台灣智能障礙老人一般老人之流感疫苗接種情形比較

Comparison of Influenza Vaccination Rates between the General Elderly and the Elderly with Intellectual Disability in Taiwan

10.30072/JDR.201212.0004

張育嘉(Yu-Chia Chang)；董和銳(Ho-Jui Tung)；徐尚為(Shang-Wei Hsu)；江博煌(Po-Huang Chiang)

老人 ； 流感疫苗 ； 智能障礙 ； Elderly ； influenza vaccination ； intellectual disability

身心障礙研究季刊

10卷4期（2012 / 12 / 01）

276 - 289

繁體中文

目的：免疫力較差的老人、幼兒與慢性病患者被視為是最容易遭受流行性感冒威脅的高危險群，故需要特別照護的老人及失能者更應該確實接種流感疫苗。不過，卻少有研究探討智能障礙老人之流感疫苗接種情形，因此本研究目的旨在比較智能障礙老人與一般老人之流感疫苗接種情形的差異，並進一步呈現不同智能障礙程度之老人的流感疫苗接種情形。方法：本研究為回溯性世代研究法，資料來源包括全民健康保險學術資料庫之「智能障礙者的醫療利用特定主題母體檔」及「2005年承保抽樣百萬歸人檔」之2007年的資料，研究對象為65歲以上的老人。在控制研究對象個人特質與過去醫療利用等變項後，以複邏輯斯迴歸分析智能障礙與否與流感疫苗接種情形之關係，及不同智能障礙程度之流感疫苗接種情形。結果：本研究共納入2,437位智能障礙老人及102,004位的一般老人，其2007年之流感疫苗接種率分別為36.9%及33.2%。在控制其它變項後發現智能障礙老人較一般老人更常接種流感疫苗，其調整後勝算比為1.17（95%CI：1.08－1.28）。進一步分析不同智能障礙程度之智能障礙老人的流感疫苗接種情形後發現，相較於輕度智能障礙老人，中度及未明示之智能障礙程度老人的流感疫苗接種率較低。結論：一般而言，社經地位較低者在預防保健的利用上會落後於社經地位較高者，但本研究卻發現智能障礙老人之流感疫苗接種率顯著高於一般老人，推測可能原因為智能障礙老人與一般老人在接種流感疫苗時所存在之時間及機會成本的差異。

Objective: Vaccination is one of the most effective strategies in preventing seasonal influenza, especially for the immune-compromised elderly. However, few studies have investigated the difference in vaccination against seasonal influenza among these vulnerable populations. This retrospective cohort study aimed to examine the vaccination rates between the general elderly and the elderly with intellectual disability (ID) in Taiwan. Vaccination rates for the elderly with different level of ID were also investigated. Method: The subjects of the general elderly aged 65 and over in 2007 were derived from the NHI sample files, Longitudinal Health Insurance Database 2005 in 2007. For the elderly with ID, they were identified from enrollees of NHI aged 65 and over with a diagnosis of ID (codes 317-319 were defined based on the International Classification of Diseases, Ninth Revision, Clinical Modification). The two samples of elderly were pooled together and multivariate logistic models were used to compare the rates of vaccination against seasonal influenza. Results: Results showed that, in 2007, the overall vaccination rate for the general elderly and the elderly with ID were 33.2% and 36.9%, respectively. Compared to the general elderly, the elderly with ID were 1.17 times (95% CI=1.08, 1.28) more likely to be vaccinated. In terms of the vaccination rates for the elderly with different level of ID, it was found that the elderly with a moderate or unspecified ID were less likely to be vaccinated in 2007, when compared to the elderly with a mild ID. Conclusions: It's normally expected that people from a disadvantaged group would use less needed preventive services. However, our findings suggest that the opposite is true. Plausible explanations are directed to the differences in the time/opportunity costs between the general elderly and the elderly with ID.

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