背景：本研究的目的是估計高齡血液透析個案的發生率、平均餘命、預期生命損失、年身醫療費用與終身醫療費用，並依年齡，性別和糖尿病的有無做分層分析。
方法：我們以國家衛生研究院的全民健康保險研究資料庫做分析；從1997年7月1日起至2005年12月31日，在重大傷病證明明細檔中新發生的末期腎臟病且接受血液透析的65歲以上個案，共有24,243位，計算依年齡與性別分層的末期腎臟病且接受血液透析的發生率與65歲以後20年的累積發生率。在排除3,423位癌症個案之後，追蹤這些個案至2006年年底；並藉由Monte Carlo方法從生命表建立一與個案在年齡與性別相匹配的參考人口，接著以末期腎臟病個案與參考人口之間的存活函數做外推，並依年齡、性別與糖尿病的有無做分層分析；進一步分析個案之年醫療費用與終身醫療費用，並依年齡、性別與糖尿病的有無做分層分析。
結果：高齡糖尿病末期腎臟病個案相較於沒有糖尿病的平均餘命來得短；而65-79歲間的糖尿病男性與女性，平均預期生命損失分別為10.6-5.8年與12.3-7.3年。65歲的糖尿病與非糖尿病個案未來20年進展成末期腎臟病且接受血液透析的累積發生率，分別為0.07472-0.09282與0.01572與0.01995。藉由防治末期腎臟病對高齡族群潛在所能增加之預期生命在男性為5,430.1年，女性為10,177年。高齡糖尿病末期腎臟病個案年醫療費用明顯高於非糖尿病者，隨者年齡的增加，這樣的趨勢仍然存在，只是差距縮小。
結論：未來20年高齡糖尿病個案進展成末期腎臟病且接受血液透析的風險，是沒有糖尿病高齡人口的5倍；高齡慢性腎臟病與末期腎臟病的防治是相當重要的，特別是高齡糖尿病個案。

BACKGROUND: The objective of this study is to quantify the incidence rate, life expectancy (LE), expected years of life lost (EYLL), cost per year and lifetime cost in the elderly with ESRD under maintenance hemodialysis after stratification by age, sex and the presence of diabetes.
METHODS: We conducted a population-based study by using National Health Insurance Research Database (NHIRD). We identified all incident ESRD cases aged over 65 and under maintenance hemodialysis from registry files of catastrophic illnesses in Taiwan from July 1, 1997 to December 31, 2005. There were 24,243 cases; the age- and sex-specific incidence rates and cumulative incidence rates of ESRD between age 65 and 84 years (CIR65-84) were calculated. After excluding 3,423 cases with malignancy, their survivals were followed through the end of 2006. The survival function for an age- and sex-matched reference population was generated by using the Monte Carlo method from the life table of the general population; survival ratio between ESRD cohorts and referents was used for lifetime extrapolation after stratification by age, sex, and the presence of diabetes. Cost per year and lifetime cost (including healthcare expenditures of ambulatory care and inpatient care) were further analyzed after stratification by age, sex, and the presence of diabetes.
RESULTS: The elderly with diabetes and ESRD seem to have a shorter LE than those without diabetes. The estimated average EYLL were 10.6-5.8, and 12.3-7.3 years for males and females with diabetes aged between 65 and 79. The CIR65-84 of requiring hemodialysis in the elderly with diabetes were 0.078 and 0.099 for males and females, but those without diabetes were 0.017 and 0.020 for males and females. The life years potentially saved by successful prevention of ESRD could be 5,430.1 and 10,177 life years in males and females, respectively. The cost per year was higher in those with diabetes than those without diabetes, and the trend persisted as the age advanced, although the differences between those with and without diabetes narrowed in the oldest old group.
CONCLUSION: The likelihood of developing ESRD for the elderly with diabetes in the coming 20 years was nearly 5 times of the risk in the elderly without diabetes. Prevention of ESRD among the elderly is of great importance, especially among the elderly with diabetes.

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沈德昌、顏兆熊 (2009)。老年人之糖尿病。台灣醫界，52，499-502。

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