背景：死亡率資料是監測國家全人口健康狀況的基礎資料，可以探討死亡數目較少疾病的死亡率型態。可惜，目前沒有腦性麻痺（腦麻）死亡率長期趨勢與跨國比較研究論文發表。
目的：檢視台灣與美國1987至2022年腦麻死亡年齡、腦麻死亡率與死因診斷填寫行為，腦麻疾病關聯性的趨勢改變。
方法：本研究使用台灣與美國1987，1992，1997，2002-2022年多重死因資料進行分析。首先，檢視不同年代提及腦麻個案不同年齡別死亡數分布型態與死亡年齡平均值改變。接著，計算不同年代提及腦麻與腦麻為原死因死亡率，原死因佔多重死因與腦麻填在死亡證明書第一部份的百分比。第三，估計不同年代死亡證明書中同時提及腦麻與吸入性肺炎與癲癇的調整勝算比值。
結果：台灣死亡證明書提及腦麻死亡年齡平均值由 1987 年 12.7 歲持續增加到2022 年 35.1 歲，美國由 1987 年 29.5 歲持續增加到 2022 年 48.3 歲。台美差距由1987 年 16.8 歲縮小到 2022 年 13.2 歲。台灣提及腦麻與腦麻為原死因的年齡標準化死亡率，35 年來趨勢沒有顯著差異改變。不過，年齡別死亡率趨勢型態有差異。0-9歲死亡率顯著下降，25-64 歲死亡率顯著上升。相對地，美國年齡標準化提及腦麻與腦麻為原死因死亡率都呈現顯著上升趨勢。類似地，0-9 歲死亡率顯著下降，25 歲以上死亡率都顯著上升。原死因佔多重死因百分比與腦性麻痺填在第一部份百分比，台灣都高於美國，不過兩國都沒有顯著年代改變趨勢。台灣提及腦麻相較於沒有提及腦麻出現吸入性肺炎的調整後勝算比為 8.15（95%信賴區間為 6.68-9.95），2013-2022 相較於 2003-2012 勝算比顯著降低。出現癲癇的調整後勝算比為 12.82（95%信賴區間為 11.31-11.49），2013-2022 相較於 2003-2012 勝算比顯著上升。美國出現吸入性肺炎的調整後勝算比為 14.75（95%信賴區間14.40-15.11），2018-2022 相較於 2003-2007 勝算比顯著降低。出現癲癇的調整後勝算比為 13.08（95%信賴區間為 12.61-13.57），2018-2022 相較於 2003-2007 勝算比顯著上升。
結論：根據本研究35年全人口死亡率資料分析結果顯示，台灣與美國都出現腦麻患者高齡化現象，死亡年齡都是逐年上升。台灣的年齡別死亡率趨勢型態大致上是十年落差追趕美國的趨勢型態。台灣中年死亡率已經出現上升趨勢，但是高齡者還沒有出現上升趨勢。腦麻者有相當高風險發生致死吸入性肺炎併發症與癲癇。所幸，吸入性肺炎風險有年代下降趨勢，但是癲癇風險卻逐年上升，未來應該針對這個議題更深入探討。

Background: Mortality data is a fundamental data for monitoring national population health status and can be used to examine mortality pattern of disease with small number of deaths. To the best of our knowledge, no study ever examined cerebral palsy (CP) mortality trends and cross-countries comparisons. Objectives: 1) to reveal the changes in age at death pattern among people with CP; 2) to assess the mortality trends in CP mentioned, CP as the underlying causes of death (UCOD), U/M proportion, and proportion of CP been reported in the Part 1 of the death certificate; 3) to examine the changes in associations between CP and some conditions in Taiwan and the United States (hereafter US) from 1987 to 2022. Methods: Multiple causes of death (CODs) data for years 1987, 1992, 1997, 2002 through 2022 in Taiwan and the US were used for analyses. 1) we examined the distribution of number of deaths by age group and mean age at death across years. 2) we calculated the mortality rate (deaths per 100,000) of PC mentioned and PC was selected as the UCOD, U/M proportion, and proportion of reporting CP in Part 1 of death certificate. The Cochran–Armitage trend test and join point regression model were used to assess if the changes across years were significant. 3) we estimated adjusted odds ratio of reporting two complications (aspiration pneumonia and epilepsy) among decedents with CP compared with decedents without CP across years using multivariate logistic regression models. Results: The mean age at death in 1987 and 2022 was 12.7 years and 35.1 years, respectively, in Taiwan and was 29.5 years and 48.3 years, respectively, in the US. The gap between Taiwan and the US was 16.8 years in 1987 and declined to 13.2 in 2022. No significant changes in agestandardized death rates (ASDR) for CP with mention and CP as the UCOD across 35 years was found in Taiwan. However, divergent patterns of trends in different age groups were noted. Significant decreasing trends were noted for 0-9 years age group and significant increasing trends were noted for 25-64 years age groups. In contrast,significant increasing trends were revealed in ASDR for CP with mention and CP as the UCOD in the US. Similarly, significant decreasing trends were noted for 0-9 years age group and significant increasing trends were found for 25 years and above age groups. U/M proportion and proportion of reporting CP in Part 1 of the death certificate did not change significantly across years in Taiwan and the US. The proportions were higher in Taiwan than in the US. In Taiwan, the adjusted odds ratio (aOR) for people with CP compared with people without CP for co-reporting aspiration pneumonia was 8.15 (95% CI. 6.68-9.95) and the aOR for 2013-2022 compared to 2003-2012 declined significantly. The aOR for co-reporting epilepsy was 12.82 (95% CI 11.31-11.49) and the aOR for 2013-2022 compared to 2003-2012 increased significantly. In the US, the aOR for co-reporting aspiration pneumonia was 14.75 (95% CI. 14.40-15.11) and the aOR for 2018-2022 compared to 2003-2007 declined significantly. The aOR for coreporting epilepsy was 13.08 (95% CI 12.61-13.57) and the aOR for 2018-2022 compared to 2003-2007 increased significantly.Conclusion: The findings of this national population-based with 35 years-span indicate that aging of people with CP existed in both Taiwan and the US. The age-specific mortality trends pattern in Taiwan followed those in the US with a lag of 10 years. For example, the mortality in middle aged people in Taiwan already showing increasing trends; yet no such increasing trends were noted for people aged 65 years and above.Compared with people without CP, people with CP had extremely higher risk of aspiration pneumonia and epilepsy. Fortunately, the risk of aspiration pneumonia declined across years. However, the risk of fatal epilepsy increased across years. More studies are needed in this health issue.

中華民國腦性麻痺協會。什麼是腦性麻痺？2025 年 2 月 12 日擷取網址：https://www.cplink.org.tw/tw/whatscp/ugc_whatscp.aspx
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