the impact on social medical resources. Methods: The study utilized the National Health Insurance Research Database report released by the National Institute of Health (NIH) and information collected from one million in- and out-patient subjects over the years from 1996 to 2010. During this study period, a total of 798,823 patients with thalassemia major were recruited into the study. The SPSS Version 20.0 for Windows was used for descriptive statistical analysis (determining the mean, standard deviation, distribution and incidence), inferential statistical analysis (including the Chi-square test, student’s t-test, logistic regression model analysis, ES analysis, GEE analysis and K-M survival analysis) and other statistic methods. Results: Females suffering from thalassemia increased in numbers from 57.1% in 1996 to 65.0% in 2010. The average age was 34, with ages 18-64 making up the majority of 3.371 (72.4%) sufferers. There was a significant increase from 42.9% during 1996 to 76.1% at 2010. The greatest percentage was CCI=0 (making up 87.8%) and patients with diabetes, which accounted for 9.1%. The study saw an increase in the prevalence of the disease from 0.24 per population of hundred thousand in 1996 to 2.12 per population in 2002. This number decreased the ensuing years to 0.78 per population in 2010 (P < 0.001). Patients suffering from anxiety or depressive disorder accounted for 826 cases (17.7), which saw a decrease from 22.4% in 1996 to 4.4% in 2010. Rates were highest in medical institutions,especially when tested in medical centres, with a survival rate of 4,224 cases (90.7%). This increased from 75.5% in 1996 to 94.4% in 2010. Secondly, the variables believed to be associated with thalassemia and anxiety or depressive disorders (such as demographic characteristics, clinical differences and varying trends throughout periods of time) were compared using PSM analysis to determine what factors were significantly different for thalassemia and anxiety or depressive disorders. The study found that the sex, age, amount of medical and physician services as well as the hospital rating played a significant differ-ence in the study (P < 0.001). Thirdly, in regards to the amount of community resources spent, the study showed that the outpatient cost, hospitalization cost, amount of outpatient visits and amount of days spent at the hospital were greater for patients that had anxiety or depressive disorders than those who did not. Furthermore, the average cost for hospitalization, outpatient visits and length of hospital stay for patients with anxiety or depressive disorders was found to increase over time. The average number of hospitalizations and number of outpatient visits for patients with anxiety or depressive disorders was found to decrease over time. Fourthly, the study shows that survival rates for patients that have anxiety or depressive disorders, the mean survival rate after diagnosis is 72.0±4.5 months, whereas the rate is 41.1±3.9 months for patients without anxiety or depressive disorders. The length of survival for patients with anxiety or depressive disorders is longer than those without. For patients with anxiety or depressive disorders, the rate of survival for the first year was 97.1%, 89.9% for the second year and 79.7% for the third year (P < 0.001). Relatively, for patients without anxiety or depressive disorders, the rate of survival was 71.6% for the first year, 58% for the second year and 49.4% for the third year (P < 0.001). There was a significant difference in survival rates between the two groups. Discussion and suggestion: Between the years 1996 to 2002, there was a significant increase in prevalence of thalassemia, however, the trend decreased from the years 2002 to 2010. Patients with anxiety and depressive disorders utilized more of society’s medical resources, which this was shown to slightly improve over time. The same patients also had longer survivals than patients without anxiety or depressive disorders. Following the results of this study, the author suggests to monitor the advances of medicine and shifting social dynamics. Healthcare providers are advised to continue ensure that proper care and treatment is given to patients and their families to create the best situation possible.
author2 Hon-Yi Shi
author_facet Hon-Yi Shi
Yea-Yan Lau
劉雅燕
author Yea-Yan Lau
劉雅燕
spellingShingle Yea-Yan Lau
劉雅燕
Trend, medical resources utilization and survival of thalassemia major suffer from anxiety or depression disorders
author_sort Yea-Yan Lau
title Trend, medical resources utilization and survival of thalassemia major suffer from anxiety or depression disorders
title_short Trend, medical resources utilization and survival of thalassemia major suffer from anxiety or depression disorders
title_full Trend, medical resources utilization and survival of thalassemia major suffer from anxiety or depression disorders
title_fullStr Trend, medical resources utilization and survival of thalassemia major suffer from anxiety or depression disorders
title_full_unstemmed Trend, medical resources utilization and survival of thalassemia major suffer from anxiety or depression disorders
title_sort trend, medical resources utilization and survival of thalassemia major suffer from anxiety or depression disorders
publishDate 2015
url http://ndltd.ncl.edu.tw/handle/6d3nq4
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spelling ndltd-TW-103KMC057770312019-05-15T22:18:04Z http://ndltd.ncl.edu.tw/handle/6d3nq4 Trend, medical resources utilization and survival of thalassemia major suffer from anxiety or depression disorders 探討重症海洋性貧血罹患焦慮或憂鬱症之趨勢、醫療資源耗用與存活之研究 Yea-Yan Lau 劉雅燕 碩士 高雄醫學大學 醫務管理暨醫療資訊學系碩士在職專班 103 Objective: Thalassemia is the most common hereditary disease: α-Thalassemia is found in 4% of Taiwan’s overall population while β-Thalassemia is present in 1.1% of the population. Current treatment of this disease not only impacts society’s resources, but also affects the mental and well-being of a family. Therefore, the purpose of this study is comprised of the following three areas: 1.To investigate the trend and correlation factors associated with thalassemia; 2.To investigate the relationship between anxiety or depressive disorders with regards to thalsse-mia; 3.To investigate the relationship between anxiety or depressive disorders associated with tha-lassemia and the impact on social medical resources. Methods: The study utilized the National Health Insurance Research Database report released by the National Institute of Health (NIH) and information collected from one million in- and out-patient subjects over the years from 1996 to 2010. During this study period, a total of 798,823 patients with thalassemia major were recruited into the study. The SPSS Version 20.0 for Windows was used for descriptive statistical analysis (determining the mean, standard deviation, distribution and incidence), inferential statistical analysis (including the Chi-square test, student’s t-test, logistic regression model analysis, ES analysis, GEE analysis and K-M survival analysis) and other statistic methods. Results: Females suffering from thalassemia increased in numbers from 57.1% in 1996 to 65.0% in 2010. The average age was 34, with ages 18-64 making up the majority of 3.371 (72.4%) sufferers. There was a significant increase from 42.9% during 1996 to 76.1% at 2010. The greatest percentage was CCI=0 (making up 87.8%) and patients with diabetes, which accounted for 9.1%. The study saw an increase in the prevalence of the disease from 0.24 per population of hundred thousand in 1996 to 2.12 per population in 2002. This number decreased the ensuing years to 0.78 per population in 2010 (P < 0.001). Patients suffering from anxiety or depressive disorder accounted for 826 cases (17.7), which saw a decrease from 22.4% in 1996 to 4.4% in 2010. Rates were highest in medical institutions,especially when tested in medical centres, with a survival rate of 4,224 cases (90.7%). This increased from 75.5% in 1996 to 94.4% in 2010. Secondly, the variables believed to be associated with thalassemia and anxiety or depressive disorders (such as demographic characteristics, clinical differences and varying trends throughout periods of time) were compared using PSM analysis to determine what factors were significantly different for thalassemia and anxiety or depressive disorders. The study found that the sex, age, amount of medical and physician services as well as the hospital rating played a significant differ-ence in the study (P < 0.001). Thirdly, in regards to the amount of community resources spent, the study showed that the outpatient cost, hospitalization cost, amount of outpatient visits and amount of days spent at the hospital were greater for patients that had anxiety or depressive disorders than those who did not. Furthermore, the average cost for hospitalization, outpatient visits and length of hospital stay for patients with anxiety or depressive disorders was found to increase over time. The average number of hospitalizations and number of outpatient visits for patients with anxiety or depressive disorders was found to decrease over time. Fourthly, the study shows that survival rates for patients that have anxiety or depressive disorders, the mean survival rate after diagnosis is 72.0±4.5 months, whereas the rate is 41.1±3.9 months for patients without anxiety or depressive disorders. The length of survival for patients with anxiety or depressive disorders is longer than those without. For patients with anxiety or depressive disorders, the rate of survival for the first year was 97.1%, 89.9% for the second year and 79.7% for the third year (P < 0.001). Relatively, for patients without anxiety or depressive disorders, the rate of survival was 71.6% for the first year, 58% for the second year and 49.4% for the third year (P < 0.001). There was a significant difference in survival rates between the two groups. Discussion and suggestion: Between the years 1996 to 2002, there was a significant increase in prevalence of thalassemia, however, the trend decreased from the years 2002 to 2010. Patients with anxiety and depressive disorders utilized more of society’s medical resources, which this was shown to slightly improve over time. The same patients also had longer survivals than patients without anxiety or depressive disorders. Following the results of this study, the author suggests to monitor the advances of medicine and shifting social dynamics. Healthcare providers are advised to continue ensure that proper care and treatment is given to patients and their families to create the best situation possible. Hon-Yi Shi 許弘毅 2015 學位論文 ; thesis 87 zh-TW