| Summary: | 碩士 === 國立陽明大學 === 衛生福利研究所 === 106 === Background: The public health issues of people with disability are concerned worldwide recently. The population are growing with the increase of the age and chronic diseases, and they can’t receive enough health care services due to facing many different barriers in their daily life. These problems lead them to have worse health outcomes than people without disability. Studies have shown that people with disability have higher prevalence of chronic disease, more health care utilization and higher risk of being dead. However, studies in Taiwan mostly discussed people with intellectual disability, and a study offers a whole perspective of the prevalence of chronic diseases, the health care utilization and the survival in people with disability has not been conducted.
Objective: To compare the prevalence of chronic diseases, health care utilization and survival between the people with disability and people without disability.
Methods: A retrospective cohort study was performed using National Health Insurance claims data in Taiwan from 2012 to 2015. The study population are the beneficiaries of 2013 and using the Disabled Population Profile database to define the people with disability. We then calculate the propensity score with sex and age to match the study population and were divided into two groups – people with disability group and people without disability group. We used chi-square test to compare the prevalence of chronic diseases and include diabetes mellitus, hypertension, asthma, chronic obstructive pulmonary disease(COPD), coronary artery disease(CAD), heart failure(HF) and stroke. Then, we used multiple regression to compare the health care utilization include outpatient and inpatient. And, cox regression was used to analysis the survival after controlling the demographic characteristics.
Results: People with disability have higher prevalence of diabetes mellitus(22.54% vs. 15.16%), hypertension(40.79% vs. 33.67%), asthma(3.65% vs. 2.79%), COPD(7.25% vs. 3.95%), CAD(6.99% vs. 5.59%), HF(2.85% vs. 1.26%), stroke(14.80% vs. 4.07%), hepatitis B(2.3%% vs. 2.21%), hepatitis C(2.04% vs. 1.2%),cataract(11.59% vs. 11.85%). People with disability have more health care utilization, include outpatient visits(23.18 visits vs. 16.30 visits), average outpatient expenditure(3,095 points vs. 1,102 points), inpatient visits(1.881 visits vs. 1.489 visits), average inpatient stay(33.54 days vs. 7.34 days) and average inpatient expenditure(101,776 points vs. 53,820 points). After controlling the demographic characteristics, people with disability also have significant higher risk of occurring dead(AHR=2.02; 95%CI=1.99-2.04).
Conclusions: People with disability have higher prevalence of chronic disease, more health care utilization and high risk of being death than the people without disability. Here are some suggestions for the future, firstly, strengthen the specific chronic diseases management plan for people with disability to improve the caring skills of themselves and their caregivers. Secondly, strengthen the concepts of shaping healthy lifestyle in people with disability and reduce the existence of health risk factors.
Keywords: people with disability, chronic disease, healthcare utilization, survival
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