■ 背景介紹
根據美國的調查估計教師有聲音疾病的盛行率約為11%，而一般民眾的盛行率則約為6.2%。但過去研究較少提供教師工作者經醫師診斷聲帶疾病的比例多寡，也沒有縱貫性的研究描述教師罹患聲帶疾病的發生情形。
■ 目的
了解台灣教師罹患聲帶疾病的發生率與相較一般民眾的罹病風險。
■ 方法
本研究使用台灣健保資料庫2000年百萬歸人檔，進行橫斷性研究與回溯性世代研究。我們根據投保單位屬性篩選出於2000年至2010年間曾經擔任私立大專院校與私立中小學教職員者，作為橫斷性研究的觀察組，另將其他工作者作為對照組；而在回溯性世代研究中；我們另外篩選出於2000年時為22歲至35歲，且於2000年至2010年間首次擔任私立大專院校與私立中小學教職員作為觀察世代。聲帶疾病乃根據門診診斷碼478.4與478.5定義，統計分析方式包括卡方檢定與多變項邏輯式回歸評估風險因子與勝算比，並根據世代研究畫出生存曲線，進一步利用Cox比例風險模式校正計算相對風險。
■ 結果與討論
根據橫斷性研究分析結果，於2000至2011年間罹患聲帶疾病者，占私立高中職以下教師18%，占私立大專院校以上占11%，相較於其他工作族群約8%的罹病比例較高；經校正年齡、性別、收入與共病因子後，私立高中職以下教師較其他工作者罹病勝算比為1.9(95%信賴區間介於1.7至2.1)，私立大專院校以上教師較其他工作者罹病勝算比為1.2(95%信賴區間介於1.1至1.4)。
世代研究中共選入了609位私立大專院校老師與508人私立高中職以下老師作為觀察組，對照組則有188,145位其他工作者，追蹤結果發現2000年至2010年間，擔任私立大專院校教職員罹患聲帶疾患發生率為13.4每千人年，而擔任私立中小學教職員罹患聲帶發生率為27.3每千人年，對照組罹患聲帶疾患發生率為8.6每千人年，使用Cox比例風險模式校正年齡、性別、工作年資、收入與上呼吸道疾病後，私立教師罹患聲帶疾病風險為1.6(95%信賴區間介於1.4至1.8)。此外有半數高中職以下私立教師，於任職的前三年間因聲帶疾病就診。
■ 結論
根據目前研究結果發現私立教職員相較於其他工作者有較高的風險罹患聲帶疾病，尤其又以高中職以下私立教師風險較高。

■ Background:
Previous studies reported that teachers were at higher risk of voice disorders, but few of them based on clinical diagnosis, especially in Taiwan.
■ Objective
To estimate the incidence and risks of voice disorders among teachers in Taiwan.
■ Methods
We conducted a cross-sectional study and retrospective cohort study by using the Taiwan Longitudinal Health Insurance Database 2000 (LHID2000), which randomly sampled a million members from the National Health Insurance Research Database (NHIRD) in 2000. We identified who ever being private school teachers as observation group in cross-sectional study. We selected private school teachers under 35 years old began their career between 2000 and 2010 as observation cohort. People with other occupations were selected as comparison group and comparison cohort. We identified those who were diagnosed as having voice disorders using related ICD-9-CM codes from 2000 to 2010 as patients. We used chi-square tests to evaluate the differences between teachers and the comparison in demographic characteristics. We used multiple logistic regression model to estimate the odds ratio of voice disorders. We used log-rank test and Cox proportional hazard regression model for survival analysis.
■ Results and Discussion
From cross-sectional study, the proportion of voice disorders between 2000 and 2011 was 18% in high school teachers groups and 11% in college teachers groups, which were higher than the 8% in other occupations (p < 0.001). After adjusting for sex, age, and economic status, the odds ratio of voice disorders was 1.9 (95% confidence interval: 1.7-2.1) in high school teachers and 1.2 (1.1-1.4) in college teachers.
Totally 609 teachers from private colleges and 508 teachers from private high schools were included in our cohort study. There were 188,145 people from all the other occupations as the comparison cohort. The incidence rate of voice disorders was 27.3 per 1000-person-year in high school teachers and 13.4 in college teachers, which were higher than other occupations (8.6). After adjusting for age, gender, income, work duration, sinusitis and laryngitis history, the adjusted hazard ratio of voice disorders was 1.6 (95% confidence interval: 1.4-1.8) for private school teachers when compared to other occupations. For teachers in private high or elementary school, 50% of them had voice disorders in first three years.
■ Conclusion
Teachers in private school had higher risk of getting voice disorders than other occupations in Taiwan.

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