[ 摘要 ]
背景：死亡率是瞭解一個族群健康狀況最基本的指標，山地鄉民眾在就醫資源與健康照護上是屬於比較弱勢族群，雖然政府歷年來陸續推動相關衛生政策改善之，但歷年來山地鄉民眾仍存在著死亡率較高的問題。花蓮縣共有三個山地鄉，故探討山地鄉民眾的健康狀況與非山地鄉之差異及長期趨勢變化，是值得關心之處。目的：分析花蓮縣山地鄉及非山地鄉1986-2005 年的死亡率趨勢及死因型態，並探討於健保實施前後十年變化。方法：本研究使用「衛生署死因統計檔」及「臺閩地區人口統計」分析1986 年∼2005 年花蓮縣山地鄉與非山地鄉之標準化死亡率、性別死亡率、年齡別死亡率、平均死亡年齡及死因別死亡率等指標，比較花蓮山地鄉及非山地鄉民眾之死亡率趨勢及死因之分析，並探討健保前後十年期間山地鄉與非山地鄉死亡趨勢之變化，期能提出相關山地離島政策建議。結果：1986 年∼2005 年花蓮縣山地鄉與非山地鄉之標準化死亡率下降，但其差距卻增加（1986 年死亡率比值為1.49，2005 年增加為1.96）。山地鄉15∼64 歲主要生產人口之死亡率沒有下降，且較非山地鄉高出3 倍。女性死亡率有明顯下降，但山地鄉男性死亡率卻增加9％，且高出非山地鄉男性2 倍。男女死亡年齡皆有延長，以山地鄉與非山地鄉男性平均死亡年齡差距增加最多（1995 年相差13 歲，2005 年相差15 歲）。事故傷害仍為山地鄉主要死因。結論：本研究發現山地鄉與非山地鄉之死亡率比值有增加趨勢，且在山地鄉15∼64 歲主要生產人口死亡率與男性死亡率相較於非山地鄉偏高，如何改善山地鄉男性及15∼64歲主要生產人口之健康狀況，建議需有更多的研究及政策介入。

[ 英文摘要 ]
Background: The mortality rate is the basic indicator to understand a group health state. Health careservices and related resources in remote area are more vulnerable. In many advancedcountries improving human wellbeing in remote area is defined as one of theimportant health policies. Although Taiwan government implemented many healthcare policy in aboriginal areas, but people in aboriginal areas still had higher mortalityrate over the years Hualien County has three aboriginal areas and nearly one-quartersof inhabitants are aboriginals. It’s important to assess the health status betweenaboriginals and non-aboriginal areas.Purpose: This study aimed to analyze mortality trends and causes of death between aboriginal andnon-aboriginal areas in Hualien from 1986 to 2005. The mortality trends and patternswere analyzed before and after the implementation of National Health Insurance. Weexpect the results will be helpful for the policy making in improving aboriginal health.Method: The study data comes from the Mortality Registry during 1986 to 2005, conducted byDepartment of Health. The Standardized mortality rate, Age-specific death rate,Sex-specific death rate, average age at death and the top 10 causes of death werecalculated with the mortality and population numbers between aboriginals andnon-aboriginal areas. We used Cochran Armitage test for trend to analyze the mortalitytrends before and after the implementation of National Health Insurance.Result: The trends of standardized mortality rate have been descended of aboriginal andnon-aboriginal areas in Hualian from 1986 to 2005 ,but the relative ratio of mortality ratehave been increased between aboriginal and non-aboriginal areas (1.49 times vs. 1.96times from 1986 to 2005).The mortality rate of aboriginal was significant higher thannon-aboriginal areas. Mortality rate has not been dropped between ages of 15 to 64 thatIVwere the main labor force population of aboriginal areas, but higher 3 times than thesame age group of non-aboriginal areas. The female mortality rate has been decreasedboth of aboriginal and non-aboriginal areas, but male mortality rate of aboriginal areashave been increased 9% and higher 2 times than non-aboriginal areas. Average age atdeath for male and female of aboriginal and non-aboriginal areas both have beendecreased, but the disparity for male between aboriginal and non-aboriginal areas havebeen increased (13 yeas vs. 15 years from 1986 to 2005).Accidents was still the majorcause of death of aboriginal areas.Conclusion: This study found that the relative ratios of mortality rate have been increased betweenaboriginal and non-aboriginal areas in Hualien. Mortality rate between ages of 15 to64 and male mortality rate of aboriginal areas were higher than non-aboriginal areas.There are needed more study and health policy to improve the health of male and15-64 years population of aboriginal areas.
510：#1 $aMortality trend and causes of death between aborignal and non-aborignal areas in Hualien ,1986-2005