| 研究生: |
陳嬿今 Chen, Yen-Chin |
|---|---|
| 論文名稱: |
探討女性愛滋感染者與一般婦女於子宮頸抹片篩檢利用率之差異及其影響因素 Exploring the Difference in Rate of Cervical Cancer Screening Utilization and Associated Factors between Women with HIV/AIDS and Those Without |
| 指導教授: |
柯乃熒
Ko, Nai-Ying |
| 學位類別: |
碩士 Master |
| 系所名稱: |
醫學院 - 護理學系 Department of Nursing |
| 論文出版年: | 2011 |
| 畢業學年度: | 100 |
| 語文別: | 中文 |
| 論文頁數: | 63 |
| 中文關鍵詞: | 女性愛滋感染者 、子宮頸疾病 、子宮頸抹片篩檢 、全民健保資料庫 |
| 外文關鍵詞: | HIV-infected women, cervical disease, cervical cancer screening, National Health Insurance Database (NHID) |
| 相關次數: | 點閱:99 下載:6 |
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背景:侵襲性子宮頸癌(invasive cervical cancer, ICC) 是女性愛滋病毒 (Human im-munodeficiency virus, HIV) 感染者相關愛滋診斷症候群之一,也是最常見的婦科癌症。而子宮頸抹片篩檢是目前可提早偵測女性愛滋病毒感染者子宮頸癌的工具,但綜觀國內外研究設計大多以小樣本及問卷調查方式為主,尚無長期且全國性的調查數據。
研究目的:本研究分析女性HIV感染者於2000-2009年子抹篩檢率趨勢,進而比較與一般婦女子抹篩檢率之差異及影響女性HIV感染者使用子抹篩檢之因素。
研究方法:採固定世代研究法,擷取全民健保資料庫2000~2009年共1500位18歲以上女性HIV感染者門診檔資料進回朔性資料分析,並以國民健康局2007-2009年子抹篩檢年報資料為參考組,運用標準化年齡、年度計算HIV感染者標準化篩檢比(the age-, and calendar year-specific standardized screening ratio, SSR),而後再以多變項邏輯式迴歸描述影響HIV感染者使用子抹篩檢的因素。
結果:女性HIV感染者經診斷後一年內子抹篩檢率為12.0%,十年間至少做過一次子抹篩檢為30.7%。女性HIV感染者整體子抹篩檢利用率是一般婦女的0.74倍(SSR=0.74, 95% conference interval【CI】=0.68-0.80)。影響女性感染者接受子抹篩檢的因素為;年齡越大 (adjusted odds ratio【AOR】=1.35, CI= 1.19-1.52)、高月投保收入 (AOR = 1.66, CI = 1.37-2.01)、先前曾被診斷相關子宮頸疾病(AOR =2.61, CI = 1.92-3.55)及伺機性感染病史者(AOR =2.54, CI = 1.96-3.31)。
結論:女性HIV感染者初診一年內僅12.0%曾經做過子抹篩檢,且整體篩檢率亦顯著低於一般婦女。建議國內相關健康政策應著重提昇女性HIV感染者子宮頸抹片篩檢率,且未來子抹宣導政策應著重於年紀較輕、低收入、無子宮頸相關疾病及伺機性感染病史之女性HIV感染者。
Backgound: HIV-infected women have a higher risk of suffering from cervical cancer compared with the HIV-uninfected women. Pap smear as a tool could early detect precancerous changes of uterine cervix among HIV-infected women.
However, previous studies examined the trend in screening based on the data from the studies of a small sample or self-report surveys. Longitudinal research with involvement of national survey has been scarce.
Objectives: The purpose of the study was to investigate the Pap screening rate among women with HIV during 2000-2009, to compare the rates of having Pap smears between HIV-infected women and a general population, and to identify factors associated with hav-ing Pap smears among HIV-infected women.
Methods: A population-based cohort design was conducted and a total of 1,500 certified HIV-infected women from National Health Insurance Database (NHID) between 2007 to 2009 were compared with the age-, and calendar year-specific screening rates of a general population from the database of Bureau of Health Promotion. The age-, and calendar year-specific standardized screening ratio (SSR) was used to estimate the difference in rates of having Pap smears between HIV-infected women and a general population. The multiple logistic regression was applied to identify factors associated with having Pap smear among HIV-infected women.
Results: Only 12.0% HIV-infected women had Pap smears after being diagnosed with HIV within one year. Between 2000 to 2009, the cumulative screening rate reached to 66.13% among HIV-infected women. The SSR of HIV-infected women is lower than that of a general population (SSR=0.74, 95% conference interval【CI】=0.68-0.80). Logistic regression analysis showed that the factors associated with receiving Pap smear were: age (adjusted odds ratio【AOR】=1.35, CI= 1.19-1.52), higher monthly income (AOR = 1.66, CI = 1.37-2.01), previous of cervical disease (AOR =2.61, CI = 1.92-3.55) and a history of opportunist infection disease (AOR =2.54, CI = 1.96-3.31).
Conclusions: The findings recommended there shall be a great attention paid to HIV-infected women with younger, lower income, no previous cervical diseases and no history of opportunist infection disease.
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