| Summary: | 碩士 === 國立成功大學 === 公共衛生研究所 === 105 === INTRODUCTION
Over the years, there have been noticeable gap in terms of the average life expectancy, the mortality rate and the prevalence rate of the disease between the indigenous Taiwanese and the general population of Taiwan. Although the average life expectancy serves as an indicator for the change in mortality rate, it could not appropriately picture the subtle effect bought by major diseases.Therefore, by estimating health expectancy, we can better understand the lifespan and the quality of life of the indigenous people.Furthermore, by deconstructing the life expectancy and health expectancy gap between the indigenous Taiwanese and the general population of Taiwan as well as exploring the diseases that lead to the health expectancy gap between the two communities, one can determine the root causes of health inequality, ultimately providing valuable information to the government in decision making of health care policies.
The aim of this study is to examine the health inequality between the indigenous people and general population in Taiwan, and to quantify the contribution of the major causes of death and disease to the gap of life expectancy and healthy expectancy between the indigenous people and the general population of Taiwan in 2006 and 2013. In addition, we also look for the main causes to the change in the life expectancy and health expectancy of the indigenous Taiwanese in 2006 and 2013.
MATERIALS AND METHODS
The life tables of the indigenous and the general population from Ministry of the Interior in 2006 and 2013 are included in this study. An attribution tool published by the European Union is used in this study to estimate the health risks of the various causes from each ethnic group by utilizing data from 2013 National Health interview survey(NHIS) of Taiwan.We also use the disease prevalence from Taiwan’s National Health Insurance(NHI) to estimate disability prevalence by each ethnic group.And a decomposition tool developed by Nusselder to estimate the life expectancy and health expectancy by each ethnic group and decompose the difference between the life expectancy and the health expectancy by cause between each group.
RESULTS AND DISCUSSION
The result demonstrated that the health of the indigenous people is more vulnerable in 2006 or 2013.The gap in life expectancy and health expectancy at birth in males are 10.62 and 11.02 years respectively in 2006. The main reasons are Cirrhosis of the liver, Pneumonia, Accidents and Injury, Heart disease and stroke.On the other hand, the gaps in females are smaller than in males, which are 8.81 and 7.39 years respectively. The difference observed in life expectancy is thought to be caused by diseases such as stroke, Cirrhosis of the liver, Heart disease, Pneumonia and diabetes while Cirrhosis of the liver, Pneumonia, stroke, Heart disease, Accidents and Injury account for the gap observed in health expectancy at birth in females in 2006.
Moreover, the gap in life expectancy and health expectancy at birth in males are 10.17 and 10.88 years respectively in 2013.Both 2006 and 2013 share similar reasons for the gap observed in life expectancy and health expectancy. Of note, Pneumonia and Heart disease seen a marked increase in contributions while contributions from Cirrhosis of the liver and Accidents and Injury dwindled.In women, there is a downward trend to the contributions of stroke and cirrhosis of the liver while Pneumonia and Cancer appear to have heightened contributions to the gap observed in life expectancy and health expectancy.
In addition, when comparing the change in life expectancy and health expectancy of the male indigenous Taiwanese population in 2013 with 2006, life expectancy has increased by 2.25 years while health expectancy increased by 1.24 years.Accidents and Injury, Cirrhosis of the liver and Cancer and COPD are the diseases that impact the change in health expectancy of male population the most in both 2006 and 2013.There is a positive influence from Accidents and Injury and Cirrhosis of the liver to the gap in health expectancy in 2013. However, this gain is then reduced by the impact from Pneumonia and Heart disease, which shorten the gap in health expectancy, result in only a slight improvement in the gap in health expectancy in 2013 compared with 2006. The change in the life expectancy and the health expectancy at birth in females are 3.33 and 1.42 years respectively. Stroke, Cirrhosis of the liver, Diabetes, Accidents and Injury are the main contributions to the improvement to the change in life expectancy and health expectancy at birth in females. However, this is not the case with Pneumonia, which reduces both the life expectancy and health expectancy at birth in female.
CONCLUSION
When compared with the general population, indigenous Taiwanese do not fare well in both life expectancy and health expectancy, regardless of sex or year. Of note, Cirrhosis of the liver, Pneumonia, Heart disease and Stroke are the most common chronic diseases that cause the gap seen in both population.In addition, when compared 2013 with 2006, indigenous Taiwanese saw an improvement both in life expectancy and health expectancy, largely due to a reduced mortality rate seen in Accidents and Injury and Cirrhosis of the liver.Lastly, to ultimately eradicate the health inequality seen in both population, we not only need to take public health factors into consideration but also to consider the difference in effects of socioeconomic and policy between the populations.
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