Department of Surgery, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung 842, Taiwan.
Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan.
Int J Environ Res Public Health. 2018 Jan 23;15(2):177. doi: 10.3390/ijerph15020177.
Limited access to or receipt of liver transplantation (LT) may jeopardize survival of patients with end-stage liver diseases. Taiwan launched its National Health Insurance (NHI) program in 1995, which essentially removes financial barriers to health care. This study aims to investigate where there are still demographic and urbanization disparities of LT after 15 years of NHI program implementation. Data analyzed in this study were retrieved from Taiwan's NHI inpatient claims. A total of 3020 people aged ≥18 years received LT between 2000 and 2013. We calculated crude and adjusted prevalence rate of LT according to secular year, age, sex, and urbanization. The multiple Poisson regression model was further employed to assess the independent effects of demographics and urbanization on prevalence of LT. The biennial number of people receiving LT substantially increased from 56 in 2000-2001 to 880 in 2012-2013, representing a prevalence rate of 1.63 and 18.58 per 10⁶, respectively. Such increasing secular trend was independent of sex. The prevalence was consistently higher in men than in women. The prevalence also increased with age in people <65 years, but dropped sharply in the elderly (≥65 years) people. We noted a significant disparity of LT in areas with different levels of urbanization. Compared to urban areas, satellite (prevalence rate ratio (PRR), 0.63, 95% confidence interval (CI), 0.57-0.69) and rural (PRR, 0.76, 95% CI, 0.69-0.83) areas were both associated with a significantly lower prevalence of LT. There are still significant demographic and urbanization disparities in LT after 15 years of NHI program implementation. Given the predominance of living donor liver transplantation in Taiwan, further studies should be conducted to investigate factors associated with having a potential living donor for LT.
有限的肝移植（LT）机会或获取途径可能危及终末期肝病患者的生存。台湾于 1995 年推出全民健康保险（NHI）计划，该计划从根本上消除了医疗保健的财务障碍。本研究旨在探讨在实施 NHI 计划 15 年后，LT 仍存在哪些人口统计学和城市化差异。本研究分析的数据来自台湾 NHI 住院患者理赔。共有 3020 名年龄≥18 岁的患者在 2000 年至 2013 年期间接受了 LT。我们根据时间、年龄、性别和城市化程度计算了 LT 的粗患病率和校正患病率。进一步采用多泊松回归模型评估人口统计学和城市化对 LT 患病率的独立影响。接受 LT 的人数每两年显著增加，从 2000-2001 年的 56 人增加到 2012-2013 年的 880 人，分别占每 106 人的 1.63 和 18.58。这种增加的趋势与性别无关。男性的患病率一直高于女性。在<65 岁的人群中，患病率随着年龄的增长而增加，但在老年人（≥65 岁）中急剧下降。我们注意到不同城市化水平地区的 LT 存在显著差异。与城市地区相比，卫星（患病率比（PRR），0.63，95%置信区间（CI），0.57-0.69）和农村（PRR，0.76，95% CI，0.69-0.83）地区的 LT 患病率均显著较低。在实施 NHI 计划 15 年后，LT 仍存在显著的人口统计学和城市化差异。鉴于台湾活体供肝移植的主导地位，应进一步开展研究，以探讨与 LT 活体供体相关的因素。
