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研究生：	李東欣 Lee, Tung-Hsin
論文名稱：	社經階層、工作特質與冠狀動脈心臟病之相關探討 The Associations of Socioeconomic Status, Working Conditions and Coronary Heart Diseases
指導教授：	鄭雅文 Cheng, Ya-Wen
學位類別：	碩士 Master
系所名稱：	醫學院 - 公共衛生學系 Department of Public Health
論文出版年：	2003
畢業學年度：	91
語文別：	中文
論文頁數：	49
中文關鍵詞：	社經階層、工作特質、冠心病
外文關鍵詞：	socioeconomic status, working condition, coronary heart disease
相關次數：	點閱：113 下載：8
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冠狀動脈心臟病是台灣地區重要的死亡原因之一，近年來冠心病的社會面向致病因子為歐美國家流行病學的一個熱門議題。目前台灣本土的冠心病流行病學研究仍多以生物醫學面向為主，對於社會面向因子的探討仍十分缺乏，瞭解冠心病社會面向的致病因子將有助於公共衛生政策的擬定與衛生醫療資源的分配。
本論文主要探討兩個主題，其一，以橫斷性研究調查探討冠心病危險因子在各社會因子中的分佈狀況；其二，以回溯性病例對照研究探討社經階層、工作特質對急性心肌梗塞罹病風險的影響。
社經階層的測量以個人教育程度、父親教育程度、收入、職等與婚姻狀況五種指標來衡量；工作特質除了以Karasek的Demand-Control Model（負荷-控制模型）的工作控制、工作負荷觀念外，職等、工時以及自覺工作壓力大小也列入考慮。
橫斷性研究主要發現男性教育程度越高者血壓越低、抽煙比例越低、蔬果攝取量越高；女性教育程度越高者血壓越低、蔬果攝取量越高。男性工作控制越高者其抽煙比例越低；女性工作控制越高者其高蔬果攝取比例越高、舒張壓則較低。大體而言，高社經地位族群其冠心病危險因子盛行率較低。
病例對照研究主要發現，高職等族群較好發急性心肌梗塞；在工作特質方面，每週工時超過48小時的族群比起每週工時44-47小時以下的族群其急性心肌梗塞罹病的危險對比值（odds ratio）為14.28，即超時工作可能為急性心肌梗塞發病的危險因子之一。

Coronary heart disease (CHD) is one of the most important causes of death in Taiwan. In recent years, the associations between CHD and social factors have attracted growing interests in western countries. In Taiwan, almost all studies on CHD have focused on biological risk factors; there have been few studies on social factors. A better understanding of the relationship between social factors and CHD can help improve public health policies and allocate medical resources.
There are two purposes in this study: First, we conducted a cross-sectional study to understand the relationship between CHD risk factors and social factors. Second, we conducted a retrospective case-reference study to understand the relationship of socioeconomic status, working conditions and the onset of acute myocardial infarction (AMI).
Socioeconomic status (SES) was measured by education level, father’s education level, occupational grade, income, and marital status. Working conditions were measured by Karasek’s Demand-Control model, as well as occupational grade and working hours.
Our results showed that men with higher education level had lower blood pressure (BP). They also had lower smoking rate and higher vegetable/fruit intake. Women with higher education level had lower BP and higher vegetable/fruit intake. Men with higher job control had lower smoking rate. Women with higher job control had higher vegetable/fruit intake and lower DBP. In general, people with higher SES had lower CHD risk fastors.
Another findings showed that men with higher occupational grade was at a high risk for AMI. As to working conditions, we found that when compared with men with working hours 44-47 hours/week, the odds ratio of AMI for men with working hours >48 hours/week was 14.28. Overtime work may be related to an increased risk of AMI.

中文摘要........ ...............................I
英文摘要.......................................II
誌謝..........................................III
總目錄.........................................IV
圖目錄........................................VII
表目錄.......................................VIII

第一章	研究動機、目的、重要性與研究架構.......1
第二章	文獻探討...............................3
  2.1 台灣的冠狀動脈心臟病現況..................3
  2.2 社經階層與冠狀動脈心臟病..................3
    2.2.1 社經階層的測量........................3
    2.2.2 社經階層與死亡率之相關................4
    2.2.3 社經階層與冠心病危險因子之探討........4
  2.3 工作壓力與冠狀動脈心臟病..................6
    2.3.1 工作壓力定義..........................6
    2.3.2 壓力疾病..............................6
    2.3.3 Demand-Control工作壓力理論模型........6
    2.3.4 Demand-Control工作壓力理論模型與冠狀動 脈心臟病........................................7
    2.3.5 過勞死之探討..........................7
第三章	社經階層、工作特質與冠心病危險因子之橫斷研究............................................9
  3.1 前言......................................9
  3.2 研究設計..................................9
    3.2.1 問卷設計..............................9
    3.2.2 研究族群與問卷施行...................10
    3.2.3 統計方法.............................10
  3.3 結果.....................................10
    3.3.1 研究族群年齡、血壓、健康行為資料.....10
    3.3.2 健康行為在各社經階層中之分佈.........11
    3.3.3 教育程度對於血壓之預測性.............11
    3.3.4 工作年資一年以上族群之年齡、健康行為、工作特質資料...................................11
    3.3.5 健康行為在各工作特質族群中分佈狀況...12
    3.3.6 工作特質對於血壓之預測性.............12
  3.4 討論.....................................12
    3.4.1 社經階層與冠心病危險因子之討論.......12
    3.4.2 工作特質與冠心病危險因子之討論.......13
    3.4.3 研究限制.............................14
第四章	工作特質與急性心肌梗塞之病例對照研究..15
  4.1 前言.....................................15
4.2 研究設計...................................15
    4.2.1 問卷設計.............................15
    4.2.2 病例組與對照組之選取.................16
    4.2.3 統計分析.............................17
  4.3 結果.....................................17
    4.3.1 病例、對照組之年齡、社經階層、工作特質資料...........................................17
    4.3.2 社經階層、工作特質與急性心肌梗塞間的關係.............................................17
    4.3.3 病例組排除雇主及自營作業者後兩組之分析.............................................18
    4.3.3 病例組問卷資料.......................19
  4.4 討論.....................................19
    4.4.1 研究發現.............................19
    4.4.2 職等、工作負荷與心肌梗塞之討論.......20
    4.4.3 工時與急性心肌梗塞之相關探討.........20
    4.4.4 研究限制.............................21
第五章	總結與建議............................22
    5.1 總結...................................22
    5.2 建議...................................22
參考文獻.......................................23

附錄一 職業與社會心理因素對急性冠心病之影響研究問卷.............................................29

圖2.1台灣心臟疾病標準化死亡率長期趨勢..........36
圖2.2 2000年台灣各類心臟疾病比例...............36
圖2.3 2000年台灣各類冠心病比例.................37
圖2.4台灣冠心病標準化死亡率長期趨勢............37
圖2.5工作壓力致病理論架構......................38
圖2.6 Karasek Demand-Control工作壓力理論模型...38

表3.1 研究族群年齡、血壓、健康行為資料.........39
表3.2 健康行為在各社經階層中之分佈.............40
表3.3 教育程度對於血壓之預測性.................41
表3.4 年資一年以上族群之年齡、健康行為、工作特質資料...........................................42
表3.5 健康行為在各工作特質族群中之分佈.........42
表3.6 工作特質對於血壓之預測性.................43
表4.1 病例組與對照者之年齡、社經階層、工作特質資料.............................................44
表4.2 社經階層、工作特質與急性心肌梗塞之迴歸分析.............................................45
表4.3病例組與對照者之年齡、社經階層、工作特質資料
    （病例組排除雇主及自營作業者）.............46
表4.4社經階層、工作特質與急性心肌梗塞之迴歸分析
    （病例組排除雇主及自營作業者）.............47
表4.5 病例組問卷資料...........................48
                                    

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