研究背景：
氣喘是慢性發炎性肺部疾病，是兒童最常見慢性肺病，在成人也是常見慢性肺病之一。氣喘的主要症狀是咳嗽、胸悶、喘鳴以及呼吸困難，氣喘急性發作時甚至需要至急診就醫甚至住院治療，對於個人健康、家庭以及醫療照護系統皆是負擔。全球氣喘盛行率自20世紀下半葉上升，進入21世紀後，不同國家的氣喘盛行率有各自不同的趨勢變化。先前在台灣有許多探討氣喘盛行率的研究，唯多數是利用問卷重複數次的橫斷性研究，但所調查的研究族群規模較小，研究結果較缺乏外推性。2015年有兩篇以全人口為基礎的國內健保資料庫研究，研究族群分別是兒童及成人，研究結果不論是兒童或是成人氣喘盛行率皆呈現上升趨勢。至於氣喘病人因氣喘發作至急診就醫或是住院比率的趨勢變化研究，分別僅有兒童族群2001-2010年以及2001-2012年的數據。近年來，有些國家的氣喘盛行率達到頂峰甚至呈現下降趨勢。有鑑於最新的國內氣喘盛行率、急診就醫率以及住院率是十年前的數據，因此本研究將探討2011-2021年兒童以及成人氣喘盛行率、氣喘病人急診就醫率以及住院率。

目的：
探討國內2011年至2021年兒童以及成人氣喘盛行率、氣喘病人因氣喘急性發作之急診就醫率以及住院率趨勢變化以及人口學特徵對這些指標的影響。

研究方法：
本研究利用「衛生福利部衛生福利資料科學中心」所提供的2011年至2021年之台灣全民健康保險研究資料庫作為資料來源，以當年度全人口為研究對象。接著以使用連結點迴歸模型（joinpoint regression analysis）分析氣喘盛行率、因氣喘急性發作至急診就醫率以住院率的趨勢變化。並以多變量卜瓦松回歸分析檢定各個衡量指標與人口學特徵、年分、都市化、社經地位的關聯性。

結果：
在2011年至2021年間，2至17歲兒童的氣喘盛行率從3.65 %降至2.31 %。根據多變量分析，男性、2-4歲組、保險費用高於中位數以及投保地為都市地區的兒童氣喘盛行率較高。同樣地，兒童的氣喘急診就醫率也顯著下降，從2011年的13.9 %降至2021年的4.88 %。男性急診就醫率高於女性，2-4歲組的急診就醫率最高。多變量分析顯示，男性、2-4歲組、保險費用較低的兒童急診就醫率較高，而都市地區與鄉村地區的急診就醫率無顯著差異。兒童氣喘住院率在此期間也有所下降，從2011年的9.41 %降至2021年的6.75 %，但統計並不顯著。從多變量分析來看，男性、2-4歲組、保險費用較低的住院醫率較高，而都市地區與鄉村地區的住院率無顯著差異。
成人氣喘方面，盛行率從2011年的0.96 % 微幅上升至2021年的0.98 %。根據多變量分析，女性、25-54歲組、保險費用小於20,000氣喘盛行率較高，以及投保地的效應並不明顯。氣喘急診就醫率從8.41 %下降至3.91%。多變量分析顯示女性、18-24歲組、保險費用小於20,000、投保地為鄉村地區急診就醫率較高。氣喘住院率也在此期間有顯著下降（APC為1.0）。多變量分析顯示女性、18-24歲組、保險費用小於20,000、投保地為鄉村地區住院率較高。
結論：
在COVID-19疫情之前，兒童的氣喘盛行率保持穩定趨勢，而成人的氣喘盛行率持續上升。然而在疫情期間，兒童和成人的氣喘盛行率都有顯著下降。而氣喘急診就醫率和住院率方面，除了兒童的氣喘住院率未有顯著變化外，氣喘急診就醫率和住院率在整個研究期間呈現下降趨勢。
由於免疫負債和防疫措施的鬆綁，後疫情時代呼吸道感染可能增加，這可能導致氣喘急性發作也隨之增加。因此，對於氣喘相關指標的定期監測是至關重要的。除此之外，進一步研究哪些因素是導致低社經地位這個族群氣喘發作比率較高，以及導致青少年和年輕成人氣喘住院率上升的原因也是未來研究的方向。如此一來可以制定相應的策略以增進氣喘照護品質。

Asthma is a chronic inflammatory lung disease with primary symptoms including coughing, chest tightness, wheezing, and shortness of breath. Acute asthma attacks can lead to emergency department visits or hospitalization, burdening individual health, families, and healthcare systems. Asthma prevalence changes over time and varies globally. Understanding the prevalence of asthma and asthma-related healthcare utilization is essential for effective treatment and prevention strategies. This study examines asthma prevalence and rates of emergency department visits and hospitalizations among children and adults in Taiwan from 2011 to 2021, analyzing secular trends. Data were obtained from Taiwan's National Health Insurance (NHI) database for this period. We assessed trends in asthma prevalence, emergency department visits, and hospitalizations, as well as the impact of demographic characteristics, insurance premiums, and urbanization using multivariate Poisson regression analysis.
Before the COVID-19 pandemic, asthma prevalence remained steady in children but was rising in adults. However, a significant decline was observed in both groups during the pandemic. Asthma-related outcomes improved over the study period, except for pediatric hospitalization rates, which remained unchanged. Insurance premiums were a key determinant of health outcomes among asthmatic patients, while geographic area had no significant impact in the pediatric population. In contrast, adults in rural areas were associated with worse asthma-related outcomes.

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