博碩士論文 109454023 詳細資訊




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姓名 陳佳葳(Chia-Wei Chen)  查詢紙本館藏   畢業系所 產業經濟研究所在職專班
論文名稱 空氣污染與冠狀動脈心臟病醫療診治與支出研究
(Air pollution and Coronary Artery Disease medical diagnosis rate and expenditure research)
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摘要(中) 本研究分析了空氣污染物與冠狀動脈心臟病之間的相關性,實證資料採用2010年至2019年共計10年臺灣各縣市的總體資料,主要資料來源為衛生福利部全民健康保險資料庫「門、住診合計就醫總醫療費用統計」及「門、住診合計就醫人數統計」、行政院環境保護署「歴年空污監測資料」所建構而成。本研究使用OLS迴歸及固定效果進行實證分析,依變數為冠狀動脈心臟病每10萬人就診率及醫療支出,自變數包含懸浮微粒(PM10)、二氧化硫(SO2)、二氧化氮(NO2)、一氧化碳(CO)、臭氧(O3),控制變數包含男性人口數、女性人口數、人口結構、年份。從OLS迴歸實證結果顯示,懸浮微粒(PM10)濃度增加1 μg/?3、二氧化硫(SO2)濃度增加1 ppb及二氧化氮(NO2)濃度增加1 ppb,對冠狀動脈心臟病每10萬人的就診率呈現正向且顯著的影響,分別會造成每10萬人口25人、467人及54人的冠狀動脈心臟病就診率。然而,懸浮微粒(PM10)濃度增加1 μg/?3、二氧化硫(SO2)濃度增加1 ppb,對冠狀動脈心臟病每10萬人醫療支出呈現正向且顯著的影響,分別會造成每10萬人醫療支出增加769,666元、1,050,000元。另一方面,固定效果與OLS迴歸估計結果大致相同,固定效果實證結果顯示,懸浮微粒(PM10)濃度增加1 μg/?3、二氧化硫(SO2)濃度增加1 ppb及二氧化氮(NO2) 濃度增加1 ppb,對冠狀動脈心臟病每10萬人的就診率呈現正向且顯著的影響,分別會造成每10萬人口26人、476人及55人的冠狀動脈心臟病就診率。懸浮微粒(PM10)濃度增加1 μg/?3、二氧化硫(SO2)濃度增加1 ppb,對冠狀動脈心臟病每10萬人醫療支出呈現正向且顯著的影響,分別會造成每10萬人醫療支出增加807,199元、1,130,000元。
摘要(英) This study analyzes the correlation between air pollutants and Coronary Artery Disease. The empirical data are based on the overall data of Taiwan′s counties from 2010 to 2019. The main data sources are "Statistics of the outpatient visits " and "Statistics on medical expenses" of the Ministry of health and welfare database, and "annual air pollution monitoring data" of the Environmental Protection Administration, Executive Yuan. This study uses OLS regression and fixed effect for empirical analysis. The Dependent variables were Coronary Artery Disease visits per one hundred thousand people and medical expenditures, the independent variables include PM10, SO2, NO2, CO and O3, and the control variables include male, female, population structure and year. The results from OLS regression show that the concentration of PM10 increases by 1μg/?3, SO2 increases by 1 ppb and NO2 increases by 1 ppb have a positive and significant impact on the visit rate of Coronary Artery Disease for per one hundred thousand people, resulting in 25, 467 and 54 visit rate of Coronary Artery Disease for per one hundred thousand people, respectively. However, the concentration of PM10 increases by 1μg/?3 and SO2 increases by 1 ppb will have a positive and significant impact on the medical expenditure of Coronary Artery Disease for per one hundred thousand people, resulting in 769,666 NT dollars and 1,050,000 NT dollars respectively. On the other hand, the fixed effect is roughly the same as the OLS regression estimation results. The results from fixed effect show that the concentration of PM10 increases by 1μg/?3, SO2 increases by 1 ppb and NO2 increases by 1 ppb have a positive and significant impact on the visit rate of Coronary Artery Disease for per one hundred thousand people, resulting in 26, 476 and 55 visit rate of Coronary Artery Disease for per one hundred thousand people respectively. However, the concentration of PM10 increases by 1μg/?3 and SO2 increases by 1 ppb will have a positive and significant impact on the medical expenditure of Coronary Artery Disease for per one hundred thousand people, resulting in 807,199 NT dollars and 1,130,000 NT dollars respectively.
關鍵字(中) ★ 空氣汙染
★ 冠狀動脈心臟病
關鍵字(英) ★ Air pollution
★ Coronary Artery Disease
論文目次 中文摘要i
英文摘要ii
誌謝iii
目錄iv
圖目錄v
表目錄vi
一、緒論
1.1 研究動機1
1.2 研究目的2
1.3 章節安排3
二、研究背景
2.1 臺灣空氣污染概況4
2.2 臺灣冠狀動脈心臟病總醫療支出概況10
三、文獻探討
3.1 空氣污染與冠狀動脈心臟病之相關性16
3.2 空氣污染與疾病醫療支出之相關性18
四、研究方法
4.1 實證模型設定21
4.2 資料來源與變數說明22
4.3 基本統計分析26
五、實證結果
5.1 OLS實證結果28
5.2 固定效果實證結果33
六、結論
6.1 研究發現37
6.2 研究意涵與政策建議38
6.3 研究限制與未來研究方向38
參考文獻39
附錄一42
附錄二43
附錄三44
附錄四45
參考文獻 一、中文文獻
陳英辰、翁一昊、邱亞文與楊春玉(2015),「粗顆粒物對心血管疾病住院的短期影響:熱帶城市的病例交叉研究」,《毒理學及環境健康期刊》,78(19): 1241-1253
黃鈺茹(2015),「以追蹤資料分析臺灣空氣污染與呼吸道及心血管疾病之相關性」,國立臺北科技大學環境工程與管理研究所碩士論文
王曉東、張旭敏、莊紹偉、羅紆、康昇與劉亞玲(2016),「2013-2014年中國上海空氣污染對急性心肌梗的短期影響」,《老年心臟病學期刊》,13(2): 132-137
李樂樂、杜甜甜與張馳 (2020),「空氣污染對呼吸系統疾病醫療保健支出的影響」,《RAND健康期刊》,(13): 1723-1738
行政院環境保護署(2020),《空氣品質標準法規》,2022年6月8日取自於:https://airtw.epa.gov.tw/cht/Information/Standard/Rules.aspx
行政院環境保護署(2020),《空氣品質標準修正》,2022年6 月8日取自於: https://enews.epa.gov.tw/Page/3B3C62C78849F32F/d135262a-0b65-43c6-9eb0-5cd68df99635
衛生福利部統計處(2020),《109年國人死因統計結果》,2022年6月8日取自於: https://www.mohw.gov.tw/cp-5017-61533-1.html
劉歡、胡天天與王蒙(2021),「空氣污染對居民醫療費用的影響:以中國122個城市的調查數據研究」,《公共衛生期刊》,9: 743087
苗栗縣政府環境保護局(2021),《苗栗縣室內空氣品質監測網》,2022年6 月8日取自 於: https://w3.ncet.com.tw/A2/MiaoliWeb/2air.html
李舟、錢忠與楊晶晶 (2022),「中國空氣污染與家庭醫療費用」,《公共衛生期刊》,9: 798780
二、英文文獻
Miller, Kristin A., David S Siscovick, Lianne Sheppard, Kristen Shepherd, Jeffrey H. Sullivan, Garnet L. Anderson, and Joel D. Kaufman. 2007. “Long-Term Exposure to Air Pollution and Incidence of Cardiovascular Events in Women.” New England Journal of Medicine, 356(5): 447-458.
Narayan, Paresh K., and Seema Narayan. 2008. “Does environmental quality influence health expenditures? Empirical evidence from a panel of selected OECD countries.” Ecological Economics, 65(2): 367-374.
Brook, Robert D., Sanjay Rajagopalan, Arden C. Pope, Jeffrey R. Brook, Aruni Bhatnagar, Ana V. Diez-Roux, Fernando Holguin, Yuling Hong, Russell V. Luepker, Murray A. Mittleman, Annette Peters, David Siscovick, Sidney C. SmithJr, Laurie Whitsel, and Joel D. Kaufman. 2010. “Particulate Matter Air Pollution and Cardiovascular Disease.” Circulation, 121(21): 2331–2378.
Romley, John A., Andrew Hackbarth, and Dana P. Goldman. 2012. “The Impact of Air Quality on Hospital Spending.” RAND Health Quarterly, 2(3): 6.
Tatyana Deryugina, Garth Heutel, Nolan H. Miller, David Molitor, and Julian Reif. 2019. “The mortality and medical costs of air Pollution: Evidence from changes in wind direction.” National Bureau of Economic Research Working Paper 22796.
Wang Meng, Paul D. Sampson, Lianne E. Sheppard, James H. Stein, Sverre Vedal, and Joel D. Kaufman. 2019a. “Long-Term Exposure to Ambient Ozone and Progression of Subclinical Arterial Disease: The Multi-Ethnic Study of Atherosclerosis and Air Pollution.” American Journal of Epidemiology, 167(6): 667–675.
Wang Meng, ZhiHui Hou, Hao Xu, Yang Liu, Matthew J. Budoff, Adam A. Szpiro, Joel D. Kaufman, Sverre Vedal, and Bin Lu. 2019b. “Association of Estimated Long-term Exposure to Air Pollution and Traffic Proximity With a Marker for Coronary Atherosclerosis in a Nationwide Study in China.” JAMA Network Open, 2(6):e196553.
Lelieveld Jos, Klaus Klingmüller, Andrea Pozzer, Ulrich Pöschl, Mohammed Fnais, Andreas Daiber, and Thomas Münzel. 2019. “Cardiovascular disease burden from ambient air pollution in Europe reassessed using novel hazard ratio functions.” European Heart Journal, 40(20): 1590–1596.
Gestro Massimo, Vincenzo Condemi, Luisella Bardi, Laura Tomaino, Eliana Roveda, Antongiulio Bruschetta, Umberto Solimene, and Fabio Esposito. 2020. “Short-term air pollution exposure is a risk factor for acute coronary syndromes in an urban area with low annual pollution rates: Results from a retrospective observational study.” Archives of Cardiovascular Diseases - journals elsevier, 113(5):308-320.
WHO. Ambient (Outdoor) Air Pollution. Retreived from: https://www.who.int/news-room/factsheets/detail/ambient-(outdoor)-air-quality-and-health (accesesed April 22, 2022).
指導教授 劉錦龍(Jin-Long Liu) 審核日期 2022-6-30
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