研究背景：全球中風疾病負擔仍然很大，而且隨著人口不斷老齡化，這種負擔正在增加。中風後呼吸道感染通常發生在前 7 天以內，發生率呼吸道感染介在 11.2% 到 18% 之間。而值得注意的是中風最常見的非神經系統併發症是感染症，與中風相關的肺炎相關的中風即是其中之一，尤其是在於急性缺血性中風患者發生率更高。正常人如果進食被嗆到並不會產生很大的問題，但是在某些重病的患者、有咳嗽反射功能比較差的患者、口腔衛生較差、中風患者等，會因為呼吸道氣管的異物或食物的量太多導致無法清除，就可能會因為誤吸入了食物或異物產生肺炎，這稱為吸入性肺炎。而較容易發生吞嚥困難的三個主要人群為老年人、患有神經系統疾病或神經退行性疾病的患者，以及患有頭頸部疾病的患者。在台灣，有關中風患者發生吸入性肺炎的流行病學數據仍屬有限。
研究目的：本研究欲使用衛生福利部統計處衛生福利資料科學中心之2000年兩百萬人世代追蹤全民健康保險申報資料抽樣檔作為研究資料，比較中風疾病者與非中風疾病者吸入性肺炎發生的絕對與相對相關風險，並分析中風與精神疾病的可能交互作用。
研究方法：本研究採回溯性世代研究設計方法，擷取2005年至2017年期間成年（≥20歲）住院患者首次發生中風之病人為中風世代，並串聯承保檔以中風樣本之年齡、性別及指標日以1：4方式進行個人配對，選取沒有中風病史之被保險人為對照組世代，最後共獲得23,288名中風病人以及68,675名對照組個案。所有樣本追蹤至 2018 年 12 月 31 日，分析吸入性肺炎的發生率。此研究使用Kaplan–Meier分析比較中風與非中風樣本之吸入性肺炎累積存活率，並使用Cox比例風險模型估計兩組樣本的吸入性肺炎發生風險對比值。研究也將樣本比對死因統計檔，將全因死亡視為競爭死因事件，利用Fine and Gray’s method進行考慮競爭死因風險的存活分析。此外，所有樣本將從指標日往前3年觀察精神疾病的發生，並進一步中風與精神疾病對於發生吸入性肺炎的交互作用。
研究結果：本研究在經過最多14年之追蹤後，中風世代組發生吸入性肺炎的發生密度比對照組來得高（11.30/1,000人年 vs 1.51/1,000人年）; 而在性別分層後也有相似的結果。經過校正潛在干擾因子後，中風世代發生吸入性肺炎風險是對照組的3.41倍（95% confidence interval（CI）, 3.30-3.52），而進一步使用競爭風險分析後中風世代發生吸入性肺炎風險是對照組的3.64倍（95% CI, 3.27-4.05）。性別與年齡分層分析結果發現：男性與女性的危害對比值相當，分別為3.53與3.27。此外，無論男性或女性，吸入性肺炎的危害對比值均隨年齡增加而下降。本研究也發現了，中風患者之指標住院住院日數越長，發生吸入性肺炎的相對風險越高，發生吸入性肺炎的風險在住院日數>28天（相對於0-7天）的樣本調整後的危害對比值為6.82（95% CI, 6.21-7.72）。此外，本研究也進行了中風有無與各類精神疾病之間發生吸入性肺炎的交互作用。結果發現，中風患者同時合併有思覺失調症者，吸入性肺炎的發生密度為最高（17.42/1,000人年）。交互作用檢定顯示，中風與憂鬱症或思覺失調症均有顯著的交互作用，但中風與雙極症之交互作用則是不顯著。
結論：本研究發現，中風會顯著增加吸入性肺炎發生的風險，此外，中風與特定精神疾患對於吸入性肺炎發生具有顯著的交互作用。

There is limited research on the association of incidence and prevalence of aspiration pneumonia with stroke patients among people in Taiwan. This retrospective cohort study, including 23,288 stroke patients and 68,675 matched controls identified from 2-million people registered with Taiwan National Health Insurance (NHI) program in 2000, supervised by the Health and Welfare Data Science Center (HWDC), conducted to the relative risks of aspiration pneumonia in stroke group and control group. All the study subjects were followed from the index date to the last day of 2018. After adjustment for potential confounders, the risk of aspiration pneumonia in the stroke group was 3.14 times that of the control group; and further employment of Fine and Gray method in a competing risk analysis, the relative hazard increased to 3.64 times. We also noted a dose-response relationship between length of hospital stay and risk and relative hazard of aspiration pneumonia. In addition, stroke patients with schizophrenia experienced the highest incidence density of aspiration pneumonia at (17.42 per 1,000 person-years). The analysis of interaction suggested that stroke interacted with depression and schizophrenia, but not with bipolar disorder in the incidence of aspiration pneumonia.

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