Takahashi Kyoko, Tsukishima Eri
Health Services Center, Otaru University of Commerce.
Regional Medical Survice Division, Department of Health and Welfare, Hokkaido Government.
Nihon Koshu Eisei Zasshi. 2017;64(11):655-663. doi: 10.11236/jph.64.11_655.
Objectives Extending health expectancy is important; however, health and welfare programs in local areas and communities present their own issues. This study aimed to identify main diseases requiring severe-level care certification for long-term care insurance based on information gathered from opinion papers prepared by primary doctors.Methods Data were obtained for 4,089 patients aged ≧65 years who were certified for long-term care insurance for the first time between April 1, 2013, and March 31, 2015. Their disorders were categorized into the groups used in the Comprehensive Survey of Living Conditions long-term care questionnaire. The subjects were categorized into "mild" and "severe" groups according to their long-term care insurance levels. Subjects in the severe group were long-term care insurance levels 2-5. The associations with diseases in the two groups were examined using chi-square tests according to gender. Multiple logistic regression analyses were conducted for those diseases which showed significant associations by chi-square test for the dependent variables after adjusting for age.Results Malignancy was the most frequent disorder in men, whereas joint disease was most frequent in mild group women. In men, there was a significant difference in the frequency of diseases between the mild and severe groups for stroke (P<0.001), malignancy (P<0.001), joint disease (P<0.001), diabetes (P=0.015), fracture and falls (P=0.028), and others (P<0.001) by chi-square tests. In women, there was a significant difference in the frequency of diseases between the mild and severe groups for stroke (P<0.001), malignancy (P<0.001), joint disease (P<0.001), dementia (P<0.001), Parkinson's disease (P=0.003), and others (P<0.001). In men, multivariate logistic regression analysis revealed that stroke, malignancy, and fracture and falls were significantly and positively associated with severe-level, long-term care insurance, while joint disease and hypertension were negatively associated. In women, stroke, malignancy, dementia, and Parkinson's disease were significantly associated with severe long-term care insurance level, while joint disease and hypertension were negatively associated.Conclusion The main diseases requiring severe-level care in both men and women were stroke and malignancy. These diseases occurred in large numbers among those less than 74 years of age. This finding suggests the importance of preventing lifestyle-related diseases before the age of 65 years in order to avoid requiring nursing care.
目的 延长健康期望寿命很重要；然而，地方和社区的健康与福利项目存在自身的问题。本研究旨在根据从初级医生撰写的意见书收集的信息，确定需要长期护理保险重度护理认证的主要疾病。
方法 获取了2013年4月1日至2015年3月31日期间首次获得长期护理保险认证的4089名65岁及以上患者的数据。他们的疾病被分类为生活状况综合调查长期护理问卷中使用的组。根据长期护理保险级别，将受试者分为“轻度”和“重度”组。重度组受试者的长期护理保险级别为2 - 5级。根据性别，使用卡方检验检查两组疾病之间的关联。对卡方检验显示有显著关联的疾病进行多因素逻辑回归分析，以年龄作为自变量进行校正。
结果 男性中最常见的疾病是恶性肿瘤，而轻度组女性中最常见的是关节疾病。在男性中，通过卡方检验，轻度和重度组之间中风（P<0.001）、恶性肿瘤（P<0.001）、关节疾病（P<0.001）、糖尿病（P = 0.015）、骨折和跌倒（P = 0.028）以及其他疾病（P<0.001）的疾病发生率存在显著差异。在女性中，轻度和重度组之间中风（P<0.001）、恶性肿瘤（P<0.001）、关节疾病（P<0.001）、痴呆（P<0.001）、帕金森病（P = 0.003）以及其他疾病（P<0.001）的疾病发生率存在显著差异。在男性中，多因素逻辑回归分析显示，中风、恶性肿瘤以及骨折和跌倒与重度长期护理保险显著正相关，而关节疾病和高血压与重度长期护理保险呈负相关。在女性中，中风、恶性肿瘤、痴呆以及帕金森病与重度长期护理保险级别显著相关，而关节疾病和高血压与重度长期护理保险呈负相关。
结论 男性和女性需要重度护理的主要疾病是中风和恶性肿瘤。这些疾病在74岁以下人群中大量发生。这一发现表明在65岁之前预防与生活方式相关的疾病以避免需要护理的重要性。
