| Summary: | 博士 === 輔仁大學 === 商學研究所博士班 === 104 === In Taiwan, the prevalence of hypertension and urinary incontinence affects 30% of women above 60 years of age. In fact, high blood pressure is one of the comorbidities of urinary incontinence. Thus, hypertension causes women urinary incontinence and which may provide reference and recommendation to clinicians who treat hypertension and urinary incontinence during clinical diagnosis and health care services.
In this study, the primary source of information was obtained through questionnaires of the 1999 “Survey of Health and Living Status of the Middle Age and Elderly in Taiwan”, which provides the analysis of risk factors for urinary incontinence for women over age 60 with hypertension. And, the secondary source was from the 2005 edition of one million people, sampled from Taiwan National health Insurance claims data file from 1997 to 2011, which provides the analysis of the relationship between anti-hypertensive medications and urinary incontinence, and the status of the subsequent medical utilization. In this study, multivariate logistic regression, conditional logistic regression were used respectively to investigate hypertensive women urinary incontinence risk factors, and the relationship between hypertension drugs and urinary incontinence. Multivariate linear regression analysis was also implemented to assess the impact of medical utilization and related factors for incontinence surgery costs. This study also used Decision Tree Analysis “CART” and Association Rules in data mining to explore the correlation rules between hypertensive drugs and medical utilization.
Study found that women aged over 60 with hypertension suffering from urinary incontinence have risk factors as age, diabetes, BMI and previous urinary tract disease. We also found that women under regular treatment of hypertension have a lower prevalence of urinary incontinence. This study went further through the database owned by NHI of one million people file, to track data, between 1997-2011, on hypertension and urinary incontinence for women over 60 years old. The study found that diuretics, beta blockers, calcium channel blockers, ARB, ACEI and other anti-hypertensive drugs, if continually used, may help patients to avoid the occurrence of urinary incontinence. If also considering the persistent and adherence, diuretics, beta blockers, calcium channel blockers, ARB, and ACEI under continually used and highly compliant situation, medication has a protective effect on urinary incontinence, while alpha blockers and ACEI have a high risk effect. In addition, calcium channel blockers and other drugs, under some usage conditions, will cause urinary incontinence.
In urinary incontinence medical utilization, study found that usage of some drugs, such as diuretics and calcium channel blockers, will affect medical utilization. Namely, for high adherence or recently used, medical utilization is more than usual. As in urinary incontinence surgery, the use of calcium channel blockers have a protective effect, and, in obstetrics and gynecology and medical center, it has a higher risk effect. We also use decision trees and association rules to find the correlation rules among hypertensive drugs and medical utilization of incontinence. By which, we can learn, under different conditions, the relationship among hypertension medicines, medical utilization, and personal medical traits.
Finally, through the National Health Insurance database, we also found that, from 1997 to 2011, the incidence of urinary incontinence surgery and annual costs, the total cost of inpatient and surgical fee had increased year by year, but the length of hospital stay had decreased. However, the incidence and cost of urinary incontinence surgery varies among age, hospital accreditation level, and specialties divisions. This study observed that the incidences, numbers, costs had decreased since 2010. If this trend is affected by NHI's implementation of TwDRG, we should continue to observe.
We hope the result of this study could become a reference for the health authorities on making the policies that promote the prevention of hypertension and urinary incontinence, as well as be a consideration basis for clinicians to treat hypertension and urinary incontinence, and to cautiously plan such medical services for women. At last, we suggest, under the trend of aging society, to include the services for urinary incontinence into the long-term care system, to effectively improve the symptoms of urinary incontinence in the elderly, letting them regain confidence and have high-quality living.
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