台灣重要死因變動趨勢對潛在生命年數與經濟損失影響探討

The Effects of Trends in Mortality due to the Leading Causes of Death on Potential Lost Life and Economic Loss in Taiwan

10.6288/TJPH201534103102

林正祥(Cheng-Hsiang Lin)；劉士嘉(Shih-Chia Liu)；劉冠暐(Guan-Wei Liu)

死亡率 ； Lee-Carter模式 ； ARIMA模式 ； 潛在生命年數損失 ； 經濟損失 ； mortality rate ； Lee-Carter model ； ARIMA model ； years of potential life lost ； economic loss

台灣公共衛生雜誌

34卷2期（2015 / 04 / 15）

168 - 179

繁體中文

目標：事故傷害、惡性腫瘤與糖尿病長期以來一直位居台灣前十大死因，三者分別為青少年，中、老年及老年人口的主要死因，本研究藉此探討三個重要死因對台灣潛在生命年數及經濟損失之影響。方法：利用Lee-Carter模式探討近30年來重要死因死亡率變動趨勢，另以平均餘命為基礎推算出其預期生命年數損失與工作年數損失，再以人力資本法計算1985-2012年重要死因所造成的經濟損失，最後利用時間序列ARIMA模式探討並預測重要死因的經濟損失變動趨勢。結果：事故傷害與惡性腫瘤的死亡水平指數近年來呈下降趨勢，而糖尿病則為上下震盪起伏；生命年數暨工作年數損失方面，事故傷害呈下降趨勢，惡性腫瘤與糖尿病則為直線上升趨勢；經濟損失方面，三死因自1985~2012年皆呈先上升後下降趨勢，惟惡性腫瘤自2001年後其經濟損失已超越事故傷害。結論：事故傷害經濟損失呈下降趨勢，意謂政府政策有所成效，應持續努力；惡性腫瘤疾病經濟損失自2001年即位居第一，對於其之防範與治療仍須加強；至於糖尿病經濟損失金額相對較小，惟其屬老年重要疾病，容易導致其他併發症發生，其防治仍有改善空間。

Objectives: Injuries, malignancies and diabetes are always among the top 10 causes of death in Taiwan. Their occurrence varies among the young, the middle-aged, and the elderly. The aim of this study was to explore the effects of death due to these 3 causes on potential lost life and economic loss for the past 30 years. Methods: The Lee-Carter Model was used to explore the change in trends and to predict the future mortality rates of the 3 causes of death. The years of potential life lost/working life lost (YPLL/WPLL) were calculated based on information about life expectancy, and the Human Capital Method was used to determine the economic losses. Finally, a time series autoregressive integrated moving average (ARIMA) model was used to predict the economic losses. Results: The mortality indices for injuries and malignancies have decreased in recent years, while that of diabetes has fluctuated up and down. The YPLL/WPLL due to injuries decreased while the losses due to cancer and diabetes increased. The economic losses due to the 3 causes of death increased at the beginning and then went down from 1985 to 2012. Specifically, since 2001, the loss due to malignancies has been significantly higher than that caused by injuries. Conclusions: Economic loss due to injuries decreased, implying that the government's preventive policies were quite effective. Economic loss due to malignancies is the highest since 2001, meaning that effective preventive measures are still needed. Although diabetes causes a relatively small economic loss, prevention cannot be ignored since diabetes is highly correlated with metabolic syndrome in the elderly. There is still room for improvement in the prevention and treatment of diabetes.

1. 潘怜燕、邱淑媞(2011)。台灣地區1991~2007年男女性之健康差距：以平均餘命、死亡率及潛在生命年數損失為指標。台灣衛誌，30，135-49。
   連結：
2. 衛生福利部統計處：死因統計。http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=1610。引用2014/07/28。Department of Statistics, Ministry of Health and Welfare, R.O.C. (Taiwan). The cause of death statistics. Available at: http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=1610. Accessed July 28, 2014. [In Chinese]
3. 行政院主計總處：人力運用調查報告。http://www1.stat.gov.tw/lp.asp?CtNode=4991&CtUnit=1183&BaseDSD=7&mp=3。引用2014/05/01。Directorate-General of Budget, Accounting and Statistics, Executive Yuan, R.O.C. (Taiwan). Report of the manpower utilization survey. Available at: http://www1.stat.gov.tw/lp.asp?CtNode=4991&CtUnit=1183&BaseDSD=7&mp=3. Accessed May 1, 2014
4. 內政部統計處：台灣地區簡易生命表。http://sowf.moi.gov.tw/stat/Life/T05-ltquary.html。引用2014/01/11。Department of Statistics, Ministry of the Interior, R.O.C. (Taiwan). Abridged life table, Taiwan area. Available at: http://sowf.moi.gov.tw/stat/Life/T05-ltquary.html. Accessed January 11, 2014. [In Chinese]
5. 行政院主計總處：總體統計資料庫。http://statdb.dgbas.gov.tw/pxweb/dialog/statfile9L.asp。引用2014/01/11。Directorate-General of Budget, Accounting and Statistics, Executive Yuan, R.O.C. (Taiwan). Macro database. Available at: http://statdb.dgbas.gov.tw/pxweb/dialog/statfile9L.asp. Accessed January 11, 2014。http://statdb.dgbas.gov.tw/pxweb/dialog/statfile9L.asp
6. Box, GEP,Jenkins, GM(1976).Time Series Analysis: Forecasting and Control.Sun Francisco:Hoden-Day.
7. Ekwueme, DU,Chesson, HW,Zhang, KB,Balamurugan, A.(2008).Years of potential life lost and productivity costs because of cancer mortality and for specific cancer sites where human papillomavirus may be a risk factor for carcinogenesis-United States, 2003.Cancer,113,2936-45.
8. Ekwueme, DU,Guy, GP, Jr,Li, C,Rim, SH,Parelkar, P,Chen, SC(2011).The health burden and economic costs of cutaneous melanoma mortality by race/ethnicity-United States, 2000 to 2006.J Am Acad Dermatol,65,S133-43.
9. Gardner, JW,Sanborn, JS(1990).Years of potential life lost (YPLL) - what does it measure?.Epidemiology,1,322-9.
10. Lee, RD,Carter, LR(1992).Modeling and forecasting US mortality.J Am Stat Assoc,87,659-71.
11. Lewis, EB(1982).Control of body segment differentiation in Drosophila by the bithorax gene complex.Prog Clin Biol Res,85 Pt A,269-88.
12. Li, C,Ekwueme, DU,Rim, SH,Tangka, FK(2010).Years of potential life lost and productivity losses from male urogenital cancer deaths-United States, 2004.Urology,76,528-35.
13. Wilmoth, JR(1993).,Berkeley, CA:Department of Demography, University of California, Berkeley.
14. 丁先玲、王榮德、許文林(1993)。台灣地區居民意外災害及惡性腫瘤、腦血管疾病之累積死亡率與潛在生命損失之長期趨勢（1971-1990）。中華衛誌，12，84-91。
15. 丁先玲、白璐(1994)。台灣地區男女民眾各主要死因早死 潛在生命年數、損失率及其差異之比較（1991年）。醫學研究雜誌，14，397-404。
16. 林茂榮、陳美滿、王榮德(1992)。1979及1989兩年台灣地區十大死因之潛在生命損失與累積死亡率之比較。中華衛誌，11，140-9。
17. 邱淑媞、曹昭懿、王榮德(1993)。1974-90年間台灣地區老年人口意外災害死亡率及潛在生命損失之分析。中華衛誌，12，405-20。
18. 陳立慧、林茂榮、王榮德(1993)。機動車交通事故之死亡率、潛在生命年數損失及其貨幣價值。中華衛誌，12，368-79。
19. 陳麗華(2001)。,台北=Taipei:衛生福利部統計處=Department of Statistics, Ministry of Health and Welfare, R.O.C. (Taiwan)。
20. 曾奕翔、余清祥(2006)。Lee-Carter估計模式與死亡率推估研究。2006年台灣人口學會年會暨學術研討會，台北=Taipei:
21. 黃意萍、余清祥(2002)。台灣地區生育率推估方法的研究。人口學刊，25，145-71。
22. 楊銘欽、李玉春(1992)。,台北=Taipei:衛生福利部國民健康署=Health Promotion Administration, Ministry of Health and Welfare, R.O.C. (Taiwan)。