中國醫藥大學機構典藏 China Medical University Repository, Taiwan:Item 310903500/41361

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(1)ύ ୯ ᙴ ᛰ ε Ꮲ ᅺγፕЎ ጓဦǺIEH-1953 ᕎੱੰΓวғᆒઓ੯ੰ॥ᓀϐШжࣴ‫ز‬. Cohort Study on Incidence of Mental Disorder in Cancer Patients. ᕉნᙴᏢࣴ‫܌ز‬ ࡰᏤ௲௤Ǻֺᗶክ. ᏢғǺᖴስঐ Feng-Ling Hsieh ᏢဦǺ9665953 ύ๮҇୯΋żżԃ΋Д΋ΖВ.

(2) ठᖴ !. २Ӄ၈ኑ‫ޑ‬གᖴࡰᏤ௲௤ֺᗶክറγǴԴৣ஼Ј‫ޑ‬௲Ꮴ٬‫ך‬ளа΋. ᑍϦӅፁғሦୱ‫ޑ‬ు༫Ǵόਔ‫૸ޑ‬ፕ٠ࡰᗺ‫҅ך‬ዴ‫ޑ‬БӛǴ٬‫ך‬ӧ೭٤ ԃύᕇ੻ঘభǶԴৣჹᏢୢ‫ޑ‬ᝄᙣ‫ךࢂ׳‬፸Ꮲಞ‫ڂޑ‬ጄǶ !. ҁፕЎ‫ֹޑ‬ԋќѦҭளགᖴଯ໢ᙴᏢεᏢ‫ޑ‬ԴᗥεΚ‫ڐ‬շǴϷ‫ޑך‬. ‫ۆۆ‬ᅸ࣓‫ޑ‬Ѝ࡭ǶӢࣁԖգॺ‫ޑ‬ᡏፊϷᔅԆǴ٬ளҁፕЎૈ୼Ϸਔ໩ճ ‫ޑ‬ౢрǶ !. གᖴ‫ֻۏ‬ǵએখᏢߏǵ๧㧌ǵႍ໡Ꮲ‫ॺۆ‬όჇ‫ࡰޑྠځ‬р‫زࣴך‬ύ. ‫ޑ‬લѨǴЪᕴૈӧ‫ך‬଎ைਔࡰрБӛǶΨགᖴ஀ᓉǵ‫ے‬ᓄǵӼՋǵ൤ ऍǵᗶ֡ǵइዞӕᏢ‫ޑ‬ᔅԆǴգॺς࿶౥཰ǴԶ‫ך‬ᗋӧधधଓᇴǶ΋ଆ অፐ‫ֱޱޑ‬ǵॕ๭ǵऍⳮᏢ‫ॺۂ‬྽ฅΨόૈ‫૶ב‬Ǵ‫ޑॺی‬ᔅԆϷຠЈ‫ך‬ ు‫څ‬ᡏ཮Ƕ ‫ٿ‬ԃӭ္‫ޑ‬ВηǴᗨฅ྽ύଶႥΑ΋ԃǴፐ୸΢ғ౧‫ޑ‬ൔ֋‫ډ‬ᄌᄌ ಞᄍΑǵ໒‫ًڹ‬ᇴғ಍բ཰தз‫ך‬໾೸ΑတโǴᗋԖз‫ך‬ΞངΞ࡟‫ޑ‬ SAS ᇟ‫ݤ‬........Ǵགᖴ౲ՏᏢߏ‫ۆ‬ǵӕᏢǵᏢ‫ۂ׌‬ᆶ‫ך‬೭ኬ΋ၡ‫ٰو‬Ǵգ ॺ‫ޑ‬ഉՔᡣ‫ٿ‬ԃӭ‫زࣴޑ‬ғࢲᡂளКၨᇸ᚞Ƕ ! ! ! നࡕǴᙣаԜЎ᝘๏‫ך‬ኑང‫ޑ‬ᚈᒃǴᗨฅ΋ՏςόӧΓШǶ. i.

(3) ᄔा Ҟ኱ǺᕎੱੰΓёૈวғࡕុᆒઓ੯஻Ǵ‫ױ‬ᜢߏය଼நୢᚒᆶ ғࢲࠔ፦Ǵ୯ϣᕎੱੰΓ‫ޑ‬ᆒઓ੯஻࣬ᜢࣴ‫࣬ز‬ჹၨϿǶҁࣴ‫ز‬ᔕа଼ நߥᓀၗ਑௖૸ᕎੱੰΓวғࡕុᆒઓ੯஻‫ޑ‬ӒᓀϷ࣬ᜢӢηǶ Б‫ݤ‬Ǻ௦Шжଓ䅻Ǵၗ਑ٰྍࣁ଼ߥၗ਑৤ԭ࿤ΓᘜΓᔞǴа 2000 ԃԿ 2008 ԃ߃ບᘐᕎੱੰΓࣁჹຝǴҔ 1:4 БԄ٩ԃសᓎኧᒿᐒ‫ڗ‬ኬߚ ᕎੱঁਢࣁჹྣǴ௨ନϐ߻ςԖᆒઓ੯஻‫ ࣁޣ‬2001 ԃШжǴଓ䅻ᆒઓ੯ ஻วғ౗Կ 2008 ԃۭǶ಍ी௦ Cox proportional hazard regressionǴϩ‫݋‬ Ԗᆶคᕎੱບᘐ‫ޣ‬ϐᆒઓ੯஻Кၨวғǵ՗ीӒᓀǶ ่݀ǺᕎੱᆶߚᕎੱШжӧᆒઓ੯஻วғ࣬КǴ߻‫ޣ‬ϐ॥ᓀัଯǴ Ӓ্КȐhazard ratioȑࣁ 1.37 ७( 95%ёߞज़ 1.32-1.42)Ƕ‫܄ت‬ᆶζ‫࣬܄‬ КǴ߻‫ޣ‬ϐӒ্Кࣁ 1.02 ७(95%ёߞज़ 1.00-1.06)Ǵ‫ڀ‬ᖏࣚᡉ๱‫܄‬Ƕԃ ᇸΟಔ‫ޑ‬วғ॥ᓀ೿ଯ‫ ܭ‬75 ྃಔǴЪΟಔࣣၲᡉ๱ǴԶа 35-54 ྃಔ‫ޑ‬ Ӓ্Кനଯࣁ 1.47 ७(95%ёߞज़ 1.40-1.55)Ƕ໤Ьᆶ໤঩࣬КǴ ߻‫ޣ‬ϐӒ্Кࣁ 1.05 ७(95%ёߞज़ 0.96-1.16)Ǵՠόᡉ๱Ƕҗ‫ߥ׫‬Дᖒ ϩ‫݋‬Ǵե‫ ܭ‬11,000 ϡᆶե‫ ܭ‬23,000 ϡΒಔǴᆶᖒၗε‫ ܭ‬35,000 ϡಔ࣬ КǴ߻Β‫ࣣޣ‬ၲᡉ๱Ǵե‫ ܭ‬11,000 ϡಔ‫ޑ‬Ӓ্Кനଯࣁ 1.37 ७(95%ёߞ ज़ 1.27-1.48)ǶӦ୔ձวғϐ॥ᓀКǴ߾ࢂਲ༜ཥԮभਪǵ໦݅჏က ii.

(4) ѠࠄΒಔǴКѠч୷ໜୖԵಔեǴࣣࣁ 0.92 ७(95%ёߞज़ϩձࣁ 0.88 -0.97 ᆶ 0.88-0.96)Ƕ่ፕǺᕎੱШжӧ೏ບᘐрᕎੱࡕКߚᕎੱШжว ғᆒઓ੯஻ϐวғ౗ᆶӒᓀัଯǴ‫ځ‬ύа‫܄ت‬ǵၨԃᇸ‫ߥ׫܈ޣ‬Дᖒե ‫ ܭ‬11,000 ϡ‫ࣁޣ‬ၨӳว‫ޑ‬௼ဂǶԶեԏΕϷଏҶΓ঩‫ۚک‬ՐਲԮभǵ໦ ჏ࠄӦ୔‫ޣ‬Ӓ্ၨեǶ ᜢᗖӷǺШжଓ䅻ǵᕎੱǵᆒઓ੯஻ǵวғ౗ǵӒ্КǶ. iii.

(5) Cohort Study on Incidence of Mental Disorder in Cancer Patients Objectives: Previous studies have reported that depression is more prevalent in cancer patients than in the general population. This study investigated whether cancer patients in Taiwan are at higher risk of mental disorders after diagnosis with cancer. Methods and Materials: We used National Health Insurance claims data to identify 54472 newly diagnosed cancer cases from 2000 to 2008 and 229820 controls with no cancer diagnosis. Both groups were followed up until 2008 to measure the incidence of mental disorders. Results: During the follow-up period, we identified 3315 persons (1.15 per 100 person-years) with the diagnosis of metal disorders in the cancer cohort and 14570 persons (0.75 per 100 person-years) with the diagnosis of the disorders in the controls. The Cox hazard proportional regression analysis showed that cancer patients had a hazard ratio (HR) of 1.37 (95% confidence interval (CI) = 1.32-1.42) to develop mental disorders. The results also showed that men were at higher risk than women (HR = 1.02, 95% CI 1.00-1.06), younger group of age were at higher risk than older groups (HR = 1.47, 95% CI 1.40-1.55). Employeers were at higher risk than employees (HR = 1.05, 95% CI 0.96-1.16). Individuals with the monthly income of NT11,000 and less were at higher risk than individuals with the highest monthly salary of NT35,000 or higher (HR = 1.37, 95% CI 1.27-1.48). People living in Taoyuan, Hsinchu, Miaoli and Yunlin, Jiayi, Nantou were at lower risk than those living in Taipei, Keelung (HR = 0.92, 95% CI 0.88-0.97~0.96). iv.

(6) Among the metal disorders, cancer patients were prone to have higher incident affective psychoses ( 0.18 vs.0.08 per 100 person-years), acute reaction to stress ( 0.39 vs.0.22 per 100 person-years) and neurotic disorders ( 1.49vs.0.99 per 100 person-years). The corresponding hazard ratios associated with these 3 disorders were 2.18 (95% CI 1.90-2.51), 1,65 (95% CI 1.50-1.81) and 1.34 (95% CI 1.28-1.41), respectively.. Conclusion: Our study clearly suggests that male patients with cancer are at an elevated risk of developing mental disorders after the diagnosis. Low income populations and those aged 35-54 years were also at higher risk of these disorders. Prevention education is needed for cancer patients. Key words: cancer, mental disorders, incidence, hazard ratio, random sampling. v.

(7) Ҟᒵ. ಃ΋ക ᆣፕ. 1. ಃ΋࿯ ࣴ‫ز‬ङඳᆶࣴ‫୏ز‬ᐒ. 1. ಃΒ࿯ ࣴ‫ز‬Ҟ‫ޑ‬. 2. ಃΟ࿯ ࣴ‫ز‬ଷ೛. 3. ಃѤ࿯ Ӝຒࣚ‫ۓ‬. 4. ಃΒക Ў᝘ࢗ᛾. 6. ಃ΋࿯ ᕎੱᆶᆒઓ੯ੰ‫࣬ޑ‬ᜢ‫܄‬. 6. ಃΒ࿯ Шжࣴ‫ز‬. 10. ಃΟ࿯ Ӹࢲϩ‫݋‬. 11. ಃΟക ࣴ‫ز‬Б‫ݤ‬. 12. ಃ΋࿯ ၗ਑ԏ໣ၸำ. 12. ಃΒ࿯ ࣴ‫ز‬೛ी. 14. ಃΟ࿯ ࣴ‫ز‬ჹຝ. 16. ಃѤ࿯ ࣴ‫ز‬π‫ޑڀ‬ᔕ‫ۓ‬. 19. ಃϖ࿯ ၗ਑಍ीᆶϩ‫݋‬. 21. ಃѤക ࣴ‫่݀ز‬. 22. ಃ΋࿯ ᐕԃᕎੱϷᆒઓ੯஻ঁਢวғᖿ༈ vi. 22.

(8) ಃΒ࿯ ‫཮ޗ‬ΓαᏢᡂ໨ᆶᆒઓ੯஻‫ޑ‬ᜢ߯. 24. ಃϖക ૸ፕ. 36. ಃϤക ่ፕᆶࡌ᝼. 41. ಃ΋࿯ ่ፕ. 41. ಃΒ࿯ ᔈҔᆶࡌ᝼. 42. ୖԵЎ᝘. 43. ߕᒵ. 47. vii.

(9) ߄Ҟᒵ ߄ 3.1 Ӹࢲϩ‫݋‬ኳԄ٬Ҕϐှញᡂ໨Ϸᡂ໨‫ۓޑ‬က. 19. ߄ 4.1 2000 ԃԿ 2008 ԃᕎੱϷคᕎੱШж‫ޑ‬. 25. ‫཮ޗ‬ΓαᏢӢનКၨ ߄ 4.2 ᕎੱᆶߚᕎੱШж‫ ܭ‬2000 ԃԿ 2008 ԃ໔. 27. วғᆒઓ੯஻‫ঁޑ‬ਢኧ‫ک‬วғ౗‫ޑ‬Γα࣬ᜢӢηϩѲ ߄ 4.3 Cox proportional hazard ϩ‫݋‬٩ᕎੱ‫཮ޗک‬ΓαᏢ. 31. Ӣηᆒઓ੯஻Ӓ্Кीᆉ ߄ 4.4 ᕎੱШжᆶคᕎੱШж‫ܭ‬ᢀჸය໔Ӛձᆒઓ੯஻. 33. ϐวғ౗Кၨ ߄ 4.5 ᕎੱੰΓӧଓ䅻ය໔วғᆒઓ੯஻ϐ‫܄‬ձ‫ک‬ ԃសਠ҅Ӓ্К. viii. 34.

(10) კҞᒵ კ 1.1 ࣴ‫ز‬ଷ೛კ. 3. კ 3.1 Ӹࢲਔ໔ᢀჸҢཀკ. 15. კ 4.1 1996 ԃԿ 2008 ԃΜεᜪൾ‫܄‬ဍዦ‫؂‬ԃวғᕴΓኧ. 17. კ 4.2 1996 ԃԿ 2008 ԃΜεᜪൾ‫܄‬ဍዦวғᕴΓኧ‫܄‬ձКၨ. 17. კ 4.3 1996 ԃԿ 2008 ԃϤᜪᆒઓ੯ੰ‫؂‬ԃวғᕴΓኧ. 18. კ 4.4 1996 ԃԿ 2008 ԃϤᜪᆒઓ੯஻วғᕴΓኧ‫܄‬ձКၨ. 18. კ 5.1 ӄ଼҇ߥ଄୍ԏЍᖿ༈კ. 23. კ 5.2 ᕎੱШжᆶߚᕎੱШжӧᆒઓ੯ੰวғϐӸࢲϩ‫݋‬კ. 35. კ 4.5 1996 ԃԿ 2008 ԃযα๚Ϸࠒϐൾ‫܄‬ဍዦวғΓኧ. 47. კ 4.6 1996 ԃԿ 2008 ԃ੃ϯᏔ‫۔‬Ϸဎጢϐൾ‫܄‬ဍዦวғΓኧ. 47. კ 4.7 1996 ԃԿ 2008 ԃ‫֎ڥ‬Ꮤ‫۔‬Ϸૅϣϐൾ‫܄‬ဍዦวғΓኧ. 48. კ 4.8 1996 ԃԿ 2008 ԃମϷ่ጌಔᙃ,Ҝጥ,٢‫܊‬ϐൾ‫܄‬ဍዦ. 48. วғΓኧ კ 4.9 1996 ԃԿ 2008 ԃζ‫ֿݜ܄‬ғ෗Ꮤ‫۔‬ϐൾ‫܄‬ဍዦ. 49. วғΓኧ კ 4.10 1996 ԃԿ 2008 ԃ‫ֿݜ܄ت‬ғ෗Ꮤ‫۔‬ϐൾ‫܄‬ဍዦ วғΓኧ ix. 49.

(11) კ 4.11 1996 ԃԿ 2008 ԃ‫ځ‬дϷ҂ܴҢՏ࿼ϐൾ‫܄‬ဍዦ. 50. วғΓኧ კ 4.12 1996 ԃԿ 2008 ԃరЃ೷Ոಔᙃϐൾ‫܄‬ဍዦ. 50. วғΓኧ კ 4.13 2002 ԃԿ 2008 ԃζ‫܄‬ᆮાϷғ෗Ꮤ‫۔‬ϐൾ‫܄‬ဍዦ. 51. (੝ࡰ ICD9:188,189) วғΓኧ კ 4.14 2002 ԃԿ 2008 ԃ‫܄ت‬ᆮાϷғ෗Ꮤ‫۔‬ϐൾ‫܄‬ဍዦ. 51. (੝ࡰ ICD9:188,189) วғΓኧ კ 4.15 1996 ԃԿ 2008 ԃ௃ག‫܄‬ᆒઓੰวғΓኧ. 52. კ 4.16 1996 ԃԿ 2008 ԃᆒઓ‫ੱૈ۔‬วғΓኧ. 52. კ 4.17 1996 ԃԿ 2008 ԃᛰ‫ނ‬ᔲҔวғΓኧ. 53. კ 4.18 1996 ԃԿ 2008 ԃЈ౛Ӣન‫܌‬ठϐғ౛фૈѨፓ. 53. วғΓኧ კ 4.19 1996 ԃԿ 2008 ԃଚᆒᔲҔวғΓኧ. 54. კ 4.20 1996 ԃԿ 2008 ԃ࡚‫܄‬ᓸΚϸᔈวғΓኧ. 54. კ 4.21 1996 ԃԿ 2008 ԃΒ໨а΢ᆒઓ੯஻ບᘐวғΓኧ. 55. x.

(12) ಃ΋കʳ ᆣፕ ಃ΋࿯ ࣴ‫ز‬ङඳᆶࣴ‫୏ز‬ᐒ ൾ‫܄‬ဍዦࢂѠ᡼ΜεԝӢύ‫ޑ‬ಃ΋εԝӢǴᕎੱੰΓࡕុੰำёૈ วғϐᆒઓ੯஻Ǵ‫ױ‬ᜢߏය଼நୢᚒᆶғࢲࠔ፦Ǵ୯ϣԖᜢᕎੱੰΓ‫ޑ‬ ᆒઓ੯஻วғӒᓀ‫࣬ޑ‬ᜢࣴ‫࣬ز‬ჹၨϿǴॶளుΕ௖૸ࣴ‫ز‬Ƕ ᔠ᎙ᕎੱᆶᆒઓ੯஻Β‫ޣ‬ᜢᖄ‫܄‬௖૸‫ޑ‬Ў᝘Ǵ่݀ӭό΋ठǶϿኧ ᕎੱੰΓ‫ޑ‬ኁᢠੱ౰Չ౗ࣴ‫ز‬Ǵ‫ډڙ‬ᕎੱ೽Տǵ‫ݯ‬ᕍीฝǵᕎੱੰ ำǵບᘐ‫ޑೌמ‬ቹៜǴԶЪӭъࢂᐉᘐ‫زࣴ܄‬Ǵ่݀ό΋ठǴᜤа‫ۓ‬ፕ ȐHonda et al, 2004ȑ(1)Ƕ ᕎੱӢ‫ځ‬όܰ‫ݯ‬ᘰǴ΋૓஻‫ޣ‬೿཮ౢғ௃ᆣ (emotion) Ӣᔈ‫ޑ‬ୢ ᚒǴЈ౛ᓸΚǴኁᢠ‫ک‬ขቾ฻ёૈᒿϐౢғǶऍ୯‫زࣴޑ‬ว౜Ǵ೏ཥບ ᘐрᕎੱੰΓӧ۳ࡕΒԃ‫ޑ‬੯ੰ຾ำύǴԖ 12% ‫ੰޑ‬Γ཮ว৖рԿϿ Ԗ΋໨ᆒઓ੯஻‫ޑ‬ບᘐ ȐKadan-Lottick et al, 2005ȑ(2)ǶԶӧӕ΋ԃǴШ ࣚፁғಔᙃ‫ܭ‬ᇲᅟٌ୷є໒‫ޑ‬ኻࢪᆒઓ଼நଯঢ়཮᝼ύǴҭԖጇᙁൔࡰ рǺ“22% ‫ޑ‬ЈԼఒ༞ੰ஻Ǵ27%‫ޑ‬ᑗֿੰ஻Ϸ 33%‫ޑ‬ᕎੱ஻‫ܭ֚ڙޣ‬ ኁᢠੱ ”ȐJané-Llopis, 2005ȑ(3)Ƕ җፁғ࿿ϦѲ‫҇ޑ‬୯ΐΜΎԃፁғ಍ीǴΨࡰрԝ‫ܭ‬ᕎੱ‫ޑ‬ᕴΓኧ ࣁ 38,913 ΓǴ՞᏾ᡏԝΫΓኧ‫ ޑ‬27%Ǵ߄Ң‫؂‬ϖ໨ԝӢǴ൩Ԗ΋໨ࢂԝ ‫ܭ‬ᕎੱ‫ޑ‬ບᘐ ȐՉࡹଣፁғ࿿, 2009ȑ(4)ǶѠ᡼‫ޑ‬ᕎੱಉวғ౗வ҇୯Ζ Μϖԃ‫؂ޑ‬Μ࿤Γα 200 ΓǴ೴ԃᚹϲԿΐΜѤԃ‫ ޑ‬303 ΓǴԋߏ౗ࣁ 152ʘ Ȑ໳٫௵, 2008ȑ(5)Ƕҗ‫ܭ‬ᕎੱ‫ޑ‬วғ౗΢ϲǴ௢ፕཥບᘐϐᆒઓ ੯஻ঁਢΨ཮೴ԃᒿϐቚуǶ. 1.

(13) ಃΒ࿯ ࣴ‫ز‬Ҟ‫ޑ‬ җ‫ܭ‬ᕎੱੰΓӧ੯ੰ຾৖ၸำύёૈว৖рᆒઓ੯஻ǴቹៜੰΓ҂ ٰӸࢲය໔ғࢲࠔ፦Ǵҁࣴ‫ز‬ᔕճҔ଼நߥᓀၗ਑Ǵϩ‫݋‬ཥບᘐᕎੱੰ Γӧੰำύౢғᆒઓ੯஻ϐ‫ݩރ‬ᆶϩѲǶ. 2.

(14) ಃΟ࿯ ࣴ‫ز‬ଷ೛ ᆕӝ୯ϣѦ࣬ᜢЎ᝘ᆶࣴ‫ز‬᝼ᚒǴᔕ‫ۓ‬ΑΠӈϐࣴ‫ز‬ଷ೛Ǵӵკ 1.1Ƕ. კ 1.1 ࣴ‫ز‬ଷ೛კ Survival time. T2. T1. ࢤܑ. ‫گ‬Ե. 壄壀ఏ ൛࿇‫س‬. ‫ܑ᤿ڣ‬. ‫چ‬೴. censor=0 ៭ᄐ. ៭‫ۯ‬. T1Ǻᕎੱ߃ԛບᘐਔ໔ᗺ T2Ǻᆒઓ੯஻߃ԛບᘐਔ໔ᗺ ‫܄‬ձǹჹᕎੱཥঁਢࡕុวғᆒઓ੯஻ԖႣෳΚ ԃសǹჹᕎੱཥঁਢࡕុวғᆒઓ੯஻ԖႣෳΚ ᙍ཰Ǻჹᕎੱཥঁਢࡕុวғᆒઓ੯஻ԖႣෳΚ ԏΕǺჹᕎੱཥঁਢࡕុวғᆒઓ੯஻ԖႣෳΚ Ӧ୔ǹჹᕎੱཥঁਢࡕុวғᆒઓ੯஻ԖႣෳΚ ᙍՏǺჹᕎੱཥঁਢࡕុวғᆒઓ੯஻ԖႣෳΚ censor=0Ǻࡕុวғᆒઓ੯஻. 3.

(15) ಃѤ࿯ Ӝຒࣚ‫ۓ‬ ΋ǵᕎੱ ! ! ᕎੱࢂ΋ᅿဍዦǴ‫ڀ‬Ԗό‫ڙ‬௓‫ڋ‬ಒझቚғ੝‫ޑ܄‬੯ੰǴҺՖ೽Տ‫ޑ‬ ಒझ೿Ԗёૈ཮ว৖ԋᕎੱǶဍዦёϩᜪࣁൾ‫܄‬ᆶ‫܄ؼ‬Ǵόࢂ‫܌‬Ԗဍዦ ೿཮ठ‫ڮ‬Ƕҗ‫ܭ‬ᕎੱ‫ޑ‬ወҷයߏǴ٠Ԗӭख़ੰӢ‫ޑ‬բҔᐒᙯǴӵௗ᝻ठ ᕎ‫ނ‬፦ǵම೏੝‫ࢥੰۓ‬གࢉǵ‫܈‬ό଼நՉࣁ‫ޑ‬ቹៜȐ֎๨ǵഀଚȑ฻Ȑယ ඁ௵, 1986ȑ(6)Ƕ߈ԃว౜୷Ӣӭ‫܄׎‬ϐᡂ౦Ψёૈ‫ک‬ᕎੱ‫ޑ‬วғԖᜢ Ȑ၏΋‫ذ‬, 2006ȑ(7)Ƕ ੰ౛Ꮲ΢ᕎੱЬाࢂаΠӈΎঁచҹٰղ‫ࢂۓ‬ցࣁൾ‫܄‬Ȑᄃ݊݅, 2008ȑ(8)Ǻ 1.཮ߟҍ҅தಔᙃ 2.཮ᙯ౽‫ځډ‬дಔᙃ 3.ಔᙃ‫ޑ‬ᜐࣚόֹ᏾хᙟ 4.ғߏೲࡋၨ‫ז‬ 5.ಒझਡ‫ޑ‬ϩϯό҅த 6.ӸӧჹӸࢲ‫ુ࠶ޑ‬ 7.ᆶ҅தಒझ࣬՟‫܄‬Ͽ Βǵᆒઓ੯஻ ҁࣴ‫܌ز‬௖૸‫ޑ‬ᆒઓ੯஻Ǵа൳໨ၨख़ाϐບᘐࣁЬȐDavison ฻, 2004ȑ(9)Ǵхࡴ (΋) ᆒઓ‫( ੱૈ۔‬neurotic disorders) хࡴаΠಒ໨ບ ᘐǺቶ‫܄ݱ‬ขቾੱȐgeneralized anxiety disorders)Ǻ࿶ᡍӄय़‫ޑុ࡭ک‬ข ቾགᆶᏼኁǹ৮ឨੱ (phobias)Ǻ࡭ុϷόӝ౛ϐขቾ໣ύӧࢌᅿ੝ਸ‫ޑ‬ ௃ნǵࢲ୏‫܈‬ჹຝǹ৮ཉੱ (panic disorder)Ǻ໔ྂ‫ޑ‬৮ཉวբǴੱ‫ރ‬ӧ Μϩដϐϣၲ‫ډ‬ଯঢ়Ǵฅࡕ೴ᅌ੃ѨǶȐΒȑ௃ག‫܄‬ᆒઓੰ (affective psychosesȑǺኁᢠ‫ک‬ច‫ࢂئ‬௃ག‫܄‬ᆒઓੰ‫ޑ‬ख़ा௃ᆣǶԖ௃ག‫܄‬ᆒઓੰ. 4.

(16) ‫ޑ‬ΓǴӧ΋ࢤߏਔ໔᝺ளߚதൿ໾Ǵ‫ߚ܈‬தਁᏟǶ೭٤ᆒઓੰхࡴख़ᢠ ੱϷᚈཱུੱȐច‫ئ‬วբ‫ک‬ኁᢠวբҬඹр౜ȑǶ҅த‫ޑ‬ኁᢠǴࡐϿᝄख़ ‫ډ‬ᡉ๱ӦቹៜВதғࢲфૈǴ‫ࡐុ࡭܈‬Φ‫ޑ‬ਔ໔ǴѬёаЇᏤ஻‫ޣ‬௖઩ ϣӧ‫ޑ‬Ծ‫ך‬Ǵ٬ϐр౜΋ᅿ‫׳‬ԖΚǵ‫݀׳‬ᘐ‫ޑ‬ག᝺Ƕᖏ‫ޑ׉‬ኁᢠੱ཮ౢ ғᝄख़‫ߏک‬ය‫ޑ‬Ј౛ภधǴ٠ёૈᒿ๱ਔ໔‫ࢬޑ‬ೳԶ‫ࣁ׳‬மਗ਼ǶȐΟȑ ‫ނ‬፦ᜢᖄ੯஻ (substance-related disorder) хࡴаΠಒ໨ບᘐǺᛰ᠅ (drug dependence)ǵଚᆒᔲҔ (alcohol abuse)Ƕ೭٤੯஻ࢂӢࣁঁΓၸࡋ ‫ߏک‬ය٩ᒘ‫ނ‬፦٬ҔǴቹៜύኰઓ࿶‫س‬಍‫܌‬ЇଆǴ೭ᅿՉࣁ཮ཞ্΋ঁ Γ‫ޑ‬ৎ৥ǵ‫཮ޗ‬ᜢ߯ǵπբૈΚǴ‫܈‬࿼Ծρ‫ک‬дΓ‫ܭ‬ӒᓀύǶȐѤȑ࡚ ‫܄‬ᓸΚ‫܄‬ϸᔈϷ‫ځ‬д (acute reaction stress & other uncertain disorders)Ǵ хࡴߏය‫܄‬ബ໾ࡕᓸΚ੯஻ Ȑprolonged posttraumatic stress disorderȑǺ ੝ձ‫ޑ‬৮ឨ‫܈‬ബ໾٣ҹ (ӵᏯ‫ݾ‬ǵமኪǵሉӉ) ςಖЗϷ࠶ુς੃Ѩ ࡕǴੰ஻೏࡭ុ‫܄‬ขቾᆶ৮ឨϸᔈ‫ש܌‬ᑃǶᆶᅵ઀ምᛖǵᕉნ፾ᔈምᛖ ฻ບᘐǶȐϖȑЈӢ‫܄‬Їଆғ౛фૈምᛖ(physiological malfunction arising from mental factors)Ƕӧ Honda and Goodin 2004 ԃ‫زࣴޑ‬Ǵ٠ؒԖયΕ ȨЈӢ‫܄‬Їଆғ౛фૈምᛖȩࣁᆒઓ੯஻ϐ໨ҞȐHonda et al, 2004ȑ(1)Ƕ. 5.

(17) ಃΒക Ў᝘ࢗ᛾ ಃ΋࿯ ᕎੱᆶᆒઓ੯ੰ‫࣬ޑ‬ᜢ‫܄‬ ΋ǵᕎੱ‫ک‬ᆒઓ੯஻‫ޑ‬ᜢᖄ‫܄‬ Вҁ‫ޑ‬΋ጇࣴ‫ز‬ᡉҢǴᕎੱੰΓऩᐱۚ‫܈‬ӧੰำ‫ࢂޑ‬ఁයǴวғЈ ౛֚ᘋ‫ޑ‬യᆉК(odds ratio [OR]) ଯǴϩձࣁ 5.77 (95% ёߞज़ confidence interval [CI] = 1.41–39.7) ‫ ک‬4.83 (95% CI = 1.04–22.2) (Kugaya et al, 2000)(10) Ƕऍ୯ Honda ฻ӧ 2004 ‫زࣴޑ‬Ǵว౜Ԗᕎੱ‫ޣ‬К ؒԖᕎੱ‫ޣ‬ӧ௃ག‫܄‬ᆒઓੰวғ‫ޑ‬യᆉ࣬КǴ߻‫ޣ‬ଯΑ 3.8 ७ (95% CI = 1.44 - 8.8)ǴЪ‫܄ت‬ᕎੱ‫ޑ‬Οεᜪᆒઓ੯஻҂ਠ҅യᆉКᆶߚᕎੱੰΓ࣬ КǴКଆζ‫܄‬҂ਠ҅യᆉКࣣଯр೚ӭȐHonda et al, 2004ȑ(1)Ƕќ΋ጇ у৾ε‫ޑ‬ᐉᘐ‫زࣴ܄‬ύǴਠ҅Α‫཮ޗ‬ΓαᏢᡂ໨ࡕǴள‫ډ‬Α 15-54 ྃ‫ޑ‬ ᕎੱੰΓКߚᕎੱੰΓख़ᢠੱ‫ک‬৮ཉวբയᆉКଯ (OR = 3.18,95% CI = 1.69- 5.96/ OR = 2.15, 95% CI = 1.22–3.77) (Rasic et al, 2008)(11)Ƕу৾ε Sareen ଞჹബ໾ࡕੱংဂ (posttraumatic stress disorderǴPTSD)ࣴ‫ز‬Ǵว ౜ߙ֧ԃ௼ဂวғ PTSD യᆉКനଯ (OR = 2.29Ǵ95% CI = 1.47–3.57)Ǵ ‫ځ‬ԛࣁനԃᇸ௼ဂ (OR = 1.93Ǵ95% CI = 1.25–2.99)ǴԏΕཇଯയᆉК Ψཇե (OR = 0.25,95% CI = 0.17–0.37) (Sareen et al, 2005)(12)Ƕ ऍ୯‫زࣴޑ‬ว౜Ǵ೏ཥບᘐрᕎੱੰΓӧ۳ࡕΒԃ‫ޑ‬੯ੰ຾ำύǴ Ԗ 12% ‫ੰޑ‬Γ཮ว৖рԿϿԖ΋໨ᆒઓ੯஻‫ޑ‬ບᘐȐKadan-Lottick et al, 2005ȑ(2)ǶԶӧӕ΋ԃǴШࣚፁғಔᙃ‫ܭ‬ᇲᅟٌ୷є໒‫ޑ‬ኻࢪᆒઓ଼நଯ ঢ়཮᝼ύǴҭԖጇᙁൔࡰрǺ“22% ‫ޑ‬ЈԼఒ༞ੰ஻Ǵ27%‫ޑ‬ᑗֿੰ஻ Ϸ 33%‫ޑ‬ᕎੱ஻‫ܭ֚ڙޣ‬ኁᢠੱ”ȐJané-Llopis, 2005ȑ(3)Ƕ‫ݤ‬୯‫ޑ‬΋ጇੰ ‫ٯ‬ჹྣࣴ‫ز‬ᕇளаΠ่ፕǺζ‫܄‬٢ᕎੰΓಔКჹྣಔวғቶ‫܄ݱ‬ขቾੱ ‫ک‬ख़ᢠੱǴ߻‫ޣ‬วғ౗ଯǴࣁࡕ‫ ޣ‬2 Կ 4 ७ (Gandubert et al, 2009) (13)Ƕ ऍ୯‫ޑ‬΋໨ᐉᘐ‫زࣴ܄‬Ǵϩ‫݋‬ΖίӭӜᕎੱੰΓวғขቾੱ‫܈‬ኁᢠੱϐ. 6.

(18) К౗ࣁ 30% (Brintzenhofe-Szoc et al, 2009) (14)ǶDerogatis฻ଞჹऍ୯ᙴᏢ ύЈϐཥᕎੱੰΓ຾Չϖ໨ᆒઓ੯஻ϐࣴ‫ز‬ǴᡉҢ 44%‫ޑ‬ᕎੱੰΓ཮Ԗ ፾ᔈ੯஻ǵ௃ག‫܄‬ᆒઓੰᆶขቾ੯஻‫ځ‬ύ΋໨ບᘐǶᕎੱੰΓᆒઓ੯஻ วғԭϩКനଯࣁ፾ᔈ੯஻ (68 %)ǴಃΒࣁ௃ག‫܄‬ᆒઓੰ (13%)ǴಃΟ ࣁขቾ੯஻ (4%) (Derogatis etal,1983) (15)ǶPrieto฻ଞჹՋ੤УՈᕎՐଣ ੰΓ຾ՉѤᅿᆒઓ੯஻วғ౗‫زࣴޑ‬Ǵว౜ՈᕎੰΓ᏾ᡏᆒઓ੯஻วғ ౗ࣁ 44.1%Ǵᆒઓ੯஻วғ౗നଯࣁ፾ᔈ੯஻ (22.7%)ǴಃΒࣁ௃ག‫܄‬ ᆒઓੰ (14.1%)ǴಃΟࣁขቾ੯஻ (8.2%) (Prieto et al, 2002)(16) Ƕऍ୯ Kadan-Lottick฻аςᙯ౽ᕎੱੰΓଞჹख़ᢠੱǵขቾੱǵ৮ཉੱǵബ໾ ࡕੱংဂѤᅿᆒઓ੯஻຾Չวғ౗‫زࣴޑ‬Ǵள‫ډ‬᏾ᡏԖ 12%‫ੰޑ‬Γ಄ӝ ᆒઓ੯஻‫ޑ‬చҹǴ28%‫ੰޑ‬Γӧวғᕎੱਔ൩ௗ‫ڙ‬Ј౛ϟΕ‫ݯ‬ᕍ (Kadan- Lottick et al, 2002)(2)Ƕऍ୯Kessler฻Γϩ‫݋‬ϖᅿᆒઓ੯஻‫ޑ‬౰Չ ౗ 12 ঁДǴขቾੱࣁ 18.1%Ǵ௃ག‫܄‬੯஻ࣁ 9.5%Ǵଚᆒ٩ᒘࣁ 1.3%Ǵ ᛰ‫ނ‬٩ᒘࣁ 0.4%ǴҺ΋ᅿ੯஻ࣁ 26.2%ǶԶӧᆒઓ੯஻аΎ฻ભϩᜪǴ ᝄख़ࡋനଯ‫ੰޑ‬ΓࢂۚՐӧཇ᎞߈೿཮୔‫ޑ‬ΓǴᆒઓ੯஻Ӓ্Ԗཇଯ‫ޑ‬ ᖿ༈ǴԏΕཇեӒ্КΨཇଯ (Kessler et al, 2005) (17)ǶВҁAkechi฻Γ ଞჹ҃යᕎੱੰΓ‫ޑ‬วғ౗ࣴ‫ز‬Οᅿᆒઓ੯஻ǴੰΓวғԭϩКᡉҢа ขቾੱǵख़ᢠੱ‫ک‬ബ໾ࡕੱংဂࣁЬǴಃ΋ԛፓࢗϩձࣁ 16.3%Ǵ6.7% ‫ ک‬0% (Akechi et al, 2004)(18)ǶВҁAkechiଞჹᙯບᕎੱੰΓ຾ՉЈ౛ຑ ՗Ǵϩ‫݋‬Οᅿᆒઓ੯஻‫ޑ‬วғ౗Ǵ่݀ᡉҢวғ౗ၨଯ‫ޑ‬ϩձࣁ፾ᔈ੯ ஻ 34%‫ک‬ख़ᢠੱ 14% (Akechi et al, 2001) (19)Ƕ ВҁUchitomi฻௖૸ߚλಒझ‫ޤ‬ဏᕎੰΓ຾ՉЋೌࡕ‫ঁޑ‬ਢኁᢠ੯ ஻Ǵೌࡕ΋ঁДᆶೌࡕ΋ԃวғ౗ࢂ 4.7%‫ ک‬8.0%Ǵ௲‫ػ‬ำࡋեࢂႣෳ ೌࡕ΋ԃኁᢠ੯஻วғ‫ޑ‬ख़ाӢη (Uchitomi et al, 2001) (20)Ƕ म୯Hopwoodଞჹߚλಒझ‫ޤ‬ဏᕎᆶλಒझ‫ޤ‬ဏᕎঁਢ‫زࣴޑ‬Ǵ่݀ᡉ. 7.

(19) ҢЋೌ߻‫ޑ‬ኁᢠ੯஻Ծॊวғ౗ࣁ 33%Ǵೌࡕ߾ቚу‫ ډ‬50%Ƕλಒझ‫ޤ‬ ဏᕎᆶߚλಒझ‫ޤ‬ဏᕎঁਢ࣬ၨǴኁᢠ੯஻วғ౗߻‫ ޑޣࡕࣁޣ‬3 ७ (25% vs.9%; P<0.0001) (Hopwood et al, 2000)(21)Ƕ म୯Burgess‫߾زࣴޑ‬ऊԖ 50%‫ޑ‬٢ᕎੰΓǴບᘐԐයջԖขቾ੯஻ ᆶኁᢠ੯஻Ǵບᘐࡕ 2-4 ԃऊԖ 25%Ǵಃϖԃ߾ࣁ 15%ǹӧ٢ᕎບᘐਔ ջԖΒ໨ᆒઓ੯஻Ǵ‫ځ‬ᗺ౰Չ౗ࣁ 33%Ǵ΋ԃࡕΠफ़Կ 15%Ǵ٢ᕎບᘐ ࡕ 45%‫ঁޑ‬ਢҺ΋໨ᆒઓ੯஻Ԗൺวౢғ (Burgess et al, 2005) (22)Ƕ ΋ጇᆕፕࠠࣴ‫ز‬ᡉҢǴவ 1960 ԃ໒‫ۈ‬ςԖ࣬྽ӭଞჹᕎੱੰΓวғ ኁᢠੱ‫زࣴޑ‬Ǵхࡴख़ᢠੱ‫ޑ‬౰Չ౗ (0-38%)Ǵᇸᢠੱ‫ޑ‬౰Չ౗ (0%–58%)Ǵӭኬ‫่݀ޑ‬ǴଆӢ‫ܭ‬ჹኁᢠᇡ‫ޕ‬όӕǴղ‫ۓ‬ኁᢠ‫ޑ‬ບᘐచ ҹǴӚᜪෳໆኁᢠำࡋБ‫ݤ‬ᏢǴϷࣴ‫ز‬೛ी฻ӭኬ‫ޑ‬ৡ౦೷ԋ (Massive, 2004) (23)Ƕ ફՋើMoffittว౜ӧख़ᢠੱวғ߻ջԖขቾ੯஻‫ঁޑ‬ਢวғ౗ࣁ 37%Ǵӧขቾ੯஻วғ߻ջԖख़ᢠੱঁਢวғ౗ࣁ 32%Ǵขቾ੯஻ঁਢ Ԗኁᢠ੯஻‫ޑ‬ಖғӅੰၲ 72%Ǵኁᢠ੯஻ঁਢԖขቾ੯஻‫ޑ‬ಖғӅੰၲ 48% (Moffitt et al, 2007) (24)Ƕऍ୯Brownଞჹขቾᆶ௃ᆣ੯஻ϐӅੰࣴ ‫ز‬Ǵว౜ӧ౜Չᆶಖғ౰Չ౗ࣁ 57% vs.81%Ǵ‫ځ‬ขቾᆶ௃ᆣ੯஻‫ޑ‬ಖғ Ӆੰ‫ߚڀ‬தଯ‫࣬ޑ‬ᜢ‫( ܄‬Brown et al, 2001)(25)Ƕ ऩа‫؂‬Μ࿤Γαᕎੱಉวғ౗ࣁ 303 ΓٰीᆉǴѠ᡼ᕎੱཥวғঁ ਢኧ௢՗ऊԖ 3030 ΓȐ໳٫௵, 2008ȑ(5)Ƕ2000 ԃѠ᡼‫زࣴޑ‬ว౜Ǵኁ ᢠ੯஻ԃวғ౗ࣁ 0.44%Ǵζ‫܄‬՞ 60.7%ǴੰΓ‫ޑ‬ಃΒԃ൩ບ౗ၨե Ȑࢫྷࡀ, 2006)(27)Ǵ‫ځ‬໔‫࣬ޑ‬ᜢॶள‫ݙ‬ཀǶ. 8.

(20) Βǵ࣬ᜢଷ೛! ! Γα‫཮ޗ‬ᏢӢન‫ޑ‬ৡ౦Ǵ໻೽ϩှញΑᕎੱᆶᆒઓ੯஻Β‫ޣ‬ϐᜢᖄ ǶHonda ฻ว౜‫ڀ‬ၨቶ‫཮ޗ‬Ѝ࡭ϐᕎੱζ‫܄‬ԖၨϿϐኁᢠੱวғǴԶӧ‫ت‬ ‫߾܄‬คԜ౜ຝวғǶၨϿౢғኁᢠੱ‫ޑ‬ᕎੱঁਢǴ‫ޔ‬ௗᆶঁΓ‫ޑ‬Ӣᔈૈ Κ (coping) ၗྍᆶԾ‫ך‬௓‫ڋ‬གԖᜢȐHonda et al, 2004ȑ(1)Ƕ ᕎੱੰΓ‫ޑ‬ᆒઓ੯஻ନΑΓα‫཮ޗ‬ӢηǴᕉნ‫ک‬ᒪ໺ӢηΨԖ࣬ᜢ (Gallo et al, 2000)(26)Ǵՠӄ଼҇ߥၗ਑લԜၗ਑Ƕ Honda ฻ว౜‫܄ت‬ᕎੱ஻‫ޣ‬วғᆒઓ੯஻‫ޑ‬҂ਠ҅Ӓ্К‫߻ޑ‬ΟӜ ࣁ௃ག‫܄‬ᆒઓੰǵᛰ‫ނ‬ᔲҔǵᆒઓ‫ੱૈ۔‬Ƕζ‫܄‬ᕎੱ஻‫ࢂ߾ޣ‬ᆒઓ‫ૈ۔‬ ੱǵ௃ག‫܄‬ᆒઓੰǵଚᆒᔲҔȐHonda et al, 2004ȑ(1)Ǵ‫ت‬ζԖձǶ ΋໨ኻࢪӭख़੯ੰࣴ‫ز‬ள‫ډ‬аΠ่ፕǴե௲‫ػ‬ำࡋ‫܄ت‬ӧวғӭख़ ੯ੰ‫ޑ‬യᆉКၨଯ௲‫ػ‬ำࡋࣁଯǴၲ 1.43 ७ (OR = 1.43, 95% CI = 1.28– 1.61)Ǵζ‫߾܄‬ၲ 1.33 ७ (OR = 1.33,95% CI = 1.18–1.57) (Nagel, 2008) Ǵ ᕎੱ஻‫ޣ‬Ԗӭख़੯ੰวғᆒઓ੯஻‫ޑ‬ӒᓀΨၨଯǶ. (28). Rasic‫زࣴޑ‬ύǴӧԏΕಃΒեϐᜪձ (уჾ$15,000–29,999ǴӅϖ ᜪǴୖԵಔࣁനଯԏΕДᖒಔ)Ǵวғᆒઓ੯஻‫ޑ‬॥ᓀനଯǴ(OR = 2.39,95% CI = 1.53–3.74)ǴԖӢԏΕቚуԶ٬॥ᓀКफ़ե‫ޑ‬ᖿ༈ (Rasic, 2008) (11)Ƕՠऍ୯‫ޑ‬΋໨ᐉᘐ‫زࣴ܄‬٠҂ว౜ԏΕᆶஆ࠷‫ރ‬ᄊ‫ک‬ᆒઓ੯ ஻Ԗᡉ๱࣬ᜢ (Brintzenhofe-Szoc et al, 2009) (14)Ƕ Вҁ‫ޑ‬ќ΋ጇࣴ‫ز‬ΨᡉҢǴᕎੱੰ஻‫ޑ‬πբ‫ރ‬ᄊ‫ک‬Ј౛֚ᘋ‫ޑ‬วғ คᡉ๱࣬ᜢ (Kugaya et al, 2000) (10)Ƕ ӧ݅λስ฻ӧ 2004 ԃଞჹζ‫܄‬ኁᢠ‫ރ‬ᄊϐࣴ‫ز‬ว౜ǴۚՐӦᗺ‫ک‬Ԗ คኁᢠੱ‫ރ‬วғคᡉ๱࣬ᜢ (x2=3.84,p=0.43) (݅λስ฻, 2004) (29)Ƕ‫ݤ‬୯ ΋ጇੰ‫ٯ‬ჹྣࣴ‫ز‬ᕇளаΠ่ፕǴζ‫܄‬٢ᕎੰΓಔКჹྣಔǴᡉҢӧۚ ՐӦ‫ޑ‬ৡ౦ၲᡉ๱Нྗ (p<0.02) (Gandubert et al, 2009) (13)Ƕ. 9.

(21) ಃΒ࿯ Шжࣴ‫ز‬ ٬ҔШжࣴ‫ٰز‬ଓ䅻ࣴ‫ز‬ჹຝ‫ޑ‬ᓬ༈Ǵӧ‫ܭ‬ёीᆉрགྷ௖૸੯ੰϐ วғ౗ (incidence rates)ǵ࣬ჹӒᓀ (RR)ǵϷ 95%ёߞज़ (CI)ǶၮҔ೭ ᅿБ‫߄ݤ‬ၲࣴ‫่݀ز‬ǴஒК໻և౜ p ॶǴှញਏ݀‫׳‬٫Ψ‫׳‬ᝄᙣǶШж ࣴ‫ز‬Ψࢂᒣܴ੯ੰচӢ‫ځک‬Ծฅว৖ў‫ޑ‬നӳБ‫ݤ‬ǴΨёаҔٰፓࢗ ൂ΋ኪ៛Ӣη೷ԋ‫ޑ‬ӭኬϯ่݀ (Mann, 2003) (30)Ƕ Ⴝ Gallo ฻ӧ 2000 ‫ࢂزࣴޑ‬ଓ䅻 13 ԃ‫ޑ‬Шжࣴ‫ز‬Ǵ௖૸‫ࢂޑ‬ᕎੱੰ Γࡕុኁᢠੱวғ‫ޑ‬௃‫( ݩ‬Gallo et al, 2000)(26)Ƕ. 10.

(22) ಃΟ࿯ Ӹࢲϩ‫݋‬ ӧШжࣴ‫ز‬ύǴӸࢲਔ໔ၗ਑ࣁ΋ᅿத‫زࣴޑـ‬ၗ਑,Кӵঁਢҗບ ᘐрᕎੱ‫ډ‬ԝΫϐ໔‫ޑ‬Ӹࢲਔ໔ϩѲǴӧ಍ी΢೭٤Б‫ݤ‬ᆀࣁӸࢲϩ ‫݋‬Ƕ ᏾ᡏٰᇥǴӸࢲϩ‫݋‬Б‫ࢂݤ‬Ҕٰࣴ‫܈ز‬ϩ‫݋‬ᢀჸჹຝӧࢌ΋ࢤਔ໔ ߏࡋϐϩଛǴԶ΋ࢤਔ໔ߏࡋ೯தࢂவ΋੝‫ۓ‬٣ҹଆ‫ۈ‬ϐଆᓐਔ໔ᗺ໒ ‫ۈ‬ᆉଆǴीᆉ‫ࢌډ‬΋੝‫ۓ‬٣ҹวғ‫ޑ‬ਔ໔ᗺωଶЗǴ೯தᆀࣁ٣ҹਔ໔ ‫܈‬Ӹࢲਔ໔Ƕ ٣ҹਔ໔‫ޑ‬ၗ਑և౜Ǵ᝽ӵᕎੱӸࢲ౗ǵԝΫ౗ǵғ‫ڮ‬ໆ߄฻Ƕ ࣴ‫ز‬ύததϩ‫݋‬ᢀჸჹຝவບᘐрᕎੱ‫ډ‬ԝΫϐ໔‫ޑ‬Ӹࢲਔ໔Ǵՠ ࢂ٠ߚ‫܌‬Ԗ຾Εࣴ‫ޑز‬ኬҁǴдॺ‫ޑ‬೏ଓᙫਔ໔೿‫ߏ୼ى‬ΦǴӆ‫ޣ‬ӵ݀ ঁਢѨѐᖄ๎‫ߚࢂ܈‬ᕎੱੰӢԶԝΫǴ೿཮ᡣࣴ‫ޣز‬ค‫ݤ‬ᢀჸ‫܌ډ‬Ԗ೏ ࣴ‫ز‬ჹຝനࡕౢғ‫่݀ޑ‬ǴϷ‫܌‬ԖวғԝΫ٣ҹ‫ޑ‬ਔ໔ᗺǴႽ೭ᅿၗ਑ ൩೏ᆀࣁ೛ज़ၗ਑Ȑcensor)Ƕ ᢀჸჹຝ຾Εࣴ‫ز‬ᗺ‫ޑ‬ਔ໔ёаόӕǴӢࣁᢀჸ‫ޑ‬ଆ‫ۈ‬ᗺ‫ۓ‬ကࣁঁ ਢ໒‫ۈ‬೏ᢀჸ‫ޑ‬ਔ໔Ǵ٠ߚࣴ‫ز‬Ծρ໒‫ޑۈ‬ਔ໔ᗺȐEfron, 1988ȑ(31)Ƕ ऩा௖૸ߏයଓᙫၗ਑‫ک‬٣ҹวғ‫ޑ‬ᜢ߯Ǵ೯த௦ҔCoxК‫ٯ‬Ӓ্ ኳࠠȐCox, 1972ȑ(32)ǶӒ্Кॶε‫ ܭ‬1Ǵж߄วғ॥ᓀᐒ౗ቚу;ऩλ‫ܭ‬ 1Ǵ߾ж߄วғ॥ᓀᐒ౗෧ϿǴऩ฻‫ ܭ‬1Ǵж߄วғ॥ᓀᐒ౗ᆶୖԵ௼ဂ ࣬ӕǶ. 11.

(23) ಃΟക ࣴ‫ز‬Б‫ݤ‬ ಃ΋࿯ ၗ਑ԏ໣ၸำ ʳ ʳ ҁࣴ‫ޑز‬ၗ਑ٰྍǴࣁ 2005 ԃӄ଼҇நߥᓀࣴ‫ز‬ၗ਑৤ϐԭ࿤଼ߥ. ᘜΓᔞǶࣴ‫ز‬π‫ڀ‬ሡ٬Ҕ‫ޑډ‬ၗ਑৤ϣ৒ӵΠǺ 1. ߐບೀБϷ‫ݯ‬ᕍܴಒᔞ (CD)Ƕ൩ᙴࣽձǵ൩ᙴВයǵ‫ݯ‬ᕍ่‫״‬ Вය฻Ƕ 2. Րଣᙴᕍ຤Ҕమൂܴಒᔞ (DD)ǶЬບᘐжዸǵΕଣԃДВǵᙴ ٣ᐒᄬжဦǵ൩ᙴࣽձ฻Ƕ 3. ‫ߥ܍‬ၗ਑ᔞ (ID)Ƕ‫ߎߥ׫‬ᚐǵ‫ي‬ҽձǵуߥձ฻Ƕ 4. ख़ε໾ੰ᛾ܴܴಒᔞ (HV)Ƕ‫ي‬ҽжဦǵບᘐжዸǵख़ε໾ੰᜪ ձжዸǵрғВයǵ‫܄‬ձ฻Ƕ ᘏ‫ߐڗ‬ບೀБϷ‫ݯ‬ᕍܴಒᔞ (CD)ǴԿϿ಄ӝΠӈΟ໨చҹ‫ځ‬ύϐ΋ ϐ‫܌‬Ԗၗ਑ǺឯՏӜᆀࣁȨ୯ሞ੯ੰϩᜪဦ΋ȩ‫܈‬Ȩ୯ሞ੯ੰϩᜪဦΒȩ ‫܈‬Ȩ୯ሞ੯ੰϩᜪဦΟȩ Ȑύѧ଼நߥᓀֽ, 2005ȑ(34)Ƕ ᕎੱ (ൾ‫ੰ )܄‬஻ϐບᘐዸǴ‫߻ځ‬Οዸϟ‫ ܭ‬140ɴ239 ‫ޣ‬Ǵ٠ϩᜪࣁ Με໨Ǻ140-149 Ȩযǵα๚Ϸࠒȩǹ150-159 Ȩ੃ϯᏔϷဎ๚ȩǹ160-165 Ȩ‫֎ڥ‬Ϸૅȩǹ170-175 ȨମϷ่ጌǵҜጥǵ٢‫܊‬ȩǹ179-184Ȩζ‫ݜ܄‬ ֿғ෗ȩǹ185-187 Ȩ‫ֿݜ܄ت‬ғ෗ȩǹ190-199 Ȩ‫ځ‬дϷ҂ܴҢՏ࿼ȩǹ 200-208 ȨరЃϷ೷ՈಔᙃȩǴ188,189 Ȩζ‫܄‬ᆮાϷғ෗Ꮤ‫۔‬ȩǹ188,189 Ȩ‫܄ت‬ᆮાϷғ෗Ꮤ‫۔‬ȩǶ௨ନ‫܄ؼ‬ϐᕎੱບᘐዸǴᇆ໣ 2000 ԃԿ 2008 ԃ‫܌‬ԖཥวғᕎੱঁਢǶ ᆒઓ੯஻ບᘐዸϩᜪࣁϤε໨Ǵࣁ 296 Ȩ௃ག‫܄‬ᆒઓੰȩǹ300 Ȩᆒ ઓ‫ੱૈ۔‬ȩǹ292Ǵ304Ǵ305Ǵ3051-3059 Ȩᛰ‫ނ‬ᔲҔȩǹ306 ȨЈӢ‫܄‬ Їଆғ౛фૈምᛖȩǹ291Ǵ293Ǵ 294Ǵ297Ǵ299Ǵ303Ǵ3050 Ȩଚᆒ ᔲҔȩǹ298Ǵ307-309Ǵ311Ǵ316ǴȨ࡚‫܄‬ᓸΚ‫܄‬ϸᔈϷ‫ځ‬дȩǶ. 12.

(24) ҁጇࣴ‫ز‬Ӣ௦Ҕ 2005 ԃӄ଼҇நߥᓀࣴ‫ز‬ၗ਑৤ϐԭ࿤଼ߥᘜΓ ᔞǴၗ਑‫ޑ‬ᒪᅅᆶό҅ዴ‫܄‬Ǵ೿ࢂѸ‫ۓ‬Եቾ‫ޑ‬ᇤৡǶਥᏵ஭ϐࣴ‫ز‬ǴՉ ࡹၗ਑΋ठ‫܄‬ӧ Kappa ॶࣣၲ 95%а΢Ǵੰᐕ૶ᒵᆶ଼ߥҙൔၗ਑ϐࢗ ᅟහࡰ኱᏾ᡏ Kappa ॶࣁۘё‫ډ‬ύ฻໘ࢤǴࡺё෧ϿԜ໨ᅪቾ (஭զǴ 2004) (35)Ζ. 13.

(25) ಃΒ࿯ ࣴ‫ز‬೛ी ҁࣴ‫ز‬௦ҔШжࣴ‫ز‬Ǵ٠Ҕ 1:4 БԄ٩ԃសᓎኧϩѲᒿᐒ‫ߚڗܜ‬ᕎ ੱੰΓǴӕਔଓ䅻Կ 2008 ԃۭǶ ࣁΑीᆉᢀჸΓԃኧǴ٠௖૸ঁਢวғԝΫǵѨᖄ‫ޑ‬ёૈǴ‫׳‬ӆՍ ᖄՐଣᙴᕍ຤Ҕమൂܴಒᔞ (DD)ǵ‫ߥ܍‬ၗ਑ᔞȐIDȑᆶख़ε໾ੰ᛾ܴܴ ಒᔞ (HV)ǴаᕇளଏߥВයǵᙯᘜжዸǵрଣВයǵଏߥচӢᆶԝΫ ВයǴளа‫פ‬рঁਢ‫ޑ‬ᢀჸ่‫״‬ВයᆶচӢǶ ਥᏵ (Le, 1997) (33) ჹӸࢲਔ໔‫܌‬ा‫ޑ؃‬Ο໨‫ۓ‬ကǴϩॊӵΠǺ 1.‫ۓ‬ကӸࢲਔ໔‫ޑ‬ଆ‫ۈ‬ᗺǶҁࣴ‫܌ز‬ଓ䅻ᕎੱཥวғঁਢᆶჹྣϐ ߚᕎੱঁਢǴΒ‫ޣ‬ଆ‫ۈ‬ᗺВයࢂ٩Ᏽཥวғᕎੱঁਢዴ‫ۓ‬ບᘐϐ൩ບВ යࣁଆ‫ۈ‬ᗺǶ 2.‫ۓ‬ကӸࢲਔ໔‫ޑ‬ෳໆൂՏǶҁࣴ‫ز‬аȨΓԃȩࣁൂՏǴவঁਢ߃ບ ᘐᕎੱਔ໔໒‫ۈ‬ीᆉǴ‫ډޔ‬วғᆒઓ੯஻ಕी‫ޑ‬ԃኧࣁЗǶ 3.‫ۓ‬ကӸࢲਔ໔ᢀჸଶЗᗺǶҁࣴ‫ز‬а 2008 ԃ 12 Д 31 Вࣁࣴ‫ز‬ଶ Зਔ໔Ǵ٠‫ۓ‬ကଓ䅻Шжύཥᕎੱঁਢวғᆒઓ੯஻‫ޑ‬٣ҹࣁcensor = 0ǴऩঁਢؒԖวғᆒઓ੯஻‫ޑ‬٣ҹ߾ࣁcensor = 1Ƕ ࣁᗉխᒧ᏷‫ୃ܄‬ৡǴЪԵቾ‫ډ‬ᆒઓ੯஻ੰΓಃ΋ԃ൩ບ౗ଯ‫ܭ‬ಃΒ ԃ‫ޑ‬൩ᙴಞᄍȐࢫྷࡀ, 2006ȑ(27)Ǵҗ 2000 ԃ۳߻ӣྉᕎੱᆶᆒઓ੯஻ ൩ບ૶ᒵԿ 1996 ԃǴ௨ନς࿶ᑡ஻ᕎੱᆶᆒઓ੯஻‫ঁޑ‬ਢǶҁࣴ‫ز‬аᆒ ઓ੯஻วғВයఁ‫ܭ‬ᕎੱཥບᘐВයࣁచҹǴҞ‫ࢂޑ‬Ꮓёૈᙶమᕎੱᆶ ᆒઓ੯஻วғ໩‫ׇ‬ϐӢ݀‫܄‬Ƕ٠ୖԵ Honda ฻ࣴ‫ز‬ϐᆒઓ੯஻ԏਢ኱ ྗȐHonda et al, 2004ȑ(1)Ǵࡷᒧрϖᅿᆒઓ੯஻Ǻ௃ག‫܄‬ᆒઓੰǵᆒઓ‫۔‬ ૈੱǵᛰ‫ނ‬ᔲҔǵଚᆒᔲҔǵ࡚‫܄‬ᓸΚ‫܄‬ϸᔈǴ٠уΕ΋ᅿཥ‫ޑ‬ᆒઓ੯ ஻ǺЈӢ‫܄‬Їଆғ౛фૈምᛖǴᢀჸࡕុଓ䅻Шж‫ځ‬ᆒઓ੯஻วғ௃ ‫׎‬Ƕ. 14.

(26) კ 3.1 Ӹࢲਔ໔ᢀჸҢཀკ ಍ीᢀჸਔ໔ଆ‫ۈ‬ᗺ. ಍ीᢀჸਔ໔ଶЗᗺ. (199X-200X ԃ X Д X В). (2008 ԃ 12 Д 31). Survival time. T1. T2. ɍ! T1 T1 T1. T1Ǻᕎੱ߃ԛບᘐਔ໔ᗺ T2Ǻᆒઓ੯஻߃ԛບᘐਔ໔ᗺ Ǻঁਢวғᆒઓ੯஻ (censor = 0) ǺঁਢؒԖวғᆒઓ੯஻ǴёૈӢۘ҂ᢀჸ‫ډ‬ǵԝΫ‫܈‬Ѩᖄ (censor = 1) ɍ ǺԝΫ × ǺѨᖄ. 15.

(27) ಃΟ࿯ ࣴ‫ز‬ჹຝ ‫פ‬р 2000 ԃԿ 2008 ԃ೴ԃཥวғϐᕎੱঁਢǴ٠а 1 К 4 ᓎኧᒿ ᐒࡷᒧߚᕎੱঁਢǴ௖૸ଓ䅻ԜΒᅿᕎੱཥঁਢᆶߚᕎੱঁਢӧ҂ٰੰ ำว৖рᆒઓ੯ੰ‫ޑ‬௃‫ݩ‬Ƕ௨ନΑλ‫ ܭ‬14 ྃᕎੱ஻‫ޑޣ‬౛җǴΏୖԵϏ ഝ 2003 ࣴ‫ูٽز‬ᆶߙϿԃᕎੱ஻‫ޣ‬ϐᆒઓ੯஻Րଣ௃‫ݩ‬ǴؒԖว౜ኁᢠ ੱวғӒᓀ΢ϲȐRoss et al, 2003ȑ(39)Ƕ௨ନᆒઓ੯஻ߐບ൩ບ΋ԛ‫ޣ‬౛ җǴӢࣁค‫ݤ‬ዴ‫ۓ‬΋ԛບᘐջ಄ӝᆒઓ੯ੰບᘐ኱ྗϷԵቾ୯Γ൩ᙴ‫ޑ‬ ಞᄍǴࢂࣁΑ‫׳‬ዴ‫ۓ‬ᆒઓ੯஻ບᘐ‫҅ޑ܄‬ዴ‫܄‬Ƕ ೏ᘜયࣁᆒઓ੯஻ϐঁਢǴѸ໪಄ӝӧߐບೀБϷ‫ݯ‬ᕍܴಒᔞύǴ ൩ᙴԛኧຬၸΒԛ‫ޣ‬ǴωયΕࣴ‫ز‬ϩ‫݋‬ύǶଓ䅻Шжϐচ‫ঁۈ‬ਢኧࣁ 287,205 ΓǴ௨ନλ‫ ܭ‬14 ྃ‫ ޣ‬2907 ΓǴᆶ 6 ঁᒪᅅॶǴӅ 284,292 Γ຾ Εࣴ‫ز‬ШжύǶ ‫ځ‬ύᕎੱШжࣁ 54,472 Γ (19.2%)ǴߚᕎੱШжࣁ 229,820 Γ (80.8%) ԶᕎੱШжวғᆒઓ੯஻‫ޑ‬ԭϩКࣁ 6.1%ǴߚᕎੱШжวғᆒ ઓ੯஻‫ޑ‬ԭϩКࣁ 6.3%ǶԶҁࣴ‫ز‬ว౜ԭ࿤Γᔞύ‫؂‬ԃᕎੱཥวғঁਢ ኧϟ‫ ܭ‬5000 Γ‫ ډ‬10,000 Γϐ໔ǴԶ‫؂‬ԃᆒઓ੯஻ཥวғঁਢຬၸ 10,000 ΓǶ1996 Կ 2008 ԃΜεᜪᕎੱཥวғঁਢᕴΓኧᆶ‫܄ت‬ǵζ‫܄‬ϐᖿ༈߄ ᡉҢǴ‫ۚ܄ت‬ӭ (‫ـ‬კ 4.1Ǵკ 4.2 )Ƕ1996 Կ 2008 ԃϤᜪᆒઓ੯஻ཥว ғঁਢᕴΓኧᆶ‫܄ت‬ǵζ‫܄‬ϐᖿ༈߄ᡉҢǴᕴঁਢҗ 1998 ԃຬၸ 40,000 Γफ़‫ ډ‬2008 ԃัଯ‫ ܭ‬10,000 ΓǴζ‫ঁޑ܄‬ਢၨ‫ޑ܄ت‬ӭ (‫ـ‬კ 4.3Ǵკ 4.4 )Ƕ. 16.

(28) ˄ˌˌˉ‫ڣˋ˃˃˅۟ڣ‬ ԼՕᣊ༞ࢤᆭᒆ‫ڣޢ‬࿇‫᜔س‬Գᑇ. ቹ ˇˁ˄ʳ. ˄˃˃˃˃ ˋ˃˃˃ ˉ˃˃˃. Գʳᑇ. ˇ˃˃˃ ˅˃˃˃. ቹ ˇˁ˅ʳ. ˅˃ ˃ˋ. ˅˃ ˃ˉ. ˅˃ ˃ˇ. ˅˃ ˃˅. ˅˃ ˃˃. ˄ˌ ˌˋ. ˄ˌ ˌˉ. ˃. ԼՕᣊ༞ࢤᆭᒆ࿇‫᜔س‬Գᑇࢤֺܑለ. ˈ˃˃˃ ˇ˃˃˃ ˆ˃˃˃. Ֆࢤ. ˅˃˃˃. ߊࢤ. ˄˃˃˃. 17. ˅˃ ˃ˋ. ˅˃ ˃ˉ. ˅˃ ˃ˇ. ˅˃ ˃˅. ˅˃ ˃˃. ˄ˌ ˌˋ. ˄ˌ ˌˉ. ˃.

(29) ˄ˌˌˉ ‫ڣ ˋ˃˃˅ ۟ڣ‬քᣊ壄壀ఏఐ‫ڣޢ‬࿇‫᜔س‬Գᑇ. ቹ ˇˁˆʳ Գᑇʳ ˈ˃˃˃˃ ˇ˃˃˃˃ ˆ˃˃˃˃ ˅˃˃˃˃ ˄˃˃˃˃. ˄ˌˌˉʳ ˄ˌˌˋ ˅˃˃˃ʳ ˅˃˃˅ ˅˃˃ˇʳ ˅˃˃ˉ ˅˃˃ˋ ˃ʳ ‫ڣ‬. ʳ. ˄ˌˌˉ ‫ڣ ˋ˃˃˅ ۟ڣ‬ʳ. ቹ ˇˁˇ Գᑇ. քᣊ壄壀ఏ൛࿇‫᜔س‬Գᑇࢤֺܑለʳ. ˆ˃˃˃˃ʳ ˅˃˃˃˃ʳ ˄˃˃˃˃ʳ ˄ˌˌˉ ˃. ˄ˌˌˋʳ. ˅˃˃˃ʳ. ˅˃˃˅. ˅˃˃ˇ. ‫ڣ‬. ʳ Ֆࢤʳ. 18. ߊࢤ. ˅˃˃ˉʳ. ˅˃˃ˋ.

(30) ಃѤ࿯ ࣴ‫ز‬π‫ޑڀ‬ᔕ‫ۓ‬ ஒѠ᡼ϩࣁϤε୔ǴѠч୷ໜǵਲ༜ཥԮभਪǵѠύᄆϯࠄ‫׫‬ǵ໦ ݅჏ကѠࠄǵଯ໢ࡀܿǵ‫ە‬ើ޸ጪѠܿᚆ৞Ƕӆ٩ᕎੱձ (ԖǴค)ǵ‫܄‬ ձ Ȑ‫ت‬Ǵζȑǵԃសձ Ȑ15-34 ྃǴ35-54 ྃǴ55-74 ྃ‫ک‬ε‫ ܭ‬75 ྃȑǵ ᙍ཰ձ (‫د‬ᔼҾ཰ϷԾ໤ǴၭᅕമπǴैϦ௲ǴեԏΕϷଏҶ฻)ǵ‫ߥ׫‬ Дᖒձ (λ‫ ܭ‬10999 ϡǴ11000 ~ 22999 ϡǴ23000 ~ 34999 ϡ‫ک‬ 35000~149999 ϡ) ‫ک‬ᙍՏձ (໤঩Ǵ໤ЬǴଏҶϷ‫ځ‬д)ϩ‫݋‬Ƕᆒ᳥੯஻ ߾ϩࣁ௃ག‫܄‬ᆒઓੰǵᆒઓ‫ੱૈ۔‬ǵᛰ‫ނ‬ᔲҔǵЈӢ‫܄‬Їଆғ౛фૈም ᛖǵଚᆒᔲҔ‫܄࡚ک‬ᓸΚ‫܄‬ϸᔈǶ ߄ 3.1 Ӹࢲϩ‫݋‬ኳԄ٬Ҕϐှញᡂ໨Ϸᡂ໨‫ۓޑ‬က ှញᡂ໨. ‫ۓ‬က. ᡂ໨ 0: Ѡч୷ໜ 1: ਲ༜ཥԮभਪ 2: Ѡύᄆϯࠄ‫׫‬. Ӧ୔. ঁਢϐ‫ߥ׫‬Ӧ୔. 3: ໦݅჏ကѠࠄ 4: ଯ໢ࡀܿ 5: ‫ە‬ើ޸ጪѠܿᚆ ৞. ঁਢวғᕎੱཥບᘐᆶߚᕎੱঁ ԃស. ਢ຾Εଓ䅻Шжਔ໔ଆ‫ۈ‬ᗺϐԃ ស. ᕎੱ. 0Ǻε‫ ܭ‬75 ྃ 1Ǻ55-74 ྃ 2Ǻ35-54 ྃ 3Ǻ15-34 ྃ. ঁਢวғཥບᘐϐᕎੱ٣ҹ. 19. 0ǺؒԖวғ 1ǺԖวғ.

(31) 1:௃ག‫܄‬ᆒઓ੯஻ 2:ᆒઓ‫ੱૈ۔‬ 3:ᛰ‫ނ‬ᔲҔ ᆒઓ੯஻ϩᜪ. ঁਢวғཥບᘐϐᆒઓ੯஻ᅿᜪ 4:ЈӢ‫܄‬Їଆғ౛ф ૈምᛖ 5:ଚᆒᔲҔ 6:࡚‫܄‬ᓸΚ‫܄‬ϸᔈ. ‫܄‬ձ. 0ǹζ‫܄‬. ঁਢϐ‫܄‬ձ. 1Ǻ‫܄ت‬ 0:‫د‬ᔼҾ཰ǵԾ໤. ᙍ཰. 1:ၭᅕമπ. ঁਢ‫ߥ׫‬ϐᙍ཰. 2:ैϦ௲ 3:եԏΕ,ଏҶ 0:35,000~149,999 ϡ. ‫ߥ׫‬Дᖒ. 1:23,000~34,999 ϡ. ঁਢ‫ߥ׫‬ϐДᖒ. 2:11,000~22,999 ϡ 3:λ‫ ܭ‬10,999 ϡ 0:໤঩. ᙍՏ. ঁਢ‫ߥ׫‬ϐᙍՏ. 1:໤Ь 2:ଏҶϷ‫ځ‬д. ʳ ʳ. 20.

(32) ಃϖ࿯ ၗ਑಍ीᆶϩ‫݋‬ ӃаьБᔠ‫ۓ‬ѐϩ‫݋‬ཥวғᕎੱঁਢᆶߚᕎੱঁਢ‫཮ޗ‬ΓαᏢ‫ޑ‬ϩ ѲࢂցԖᡉ๱ৡ౦ (‫ ߄ـ‬4.1)Ζ ӆ٩೴ԃཥวғᕎੱঁਢᆶ٩΋КѤᓎኧᒿᐒࡷᒧϐߚᕎੱঁਢǴ۳ ࡕଓ䅻Ǵ՗ीόӕΓα‫཮ޗ‬ᏢӢηวғᆒઓ੯ੰϐᕴวғ౗ (rate, ‫ ؂‬100 Γԃ) ᆶวғ౗К (rate ratio)‫ޑ‬௃‫ ߄ـ( ݩ‬4.2)Ζ ௦ Cox proportional hazard regression ϩ‫݋‬ǴӃаൂᡂ໨຾ΕኳԄٰ௖ ૸ࣴ‫ز‬ύཥวғᕎੱঁਢᆶߚᕎੱঁਢӚঁᡂ໨วғᆒઓ੯஻Ӓ্‫ޑ‬ৡ ౦Ƕ ӆаӭᡂ໨຾ΕኳԄٰ௖૸ࣴ‫ز‬ύཥวғᕎੱঁਢᆶߚᕎੱঁਢӭ ঁᡂ໨วғᆒઓ੯஻Ӓ্‫ޑ‬ৡ౦Ǵᢀჸൂᡂ໨ኳԄϩ‫݋‬ᆶӭᡂ໨ኳԄǴ Кၨ่݀և౜Ֆᅿ࣬՟‫܈‬όӕ‫ޑ‬௃‫ ߄ـ( ׎‬4.3)Ƕ ӆ٩೴ԃཥวғᕎੱঁਢᆶ٩΋КѤᓎኧᒿᐒࡷᒧϐߚᕎੱঁਢǴ۳ ࡕଓ䅻‫ځ‬วғϤᅿᆒઓ੯ੰϐӚձวғ౗ (rate, ‫ ؂‬100 Γԃ)ᆶวғ౗К (rate ratio)‫ޑ‬௃‫ ߄ـ( ݩ‬4.4)Ζ Ψ௦ Cox proportional hazard regression ϩ‫݋‬ԖᕎੱঁਢӧϤᅿ ᆒઓ੯஻ӚձวғӒ্‫ޑ‬௃‫ ߄ـ( ݩ‬4.5)Ζ നࡕ٬ҔLog-Rank testѐᔠ‫ۓ‬ཥวғᕎੱঁਢᆶߚᕎੱঁਢΒ‫ޣ‬ᆒઓ ੯஻วғӸࢲԔጕ໔ࢂցԖᡉ๱ৡ౦ (‫ـ‬კ 5.1)Ζ ಍ीϩ‫݋‬а SAS 9.1.3 ‫( ހ‬SAS Institute Inco., Cary, N.C. U.S.A) ҁ຾Չϩ‫݋‬ǴਥᏵၗ਑‫ॺך‬ளаीᆉǴӚᅿᕎੱǵᆒઓ੯஻วғ౗ᆶৡ ౦Ǵ٠Ъёаள‫ډ‬॥ᓀК‫ک‬Ӹࢲϩ‫݋‬კǶΨ٬Ҕ Log-Rank test ѐᔠ‫ۓ‬Ӹ ࢲԔጕ໔ࢂց੿Ԗᡉ๱‫܄‬ৡ౦Ǵளа௖૸ᡂ໨ჹႣෳᆒઓ੯஻วғ‫ޑ‬Ⴃ ෳΚǶ. 21.

(33) ಃѤക ࣴ‫่݀ز‬ ಃ΋࿯ ᐕԃᕎੱϷᆒઓ੯஻ঁਢวғᖿ༈ ‫܌‬Ԗᕎੱཥวғঁਢኧࣁ 54,472 ΓǴᒿᐒ‫ڗ‬ኬϐߚᕎੱੰΓࣁ 229,820 ΓǶᕎੱШжᆒઓ੯஻‫ޑ‬วғ౗ࣁ 6.1 (‫ ؂‬100 Γ) ǴߚᕎੱШж ‫ޑ‬วғ౗ࣁ 6.3% (‫ ؂‬100 Γ)ǶԶҁࣴ‫ز‬ว౜‫؂‬ԃᕎੱཥวғঁਢኧຬၸ 5000 ΓǴԶ‫؂‬ԃᆒઓ੯஻ཥวғঁਢҗऊ 40,000 Γ೴ԃΠफ़Ǵՠ‫ ډ‬2008 ԃϝຬၸ 10,000 Γ (‫ـ‬კ 4.1Ǵკ 4.3)Ζ 1996 Կ 2008 ԃΜεᜪᕎੱཥวғঁਢᕴΓኧᆶ‫܄ت‬ǵζ‫܄‬ϐᖿ༈ ߄Ǵ (‫ـ‬კ 4.1Ǵკ 4.2)ǴԶ 1996 Կ 2008 ԃΜεᜪᕎੱཥวғঁਢϐᖿ ༈߄Ǵ (‫ـ‬კ 4.5 Կკ 4.14)ǶନΑζ‫ֿݜ܄‬ғ෗ǵ‫ځ‬дϷ҂ܴҢՏ࿼Β ᅿᕎੱບᘐѦǴ‫ځ‬ᎩΖᜪᕎੱ‫ޑ‬วғᖿ༈ӭࣁ೴ԃቚуǶΜεᜪᕎੱཥ วғঁਢ‫܄ت‬К‫ٯ‬ӭ‫ܭ‬ζ‫܄‬Ƕ 1996 Կ 2008 ԃϤᜪᆒઓ੯஻ཥวғঁਢᕴΓኧᆶ‫܄ت‬ǵζ‫܄‬ϐᖿ༈ ࣬՟Ǵՠζ‫܄‬ၨӭ (‫ـ‬კ 4.3Ǵკ 4.4)ǴԶ 1996 Կ 2008 ԃϤᜪᆒઓ੯஻ ཥวғঁਢᆶ‫ڀ‬Βᅿа΢ບᘐϐᖿ༈߄ (‫ـ‬კ 4.15 Կკ 4.21)ǴࣣԖ೴ԃ Πफ़‫ޑ‬ᖿ༈ǶϤᜪᆒઓ੯஻ཥวғঁਢζ‫܄‬К‫ٯ‬ӭ‫܄تܭ‬Ƕ ӄ଼҇ߥԾ҇୯ΖΜΖԃଆวғߥᓀ຤ԏΕό‫ى‬аЍᔈᙴᕍ຤ҔЍ р‫ޑ‬௃‫ݩ‬ਔ ȐՉࡹଣፁғ࿿ύѧ଼நߥᓀֽӄౚၗૻᆛ, 2009ȑ(40) (‫ـ‬კ 5.2)Ǵଞჹ٬Ҕୃଯ‫ߐޑ‬ບǵᛰࠔǵൺ଼฻ᙴᕍ໨ҞǴჴࡼуԏ೽ϩॄᏼ ‫ޑ‬௛ࡼǶќѦǴჹ‫ܭ‬ᙴᕍ୍ܺග‫ޣٮ‬ǴჴࡼӚᅿᙴᕍ຤Ҕᆅ௓௛ࡼǴᙖ а෧Ͽό྽ϐᙴᕍੁ຤ȐՉࡹଣፁғ࿿ύѧ଼நߥᓀֽӄౚၗૻᆛ, 2009ȑ(41)Ƕҁࣴ‫ز‬ϐϤᜪᆒઓ੯஻วғᖿ༈΢ᡉҢ଼ߥ‫ׯ‬๓଄ࡹ‫ه‬ӷ‫ޑ‬ ௛ࡼࢂཱུԖԋਏǴҗ 1999 ԃ൩ບΓኧԖᡉ๱Πफ़௃‫׎‬ջёว౜(‫ـ‬კ 4.15 Կკ 4.21)Ƕ. 22.

(34) ቹ ˈˁ˄ʳ. ˇˈ˃. ٤‫ا‬೜অತ೭‫֭گ‬᝟Ⴈቹ ˆˋ˅ ˆˉˊ. ˇ˃˃ ˆ˅ˆ. ˆˆˊ. ˆˈ˃ ˅ˋˉ. ˄˃Ꮩց. ˆ˃˃ ˅ˇ˄. ˅ˈ˃ ˄ˌˇ ˅˃˃ ˄ˈ˃. ˇ˃˄. ˅˅ˆ. ˅ˇˇ. ˅ˋˈ. ˅ˉ˅ ˅ˉ˄. ˅ˆˋ. ˅ˋˇ. ˆ˃˅ ˅ˋˉ. ˆˆˊ. ˆˈˆ ˆˈ˅. ˆˋ˅. ˆˋˊ. ˆˉ˄. ˆ˃ˋ. ˅ˉˈ. অᙠ‫گ‬Ե অᙠ‫ءګ‬. ˄ˈˊ. ˄˃˃ ˈ˃ ˃ ˋˇ. ˋˈ. ˋˉ. ˋˊ. ˋˋ. ˋˌ. ˌ˃. ˌ˄. ˌ˅. ˌˆ. ˌˇ. ˌˈ. ‫ڣ‬৫. )ၗ਑ٰྍ;!Չࡹଣፁғ࿿ύѧ଼நߥᓀֽӄౚၗૻᆛ*!. 23. ˌˉ.

(35) ಃΒ࿯ ‫཮ޗ‬ΓαᏢᡂ໨ᆶᆒઓ੯஻‫ޑ‬ᜢ߯ ߄ 4.1 ഋӈᕎੱ‫ߚک‬ᕎੱΒঁШж‫ޑ‬Γα‫཮ޗ‬ӢનϩѲǴᕎੱШж ၨӭζ‫ ܄‬Ȑp = 0.009ȑǵԃសၨଯǵѠч୷ໜΓኧၨӭǵ໤঩ၨӭǵ ၭᅕമπԭϩКၨଯǵ‫ߥ׫‬Дᖒե‫ ܭ‬11,000 ϡ‫ޣ‬ၨӭ (p < 0.001ȑ (‫ ߄ـ‬4.1)Ƕ வ 2000 ԃଆԿ 2008 ԃࣁЗǴऊΐԃ‫ޑ‬ଓ䅻ਔ໔Ǵ‫܌‬Ԗᆒઓ੯ੰཥว ғঁਢኧӧᕎੱШжࣁ 3,315 ΓǴӧߚᕎੱШжࣁ 14,570 ΓǶаᕎੱШ 4 жȐᢀჸΓԃࣁ 146,840 ԃȑᆶߚᕎੱШжȐᢀჸΓԃࣁ 982,884 ԃȑᆒ. ઓ੯ੰวғ౗ᢀჸǴζ‫܄‬ᕎੱШжัଯࣁ 1.16Ǵζ‫ߚ܄‬ᕎੱШж߾ࣁ 0.75 (ൂՏࣁ‫ ؂‬100 Γԃ)Ƕ‫܄ت‬ϐᕎੱШжჹߚᕎੱШжϐᆒઓ੯ੰว ғ౗Кࣁ 1.5Ǵζ‫ ࣁ܄‬1.55 (‫ ߄ـ‬4.2)Ƕ ‫཮ޗ‬ΓαᏢӢηϐঁձวғ౗ϩ‫݋‬ᡉҢǴԃសձ‫࣬ޑ‬ᜢၨεǴ15-34 ྃᕎੱШжჹߚᕎੱШжวғ౗Кࣁ 1.9 നଯ (0.2 ჹ 0.1 ‫ ؂‬100 Γԃ)Ƕ ‫ߥ׫‬Дᖒե‫ ܭ‬35,000~149,999 ϡಔᕎੱШжჹߚᕎੱШжวғ౗К ࣁ 1.8 നଯ (0.3 ჹ 0.2 ‫ ؂‬100 Γԃ)Ƕ ໤ЬᕎੱШжჹߚᕎੱШжวғ౗Кࣁ 1.7 നଯ (0.1 ჹ 0.04 ‫ ؂‬100 Γԃ)Ǵՠ໤঩К໤Ь‫ޑ‬วғ౗ଯǶ Ѡч୷ໜಔᕎੱШжჹߚᕎੱШжวғ౗Кࣁ 1.8 നଯ (0.9 ჹ 0.5 ‫ ؂‬100 Γԃ)Ƕ ‫د‬ᔼҾ཰ǵԾ໤ಔᕎੱШжჹߚᕎੱШжวғ౗Кࣁ 1.7 നଯ (0.7 ჹ 0.4 ‫ ؂‬100 Γԃ) (‫ ߄ـ‬4.2)Ƕ. 24.

(36) ߄ 4.1. 2000 ԃԿ 2008 ԃᕎੱϷคᕎੱШж‫཮ޗޑ‬ΓαᏢӢ નКၨ ᕎੱ. !. Ԗ. ค. !. !. 54472 n(%). 229820 n(%). !. p value. ‫܄‬ձ. <0.0092. ‫ت‬. 26620(48.9) 113737(49.5). ζ. 27852(51.1) 116083(50.5). ԃសձ(ൂՏ ԃសձ ൂՏ:ྃ ൂՏ ྃ). <0.0001. 15-34. 3290(6.0). 15302(6.7). 35-54. 18053(33.1). 78472(34.2). 55-74. 22429(41.2). 93353(40.6). 75-. 10706(19.7). 42692(18.6). ‫ߥ׫‬Дᖒձ(ൂՏ ‫ߥ׫‬Дᖒձ ൂՏ: ൂՏ. <0.0001. ϡ) < 11,000. 22835(41.9). 91739(40.0). 11,000 ~ 22,999. 19769(36.3). 87828(38.2). 23,000 ~ 34,999. 4949(9.1). 21156(9.2). 35,000 ~149,999. 6925(12.7). 29097(12.7). ᙍՏձ ໤঩ ໤Ь ଏҶϷ‫ځ‬д. <0.0001 39131(71.8) 168087(73.1) 1416(2.6). 5660(2.5). 13931(25.6). 56073(24.4). Ӧ୔ձ Ѡч୷ໜ. <0.0001 18091(33.2). 25. 72482(31.6).

(37) ਲԮभ. 7021(12.9). 29655(12.9). ύᄆ‫׫‬. 9383(17.2). 51476(18.1). ໦჏ࠄ. 8759(16.1). 36848(16.1). ଯ໢ࡀܿ. 8023(14.7). 35558(15.5). ‫ܿ޸ە‬ᚆ৞. 3166(5.8). 13000(5.7). ᙍ཰ձ. <0.0001. ‫د‬ᔼҾ཰,Ծ໤. 12112(22.2). 52643(22.9). ၭᅕമπ. 22207(40.8). 95787(41.7). ैϦ௲. 5768(10.6). 22178(9.7). եԏΕ,ଏҶ. 14391(26.4). 59212(25.8). 26. !. !.

(38) ߄ 4.2. ᕎੱᆶߚᕎੱШж‫ ܭ‬2000 ԃԿ 2008 ԃ໔วғᆒઓ੯஻‫ঁޑ‬ਢ ኧ‫ک‬วғ౗‫ޑ‬Γα࣬ᜢӢηϩѲ ᕎੱ. ᡂ໨. !. Ԗ(N=54472). N=331 5. !. !. !. ค(N=229820). ঁਢኧ ᢀჸΓԃ Rate* !. !. !. !. ঁਢኧ ᢀჸΓԃ Rate* N=14570. !. !. Rate. (95% CI). ratio !. ‫܄‬ձ. ! !. ‫ت‬. 1640. 144119. 1.14. 7366. 965146. 0.76. 1.49. (1.41, 1.57). ζ. 1675. 143879. 1.16. 7204. 964908. 0.75. 1.56. (1.48, 1.64). 15-34. 308. 146256. 0.21. 1076. 980022. 0.11. 1.92. (1.69, 2.18). 35-54. 1351. 144426. 0.94. 5591. 968677. 0.58. 1.62. (1.53, 1.72). 55-74. 1256. 144759. 0.87. 5907. 968624. 0.61. 1.42. (1.34, 1.51). 75-. 400. 146236. 0.27. 1996. 978499. 0.20. 1.34. (1.20, 1.49). 1209. 144849. 0.83. 5095. 971039. 0.52. 1.59. (1.49, 1.69). 11,000 ~ 22,999. 1302. 144556. 0.90. 6263. 967168. 0.65. 1.39. (1.31, 1.48). 23,000 ~ 34,999. 297. 146335. 0.20. 1316. 979529. 0.13. 1.51. (1.33, 1.71). 35,000 ~149,999. 507. 145938. 0.35. 1896. 978087. 0.19. 1.79. (1.63, 1.98). ໤঩. 2475. 142537. 1.74. 10950. 955745. 1.15. 1.52. (1.45, 1.58). ໤Ь. 101. 146671. 0.07. 392. 981920. 0.04. 1.72. (1.39, 2.15). ଏҶϷ‫ځ‬д. 739. 145630. 0.51. 3228. 975274. 0.33. 1.53. (1.42, 1.66). Ѡч୷ໜ. 1240. 144621. 0.86. 4643. 971268. 0.48. 1.79. (1.69, 1.91). ਲԮभ. 404. 146168. 0.28. 1800. 978488. 0.18. 1.50. (1.35, 1.67). ԃសձ (ൂՏ ൂՏ:ྃ ൂՏ ྃ). ‫ߥ׫‬Дᖒձ (ൂՏ ൂՏ:ϡ ൂՏ ϡ) < 11000. ᙍՏձ. Ӧ୔ձ. 27.

(39) ύᄆ‫׫‬. 556. 145867. 0.38. 2801. 976039. 0.29. 1.33. (1.21, 1.46). ໦჏ࠄ. 493. 146063. 0.34. 2253. 977322. 0.23. 1.46. (1.33, 1.61). ଯ໢ࡀܿ. 442. 146135. 0.30. 2225. 977608. 0.23. 1.33. (1.20, 1.47). ‫ܿ޸ە‬ᚆ৞. 179. 146511. 0.12. 822. 980941. 0.08. 1.46. (1.24, 1.71). ‫د‬ᔼҾ཰,Ծ໤. 987. 145082. 0.68. 3973. 972633. 0.41. 1.67. (1.55, 1.79). ၭᅕമπ. 1348. 144514. 0.93. 6533. 966977. 0.68. 1.38. (1.30, 1.46). ैϦ௲. 337. 146253. 0.23. 1413. 979389. 0.14. 1.60. (1.42, 1.80). եԏΕ,ଏҶ. 643. 145830. 0.44. 2651. 976824. 0.27. 1.62. (1.49, 1.77). ᙍ཰ձ. * per 100 Γԃ. 28.

(40) аൂᡂ໨຾Չ Cox proportional hazard regression ‫ޑ‬ᆒઓ੯ੰӒ্ϩ ‫่݀݋‬ᡉҢᕎੱШж‫ޑ‬ᆒઓ੯஻Ӓ্Кࣁ 1.49Ǵӭᡂ໨ϩ‫ั݋‬෧ࣁ 1.37 (95%ёߞज़,1.32-1.42)Ǵ࣬ၨ 75 ྃа΢‫ޑ‬ΓǴԃស 15-34 ྃǵԃស 35-54 ྃǵԃស 55-74 ྃ‫ޑ‬Ӓ্К֡ᡉ๱ၨଯǶ ՠаӭᡂ໨຾Չ Cox proportional hazard regression ‫ޑ‬ᆒઓ੯ੰ॥ᓀ ϩ‫݋‬ǴӒ্К‫ൂک‬ᡂ໨࣬߈Ƕхࡴԃស‫ޑ‬ӢηǴ75 ྃаΠ‫ޑ‬Ӓ্К֡ၨ ଯǴхࡴ 15-34 ྃ (HR = 1.46,95% CI = 1.37-1.57)ǵԃស 35-54 ྃ (HR = 1.47, 95% CI = 1.40-1.55)ǵԃស 55-74 ྃ (HR = 1.33, 95% CI = 1.27-1.39) Кଯ‫ߥ׫‬ДᖒಔǴ10,000-22,999 ϡಔ (HR = 1.37, 95% CI = 1.27-1.48)‫ک‬ 23,000-34,999 ϡಔ (HR = 1.15, 95% CI = 1.09-1.22)‫ޑ‬Ӓ্֡ၨଯǶ Ӓ্Кλ‫ ܭ‬1 ‫ޣ‬ଏҶᆶ‫ځ‬д (HR = 0.86, 95% CI = 0.81-0.91)ǵՐӧ ਲԮभӦ୔ (HR = 0.92, 95% CI = 0.88-0.97)‫ک‬໦჏ࠄӦ୔‫( ҇ۚޑ‬HR = 0.92, 95% CI = 0.88-0.96)Ǵа΢ࣣ኱Ңӭᡂ໨ϩ‫݋‬ኧॶǶ ൂᡂ໨ᆶӭᡂ໨ϩ‫݋‬ӕਔԖᡉ๱ৡ౦‫ޑ‬໨Ҟࣁᕎੱᆶԃស 55-74 ྃǵ ԃស 35-54 ྃǵ ԃស 15-34 ྃǵ٩ᒃᆶ‫ځ‬дǵ‫ߥ׫‬Дᖒձӧ 10,000-22,999 ϡǵਲԮभӦ୔ǵ໦჏ࠄӦ୔(‫ ߄ـ‬4.3 )Ƕ Ӧ୔ձӧൂᡂ໨Ϸӭᡂ໨ϩ‫݋‬Ǵ߾ࢂਲ༜ཥԮभਪǵ໦݅჏ကѠࠄ Βಔၲᡉ๱ǴКѠч୷ໜୖԵಔ॥ᓀКեǴࣣࣁ (HR = 0.92ǹ95% CI = 0.88-0.97 / 0.88-0.96)Ƕ аൂᡂ໨ϩ‫݋‬ᙍՏಔձǴ໤ЬК໤঩(ୖԵ௼ဂ)ଯǴၲ 1.09 ७(HR = 1.09,95% CI = 1.00-1.20)Ǵӭᡂ໨ϩ‫݋‬ҭӕǶ аӭᡂ໨ϩ‫݋‬Ǵ‫܄ت‬ᆶζ‫࣬܄‬КǴӧวғᆒઓ੯ੰϐ॥ᓀ΢Ǵ߻‫ޣ‬ ࣁࡕ‫ ޑޣ‬1.02 ७(HR = 1.02, 95% CI = 1.00-1.06)Ǵՠόᡉ๱ǹ‫ߥ׫‬Дᖒλ ‫ ܭ‬11,000 ‫ ک‬11,000~22,999 ϡΒಔ‫ୖک‬Եಔ(35,000 ϡа΢)࣬КၨǴӒ্ Кၲ 1.37 (95% CI = 1.27-1.48) ‫ ک‬1.15 (95% CI = 1.09-1.22)Ȑ‫ ߄ـ‬4.3ȑǶ. 29.

(41) Ӛձᆒઓ੯஻‫ޑ‬วғ౗ (ൂՏࣁ‫ ؂‬100 Γԃ)ǴᕎੱШжаᆒઓ‫ૈ۔‬ ੱ‫ޑ‬วғനଯԖ 2,131 Γ (1.49 ‫ ؂‬100 Γԃ)Ǵ‫ځ‬ԛࣁ࡚‫܄‬ᓸΚ‫܄‬ϸᔈ 575 Γ(0.39 ‫ ؂‬100 Γԃ)‫ک‬௃ག‫܄‬ᆒઓੰ 270 Γ (0.18 ‫ ؂‬100 Γԃ)ǶߚᕎੱШ жวғനӭ‫ޑ‬Ψࢂᆒઓ‫ੱૈ۔‬ǴԖ 9,499 Γ (0.99 ‫ ؂‬100 Γԃ)Ǵ‫ځ‬ԛࣁ ࡚‫܄‬ᓸΚ‫܄‬ϸᔈ 2,117 Γ (0.22 ‫ ؂‬100 Γԃ)‫ک‬ᛰ‫ނ‬ᔲҔ (0.13 ‫ ؂‬100 Γԃ) (‫ ߄ـ‬4.4 )Ƕ җᕎੱШжჹߚᕎੱШжวғ౗К࣬ၨǴ௃ག‫܄‬ᆒઓੰ‫ޑ‬Кॶനଯ Ǵ‫ځ‬ԛࣁ࡚‫܄‬ᓸΚ‫܄‬ϸᔈ (1.82) ‫ک‬ᆒઓ‫( ੱૈ۔‬1.82)ǶᕎੱШж Ȑ2.41ȑ ‫ߚک‬ᕎੱШж‫ޑ‬ᛰ‫ނ‬ᔲҔ‫ک‬ЈӢ‫܄‬Їଆғ౛фૈምᛖวғ౗࣬߈Ƕ ᕎੱШжКߚᕎੱШжҭԖၨଯ‫ޑ‬ଚᆒᔲҔวғ౗‫ک‬Β໨а΢ᆒઓ ੯஻‫ޑ‬วғ౗ǴКॶ 1.30 ‫ ک‬1.41Ƕ а Cox Ӓ্ϩ‫݋‬ΨᡉҢᕎੱੰΓӧଓ䅻ය໔วғᆒઓ੯஻ϐӒ্К ϝа௃ག‫܄‬ᆒઓੰനଯǴၲ 2.18 (95% CI = 1.90 -2.51)ǹۚԛࣁ࡚‫܄‬ᓸΚ ‫܄‬ϸᔈǴၲ 1.65 (95% CI = 1.50- 1.81)ǹಃΟࣁᆒઓ‫ੱૈ۔‬Ǵၲ 1.34 (95% CI = 1.28-1.41)ǶᕎੱੰΓ‫ޑ‬ᛰ‫ނ‬ᔲҔ‫ک‬ЈӢ‫܄‬Їଆғ౛фૈምᛖӒ্ϸ ԶၨեǴϩձࣁ 0.91 (95% CI = 0.78-1.06) ‫ ک‬0.90 (95% CI = 0.671.21)Ǵՠόᡉ๱ǶᕎੱੰΓ‫ޑ‬ଚᆒᔲҔӒ্КΨၲ 1.15 (95% CI = 1.00-1.34) (‫ ߄ـ‬4.5)Ƕ ᕎੱᆶߚᕎੱШж‫ک‬ᆒઓ੯஻วғ‫ޑ‬ᜢ߯ǴаӸࢲϩ‫݋‬კև౜Ǵว ౜ΒచጕచؒԖख़᠄ϐೀǴЪа log-rank ຾Չᔠ‫ڀۓ‬಍ीϐᡉ๱ཀက (p< 0.0001)Ǵж߄ᕎੱШжᆶߚᕎੱШжӧᆒઓ੯ੰ‫ޑ‬วғ΢‫ڀ‬ᡉ๱‫ޑ‬ ৡ౦ (‫ـ‬კ 5.1)Ƕ. 30.

(42) ߄ 4.3. Cox proportional hazard ϩ‫݋‬٩ᕎੱ‫཮ޗک‬ΓαᏢӢηᆒઓ੯஻Ӓ ্Кीᆉ ᡂ໨. ൂᡂ໨ϩ‫ ݋‬HR(95%CI). ӭᡂ໨ϩ‫ ݋‬HR(95%CI). Ԗ. 1.40(1.30-1.40) *. 1.37(1.32-1.42) *. ค. 1. 1. ‫ت‬. 1.01(0.98-1.04). 1.02(1.00-1.06). ζ. 1. 1. 15-34. 1.47(1.37-1.57) *. 1.46(1.37-1.57) *. 35-54. 1.48(1.41-1.55) *. 1.47(1.40-1.55) *. 55-74. 1.31(1.25-1.37) *. 1.33(1.27-1.39) *. 1. 1. ᕎੱ. ‫܄‬ձ. ԃសձ(ൂՏ ԃសձ ൂՏ:ྃ ൂՏ ྃ). >75 ᙍՏձ ໤Ь. 1.09(1.00-1.20). 1.05(0.96-1.16). ଏҶϷ‫ځ‬д. 0.89(0.86-0.92) *. 0.86(0.81-0.91) *. ໤঩. 1. 1. 0.85(0.81-0.89) *. 1.37(1.27-1.48) *. 11,000 ~ 22,999. 1.03(0.98-1.07). 1.15(1.09-1.22) *. 23,000 ~ 34,999. 0.94(0.89-1.01). 0.97(0.91-1.04). 35,000 ~149,999. 1. 1. ‫ߥ׫‬Дᖒձ(ൂՏ ൂՏ:ϡ ‫ߥ׫‬Дᖒձ ൂՏ ϡ) < 11,000. Ӧ୔ձ ਲԮभ. 0.93(0.89-0.98) *. 31. 0.92(0.88-0.97) *.

(43) ύᄆ‫׫‬. 1.01(0.97-1.06). 1.00(0.96-1.04). ໦჏ࠄ. 0.94(0.90-0.98) *. 0.92(0.88-0.96) *. ଯ໢ࡀܿ. 0.95(0.91-1.00). 0.95(0.90-1.00). ‫ܿ޸ە‬ᚆ৞. 0.96(0.90-1.03). 0.96(0.90-1.03). Ѡч୷ໜ *. 1. p<0.05. 32. 1.

(44) ߄ 4.4. ᕎੱШжᆶคᕎੱШж‫ܭ‬ᢀჸය໔Ӛձᆒઓ੯஻ ϐวғ౗Кၨ. !. ᕎੱ !. !. Ԗ N=5447. ᆒઓ੯஻. ค. ! !. 2. !. !. N=22982 0. ঁਢኧ ᢀჸΓԃ Rate* ঁਢኧ ᢀჸΓԃ Rate* N=3315. Rate Ratio. (95% CI). N=14570. ௃ག‫܄‬ᆒઓੰ. 270. 146384. 0.18. 750. 980977. 0.08. 2.41. (2.10, 2.77). ᆒઓ‫ੱૈ۔‬. 2131. 143222. 1.49. 9499. 959874. 0.99. 1.50. (1.44, 1.58). ᛰ‫ނ‬ᔲҔ. 192. 146453. 0.13. 1307. 979446. 0.13. 0.98. (0.84, 1.14). ଚᆒᔲҔ. 220. 146456. 0.15. 1137. 980249. 0.12. 1.30. (1.12, 1.50). 51. 146741. 0.03. 345. 982040. 0.04. 0.99. (0.74, 1.33). 575. 145883. 0.39. 2117. 977494. 0.22. 1.82. (1.66, 2.00). 121. 146622. 0.08. 573. 981397. 0.06. 1.41. (1.16, 1.72). ЈӢ‫܄‬Їଆғ ౛фૈምᛖ ࡚‫܄‬ᓸΚ‫܄‬ϸ ᔈϷ‫ځ‬д Β໨‫܈‬а΢. * per 100 Γԃ. 33.

(45) ߄ 4.5. ᕎੱੰΓӧଓ䅻ය໔วғᆒઓ੯஻ϐ‫܄‬ձ‫ک‬ԃសਠ ҅Ӓ্К ᆒઓ੯஻. HR(95%CI). ௃ག‫܄‬ᆒઓੰ. 2.18(1.90-2.51) *. ᆒઓ‫ੱૈ۔‬. 1.34(1.28-1.41) *. ᛰ‫ނ‬ᔲҔ. 0.91(0.78-1.06). ଚᆒᔲҔ. 1.15(1.00-1.34). ЈӢ‫܄‬Їଆғ౛фૈምᛖ. 0.90(0.67-1.21). ࡚‫܄‬ᓸΚ‫܄‬ϸᔈϷ‫ځ‬д. 1.65(1.50-1.81) *. *. p<0.05. 34.

(46) Log-Rank P<.0001. ߚᕎੱШж!. ᕎੱШж!. კ 6/3! ᕎੱШжᆶߚᕎੱШжӧᆒઓ੯ੰวғϐӸࢲϩ‫݋‬კ. 35.

(47) ಃϖക ૸ፕ ‫܌‬Ԗᕎੱཥวғঁਢኧࣁ 54,472 ΓǴᒿᐒ‫ڗ‬ኬϐߚᕎੱੰΓࣁ 229,820 ΓǶऩа‫؂‬Μ࿤Γαᕎੱಉวғ౗ࣁ 303 ΓٰीᆉǴᕎੱཥวғ ঁਢኧ௢՗ऊԖ 3,030 ΓǴԶҁࣴ‫ز‬ว౜‫؂‬ԃᕎੱཥวғঁਢኧ೿ຬၸ 5,000 ΓǴᕎੱঁਢኧଯၸ໳ࣴ‫ޑز‬՗ी (‫ـ‬კ 4.1)ǶচӢёૈࣁ໳ Ȑ໳ ٫௵, 2008ȑ(5)ࣴ‫ز‬аख़ε໾ੰ᛾ܴܴಒᔞ (HV)ࣁၗ਑ٰྍǴᆶҁࣴ‫ز‬௦ ҔߐບೀБϷ‫ݯ‬ᕍܴಒᔞ (CD)ǴԶౢғόӕǶ ௗΠٰ‫૸܌‬ፕϐၸѐࣴ‫ز‬Ў᝘Ǵӧࣴ‫ز‬೛ीǵଓ䅻ԃኧ฻೿‫ک‬ҁࣴ ‫ز‬όᅰ࣬ӕǶ ҁࣴ‫ز‬ว౜ᕎੱШж‫ޑ‬௃ག‫܄‬ᆒઓੰวғ౗ࣁ 0.18/100 Γԃ (ࣁӄ ᕎШж‫ ޑ‬4.96/1000 ΓǴ‫܈‬՞‫܌‬Ԗᆒઓ੯஻‫ ޑ‬8.1%ȑǴԶߚᕎੱШж‫ޑ‬௃ ག‫܄‬ᆒઓੰวғ౗ࣁ 0.08/100 Γԃ (ࣁӄߚᕎШж‫ ޑ‬3.26/1000 ΓǴ‫܈‬՞ ‫܌‬Ԗᆒઓ੯஻‫ ޑ‬5.1%ȑǴୖԵၸѐࣴ‫ز‬Ԗᕎੱঁਢ௃ག‫܄‬ᆒઓੰวғԭ ϩКࣁλ‫ ܭ‬6% (Brintzenhofe-Szoc et al, 2009) (14) ǵ6% (Brintzenhofe-Szoc etal, 2009) (14)ǵ9.5% (Kessler et al, 2005) (17)Ǵҁࣴ‫ޑز‬ᕎШжШж௃ག‫܄‬ ᆒઓੰวғ՞౗ϟ‫ځܭ‬໔ǴᡉҢ࣬߈‫܄‬ǶՠࢂКࢫ‫ ޑ‬0.44% Ȑࢫྷࡀ, 2006ȑ(27)࣬КዴࢂଯࡐӭǴ‫ک‬Akechi฻ 6.7% (Akechi et al, 2004) (18)ࣴ‫࣬ز‬ КǴ߾໻ԖᕎੱШжวғ౗ၨଯǶ ӧᕎੱ࣬ჹߚᕎੱШжӧ௃ག‫܄‬ᆒઓ੯ੰᆶᆒઓ‫ޑੱૈ۔‬วғ౗К ϩձǴࣁ 2.41 ‫ ک‬1.5 ७Ǵ߻‫ޣ‬ᆶGandubert (2~4 ७)ࣴ‫࣬ز‬಄Ǵࡕ‫߾ޣ‬ၨ ե(Gandubert et al, 2009) (13)Ƕ ӧᆒઓ‫ੱૈ۔‬ҁጇว౜ᕎੱШжวғ౗ࣁ 1.49/100 Γԃ (՞‫܌‬Ԗᆒ ઓ੯஻‫ ޑ‬64.2 %ȑǴԶߚᕎੱШжวғ౗ࣁ 0.99/100 Γԃ (՞‫܌‬Ԗᆒઓ ੯஻‫ޑ‬՞ 65.2%ȑǴ‫ک‬ၸѐࣴ‫ ࣁز‬4% (Derogatis et al, 1983) (15)ǵ16.3% (Akechi et al, 2004) (18)ࣴ‫࣬ز‬ၨଯࡐӭǶ. 36.

(48) ӧᕎੱᆶߚᕎੱШжᛰ‫ނ‬ᔲ‫ނ‬วғ౗КǴࣁ 0.98 ७ (0.128 [‫ ؂‬100 Γԃ] / 0.13 [‫ ؂‬100 Γԃ])ǴᡉҢᕎੱШжၨϿᛰ‫ނ‬ᔲҔǴҭࣁϤᅿᆒઓ ੯஻วғϐനեǶ߻‫ޣ‬วғΓኧ՞ 5.8%Ǵࡕ‫ ࣁޣ‬9%ǴᆶKessler฻ 3.8% (Kessler et al, 2005) (17)ࣴ‫࣬ز‬КၨଯǶ ӧᕎੱᆶߚᕎੱШжଚᆒᔲҔวғ౗КǴࣁ 1.30 ७ (0.15 [‫ ؂‬100 Γ ԃ] / 0.12 [‫ ؂‬100 Γԃ] )Ƕ߻‫ޣ‬วғΓኧࣁ 6.6%Ǵࡕ‫ ޣ‬7.8%ǴᆶKessler ฻ 3.8% (Kessler et al, 2005) (17)ࣴ‫࣬ز‬КၨଯǶ ӧ࡚‫܄‬ᓸΚ‫܄‬ϸᔈϷ‫ځ‬дǴҁጇว౜ᕎੱШжวғ౗ࣁ 0.39/100 Γ ԃ (՞ 17.3%ȑǴԶߚᕎੱШжวғ౗ࣁ 0.22/100 Γԃ (՞ 14.5%ȑǴ‫ک‬ Deroga฻՞ 68% (Derogatis et al, 1983) (15)ǵAkechi฻՞ 34%ࣴ‫࣬ز‬Кࣁե (Akechi et al, 2001) (19)ǶᆶAkechi฻‫ ޑ‬0%ࣴ‫ز‬Кၨ߾ၨଯ (Akechi et al, 2004) (18)Ƕ Ӛձᆒઓ੯஻‫ޑ‬วғ౗‫ک‬՞౗Ǵό໻ҁࣴ‫ز‬Ӛό࣬ӕǴᆶӃ߻ࣴ‫ز‬ ҭԖ࣬྽࣬౦ೀǴЀ‫ࢂځ‬ᆒઓ‫܄࡚کੱૈ۔‬ᓸΚ‫܄‬ϸᔈǴ௢ፕচӢࣁҁ ࣴ‫܌ز‬௦‫ޑڗ‬ᡂ໨‫ۓ‬ကᆶ߻ӈࣴ‫ز‬όӕǴ߻य़ࣴ‫ز‬ӭࣁൂ΋੯ੰ (ᆒઓ ੯஻ᆶᕎੱ)௖૸ǴԶҁࣴ‫ࢂز‬΋ಔӭঁ੯ੰٰ૸ፕǴԶᏤठ่ፕό΋ ठǶ ԶаᕎੱੰΓӧଓ䅻ය໔วғᆒઓ੯஻ϐӒ্К຾Չϩ‫݋‬Ǵว౜௃ ག‫܄‬ᆒઓੰനଯǴۚԛࣁ࡚‫܄‬ᓸΚ‫܄‬ϸᔈϷ‫ځ‬дǴಃΟࣁᆒઓ‫ੱૈ۔‬Ƕ ᆶHonda฻ࣴ‫࣬ز‬КǴว౜ନΑ࡚‫܄‬ᓸΚ‫܄‬ϸᔈϷ‫ځ‬дѦǴ௃ག‫܄‬ᆒઓ ੰᆶᆒઓ‫ੱૈ۔‬೿ՏۚӒ্К߻ΟଯǶԶ࡚‫܄‬ᓸΚ‫܄‬ϸᔈϷ‫ځ‬дӒ্К ᆶSareen฻ 1.0% ࣴ‫( ز‬Sareen et al, 2005) (12)࣬КၨଯǴႣ՗ৡ౦চӢё ૈࢂΒ‫زࣴޣ‬௦Ҕᡂ໨όӕԶᏤठȐHonda et al, 2004ȑ(1)Ƕ ҁጇࣴ‫ز‬ว౜Ԗᕎੱ‫ޣ‬ӧ௃ག‫܄‬ᆒઓੰϐӒ্Кࣁ 2.18 (95% CI = 1.90-2.51)Ǵᆒઓ‫ੱૈ۔‬ϐӒ্Кࣁ 1.34 (95% CI = 1.28-1.41)ǴԶHonda. 37.

(49) ฻ࣴ‫ز‬௃ག‫܄‬ᆒઓੰ OR = 2.15ȐHonda et al, 2004ȑ(1) ǴRasic฻ࣴ‫ ز‬OR = 3.18 (Rasic et al, 2008) (11)Ǵᆒઓ‫ ੱૈ۔‬OR = 0.22-5.94 (Rasic et al, 2008) (11)ǶՠHonda฻ࣴ‫ز‬ϐᛰ‫ނ‬ᔲҔӒᓀ‫ۚ܄‬२Տ (OR = 3.6Ǵ95% CI =1.3-9.8)Ǵҁጇ߾ࢂಃΒե‫ޑ‬Ӓ্КǴࣁ 0.91 (95% CI = 0.78-1.06)Ƕ Ԝᅿৡ౦ёૈٰԾЎϯሽॶᢀ‫ޑ‬όӕǴӵኻࢪࢌ٤୯ৎёӝ‫ݤ‬٬Ҕ ࢌ٤‫ނ‬፦ (εഞ) (ԙٖ፣Ǵ 2003) (36)ǴՠӧѠ᡼εഞ߾ӈΕಃΒભࢥ ࠔǴ٬Ҕᆅ‫ڋ‬ᛰ‫཮ނ‬ԖӉ‫ޑݤ‬ೢҺǴӵࡼҔಃΒભࢥࠔ‫ޣ‬ǴೀΟԃаΠ Ԗය২Ӊ (‫୍ݤ‬೽‫ࢥי‬ၗૻᆛǴ 2010) (37)Ƕ ԶᕎੱੰΓวғᆒઓ੯஻Ӓ্КǴࢂ௃ག‫܄‬ᆒઓੰനଯǴۚԛࣁ࡚ ‫܄‬ᓸΚ‫܄‬ϸᔈϷ‫ځ‬дǴಃΟࣁᆒઓ‫ੱૈ۔‬Ƕᆶၸѐࣴ‫࣬ز‬КǴѝԖ௃ག ‫܄‬ᆒઓੰǴӧ‫܌‬Ԗࣴ‫ز‬ύࣣӈΕวғ௨ӈ໩‫߻ׇ‬ΟӜϣǶ ҁࣴ‫ز‬аӭᡂ໨ϩ‫݋‬Ǵ‫܄ت‬ᆶζ‫࣬܄‬КǴӧวғᆒઓ੯஻ϐ॥ᓀ ΢Ǵ‫܄ت‬ၨଯࣁζ‫ ޑ܄‬1.02 ७ (95% CI = 1.00-1.06)Ǵᆶ Honda ฻ࣴ‫࣬ز‬ ՟ȐHonda et al, 2004ȑ(1)Ƕ ӧวғᆒઓ੯஻ϐ॥ᓀ΢ǴҁጇΨԖᒿԃស΢ϲ॥ᓀКΨΠफ़‫ޑ‬ᖿ ༈Ǵ໻ 35-54 ྃಔัଯ‫ ܭ‬15-34 ྃಔǴᆶRasic‫ޑ‬฻ࣴ‫ز‬೽ϩ࣬಄ (Rasic et al, 2008). ǴᆶSareen฻ࣴ‫( ز‬Sareen et al, 2005) (12)ֹӄ࣬಄Ǵӧߙ֧. (11). ԃ௼ဂӒ্КനଯǴ‫ځ‬ԛࣁനԃᇸ௼ဂΖ ҁጇว౜‫ߥ׫‬Дᖒλ‫ ܭ‬11,000 ϡಔวғᆒઓ੯஻ϐ॥ᓀКനଯǴ 11,000~22,999 ϡۚԛǴԶ 23,000-34,999 ϡಔКୖԵಔ 35,000-149,999 ϡ ಔัեǴԖӢԏΕቚуԶᆒઓ੯஻วғ॥ᓀКफ़ե‫ޑ‬ᖿ༈Ƕ࣬ၨ‫ܭ‬Rasic ฻ (Rasic, 2008) (11)ǵSareen฻ (Sareen et al, 2005) (12) ǵKessler ฻ (Kessler et al, 2005) (17)ࣴ‫ز‬Ǵ่݀εठ࣬಄Ƕ Ӧ୔ձวғᆒઓ੯஻ϐ॥ᓀКǴ߾ࢂਲ༜ཥԮभਪǵ໦݅჏ကѠࠄ ΒಔǴКѠч୷ໜୖԵಔ॥ᓀКեǴHR ࣣࣁ 0.92 (95% CI = 0.88 -0.97 /. 38.

(50) 95% CI = 0.88-0.96)Ƕՠᆶ݅฻ࣴ‫ز‬КၨǴ่݀όӕ (݅λስ฻, 2004) Ƕҁጇࣴ‫ۚز‬ՐӦ‫ڀ‬ᡉ๱ৡ౦‫( ܄‬p< 0.0001)ᆶ Gandubert ฻ࣴ‫࣬ز‬К. (29). (Gandubert et al, 2009) (13)Ǵ่݀࣬಄Ƕ ӧࣴ‫ز‬ύԖว౜ᆒઓ੯஻วғΒᅿа΢‫ޑ‬ບᘐǴᕎੱШжᆶคᕎੱ ШжຬၸΒᅿа΢ບᘐวғ౗ϩձࣁ 0.08 (3.7%) vs.0.06 (3.9%) (‫؂‬΋ԭ Γԃ)Ǵวғ౗Кࣁ 1.41ǶҗMoffitt฻ (Moffitt et al, 2007) (24)ǵBrown฻ (Brown et al, 2001) (25) ࣴ‫ز‬ᡉҢӧขቾᆶ௃ᆣ੯஻ಖғӅੰ΢ǴΒ‫ڀޣ‬ ߚதଯ‫࣬ޑ‬ᜢ‫܄‬Ƕҁࣴ‫่݀ز‬಄ӝа΢่ፕǶ. 39.

(51) ࣴ‫ز‬ज़‫ڋ‬ ໻Ԗບᘐၗ਑Ǵคፕᕎੱ‫܈‬ᆒઓ੯஻‫ੰޑ‬௃ᇸख़Ǵคவள‫ޕ‬Ƕၗ਑ ύલϿଣѦԝΫচӢᆶВයǴӧीᆉᢀჸΓԃਔǴᆶჴሞ௃‫ݩ‬ΨёૈԖ рΕǶԶҁࣴ‫ز‬௦Ҕӭᅿᆒઓ੯஻ࣁ΋ಔບᘐձ‫زࣴޑ‬೛ीǴ٠ค‫ݤ‬ள ‫ࢌډ‬΋੝‫ۓ‬ᆒઓ੯஻‫ޑ‬วғ౗ᆶ॥ᓀКǶҗ‫زࣴܭ‬ၗ਑٬ҔΒЋၗ਑Ǵ ऩၗ਑ҁ‫ي‬ջલϿࢌϩǴӵ‫ߥ܍‬ၗ਑ᔞલϿੰ౛ᔠࢗൔ֋Ǵ‫܈‬Ј౛੯ੰ ϐບᘐπ‫ڀ‬ǵ٬ҔՖᅿЈ౛‫ݯ‬ᕍǴࣣࢂค‫ݤ‬кϩᙶమԜࣴ‫ز‬Ӣ݀ᜢ߯‫ޑ‬ υᘋӢનǶ. 40.

(52) ಃϤക ่ፕᆶࡌ᝼ ಃ΋࿯ ่ፕ ҁࣴ‫ز‬௖૸‫ڀ‬ᕎੱᆶคᕎੱШжᆒઓ੯஻ϐวғ౗ᆶ॥ᓀǴᆶ୯ϣ Ѧࣴ‫ز‬КၨǴ่݀Ԗᜪ՟ᗺǴΨԖόӕϐೀǶ௢ፕᕎੱੰΓӧੰำ຾৖ ύǴᆒઓ੯஻‫ޑ‬วғӒᓀัଯǴ‫܄ت‬ǵၨԃᇸ௼ဂǵ‫ߥ׫‬Дᖒၨեಔ‫ޑ‬ ុวӒᓀᡉ๱ǶԶᙍՏձࣁ٩ᒃϷ‫ځ‬д‫ۚکޣ‬ՐਲԮभǵ໦჏ࠄӦ୔‫ޣ‬ Ӓ্ၨեǶᙍ཰ձ΢ନΑ‫د‬ᔼҾ཰ᆶԾ໤‫ޣ‬ѦǴ‫ځ‬дΟಔ॥ᓀΨୃեǶ. 41.

(53) ಃΒ࿯ ၮҔᆶࡌ᝼ ᕎੱੰΓӢ‫ੰځ‬ำߏǴ҂ٰႣࡕၨৡǴऩӆу΢ᆒઓ੯஻วғ‫ޑ‬॥ ᓀቚуǴჹ‫ځܭ‬Ծ‫ޑي‬ғࢲࠔ፦Ǵ‫يޑޣ៝ྣࢂ܈‬ЈϷ࿶ᔮॄ಻΢Ǵ೿ ࢂॄय़‫ޑ‬ቹៜǶҁࣴ‫ࡌز‬᝼ᙴᕍᡏ‫ڋ‬ӧᕎੱੰΓྣៈ΢ǴЈ౛࣬ᜢ‫଼ޑ‬ ந᝼ᚒϪವ۹ຎǴ٠ᔈӕਔᆶ‫ي‬ᡏᙴᕍीჄ΋ଆ຾ՉǴБёԋࣁӄΓᙴ ᕍ‫ྣޑ‬ៈ‫س‬಍ (၏‫ځ‬ঢ়฻Ǵ 2003) (38)Ƕҗ‫ܭ‬ҁࣴ‫૸ز‬ፕ‫يډ‬ᡏᆶЈ౛‫ޑ‬ ੯ੰǴёаჹᔈ‫ډ‬Ѡ᡼Ҟ߻‫܌‬ගঀϐӄΓ‫ྣޑ‬ៈᡏ‫س‬Ƕ‫ځ‬ύхࡴǺғ ‫ނ‬ǵЈ౛ǵ‫཮ޗ‬ǵᡫ‫܄‬฻ቫय़‫଼ޑ‬நྣៈ (၏‫ځ‬ঢ়฻Ǵ 2003) (38)Ƕ. 42.

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(56) 21. Hopwood P, Stephens RJ. Depression in patients with lung cancer: prevalence and risk factors derived from quality-of-life data. J Clin Oncol 2000;18:893-903. 22. Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A. Depression and anxiety in women with early breast cancer: five year observational cohort study. In: BMJ, doi:10.1136/bmj.38343.670868.D3 (published 4 February 2005). 23. Massie MJ. Prevalence of depression in patients with cancer. J Nat Cancer Inst Monog 2004;32:57-74. 24. Moffitt TE, Harrington H, Caspi A, et al. Depression and generalized anxiety disorder: cumulative and sequential comorbidity in a birth cohort followed prospectively to age 32 years. Arch Gen Psychiatry 2007;64:651-660. 25. Brown TA, Campbell LA, Lehman CL, Grisham JR, Mancill RB. Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology 2001;110(4):585-599. 26. Gallo J, Armenian H, Ford D, Eaton W, Khachaturian A. Major depression and cancer: the 13-year follow-up of the Baltimore epidemiologic catchment area sample (United States). Cancer Causes Control 2000;11(8):751-8. 27. ࢫྷࡀ. ߃ԛບᘐኁᢠ੯஻‫ޣ‬ଓ䅻ΟԃϐᙴᕍճҔᆶ຤Ҕϩ‫݋‬௖૸ [ᅺγፕЎ]. Ѡύᑜ: ٥ࢪεᏢ; 2006. 28. Nagel G, Peter R, Braig S, Hermann S, Rohrmann S, Linseisen J. The impact of education on risk factors and the occurrence of multimorbidity in the EPIC-Heidelberg cohort. BMC Public Health 2008;11(8):384. 29. ݅λስǵယપ‫ד‬ǵቅ‫ᦘ܃‬. Ѡ᡼Ӧ୔ϖΜྃа΢ζ‫܄‬୯Γኁᢠ‫ރ‬ᄊ ϐ࣬ᜢӢનϩ‫݋‬. ȨΓαǵৎ৥ᆶ୯଼҇நࡹ฼ӣ៝ᆶ৖ఈȩࣴ૸཮ፕЎ 2004. 45.

(57) 30. Mann CJ. Observational research methods. Research design II: cohort, cross sectional, and case-control studies. Emerg Med J. 2003;20:54-60. 31. Efron B. Logistic regression, survival analysis, and the Kaplan-Meier curve. Journal of the American Statistical Association 1988;83(402):414-425 32. Cox DR. Regression models and life-tables. J Roy Statist Soc 1972;34(B):187-220. 33. Le CT. Applied Survial Analysis. New York: John Wiley & Sons, Inc.; 1997. 34. Չࡹଣፁғ࿿ύѧ଼நߥᓀֽ. 2001ԃICD-9-CM੯ੰዸ΋ំ߄ (94.03.29ཥቚ). In: Չࡹଣፁғ࿿ύѧ଼நߥᓀֽӄౚၗૻᆛ; 2005. 35. ஭զ. ଼ߥၗ਑ύࡽԖ੯ੰບᘐ҅ዴ‫܄‬ϐࣴ‫[ ز‬ᅺγፕЎ]. Ѡчѱ: ໚ܴᙴᏢεᏢ; 2004. 36. ԙٖ፣. εഞ྽ೀБᛰ ಻ើബᖐ ᛰ‫܊‬ǵᙴଣೡ୧ ‫ٮ‬ᕎੱǵང෷ੰ ฻஻‫ޣ‬٬Ҕ ‫ ؂‬5լ 1600Ѡჾ In: ᖄӝൔ. Ѡчѱ; 2003/09/02. 37. ‫୍ݤ‬೽. ࿘᝻ࢥࠔ‫ޑ‬Ӊೢ. In: ‫୍ݤ‬೽‫ࢥי‬ၗૻᆛ; 2010. 38. ၏‫ځ‬ঢ়, ഋቼᎩ. ৎ৥ᙴৣӄΓྣៈ‫ࡋڋ‬. ᙴᏢ௲‫ػ‬ 2003;7(3):207-209. 39. Ross L, Johansen C, Dalton SO, et al. Psychiatric hospitalizations among survivors of cancer in childhood or adolescence. N Engl J Med 2003;349:650-7. 40. Չࡹଣፁғ࿿ύѧ଼நߥᓀֽ. ଼ӄ଄୍ ӭᆅሸΠ. In: Չࡹଣፁғ ࿿ύѧ଼நߥᓀֽӄౚၗૻᆛ; 2009/3/2. 41. Չࡹଣፁғ࿿ύѧ଼நߥᓀֽ. ᡣӄ଼҇ߥ‫ܴޑ‬Ϻ‫׳‬ऍӳ. In: Չࡹ ଣፁғ࿿ύѧ଼நߥᓀֽӄౚၗૻᆛ; 2006/7/10.. 46.

(58) ߕᒵ. ˄ˌˌˉ‫ڣˋ˃˃˅۟ڣ‬ ୏Ց࿺֗লհ༞ࢤᆭᒆ࿇‫س‬Գᑇ. ቹ ˇˁˈ. ˄ʿ˅˃˃ ˄ʿ˃˃˃ ˋ˃˃ ˉ˃˃. Գᑇ. ˇ˃˃ ˅˃˃ ˃ ˄ˌˌˉ ˄ˌˌˊ ˄ˌˌˋ ˄ˌˌˌ ˅˃˃˃ ˅˃˃˄ ˅˃˃˅ ˅˃˃ˆ ˅˃˃ˇ ˅˃˃ˈ ˅˃˃ˉ ˅˃˃ˊ ˅˃˃ˋ. ˄ˌˌˉ‫ڣˋ˃˃˅۟ڣ‬௣֏ᕴࡴ֗ᆮᓂ հ༞ࢤᆭᒆ࿇‫س‬Գᑇ. ቹ ˇˁˉ ˆ˃˃˃ ˅ˈ˃˃ ˅˃˃˃. Գᑇ. ˄ˈ˃˃ ˄˃˃˃ ˈ˃˃ ˃ ˄ˌˌˉ. ˄ˌˌˊ. ˄ˌˌˋ. ˄ˌˌˌ. ˅˃˃˃. ˅˃˃˄. ˅˃˃˅. 47. ˅˃˃ˆ. ˅˃˃ˇ. ˅˃˃ˈ. ˅˃˃ˉ. ˅˃˃ˊ. ˅˃˃ˋ.

(59) ˄ˌˌˉ‫ܮࡅڣˋ˃˃˅۟ڣ‬ᕴࡴ֗౥փ հ༞ࢤᆭᒆ࿇‫س‬Գᑇ. ቹ ˇˁˊ ˄ʿ˃˃˃ ˌ˃˃ ˋ˃˃ ˊ˃˃ ˉ˃˃. Գᑇ. ˈ˃˃ ˇ˃˃ ˆ˃˃ ˅˃˃ ˄˃˃ ˃ ˄ˌˌˉ. ˄ˌˌˊ. ˄ˌˌˋ. ˄ˌˌˌ. ˅˃˃˃. ˅˃˃˄. ˅˃˃˅. ˅˃˃ˆ. ˅˃˃ˇ. ˅˃˃ˈ. ˅˃˃ˉ. ˅˃˃ˊ. ˅˃˃ˋ. ˄ˌˌˉ‫ڣˋ˃˃˅۟ڣ‬೎֗࿨ᒬิ៣ʿ‫ؼ‬ᓅʿࠂࢪ հ༞ࢤᆭᒆ࿇‫س‬Գᑇ. ቹ ˇˁˋʳ ˅ʿˈ˃˃. ˅ʿ˃˃˃. ˄ʿˈ˃˃ Գᑇ ˄ʿ˃˃˃. ˈ˃˃. ˃ ˄ˌˌˉ. ˄ˌˌˊ. ˄ˌˌˋ. ˄ˌˌˌ. ˅˃˃˃. ˅˃˃˄. ˅˃˃˅. 48. ˅˃˃ˆ. ˅˃˃ˇ. ˅˃˃ˈ. ˅˃˃ˉ. ˅˃˃ˊ. ˅˃˃ˋ.

(60) ˄ˌˌˉ‫ڣˋ˃˃˅۟ڣ‬Ֆࢤࣼ‫ཷسݟ‬ᕴࡴ հ༞ࢤᆭᒆ࿇‫س‬Գᑇ. ቹ ˇˁˌʳ. ˄ʿ˅˃˃. ˄ʿ˄˃˃. Գᑇ ˄ʿ˃˃˃. ˌ˃˃ ˄ˌˌˉ. ˄ˌˌˊ. ˄ˌˌˋ. ˄ˌˌˌ. ˅˃˃˃. ˅˃˃˄. ˅˃˃˅. ˅˃˃ˆ. ˅˃˃ˇ. ˅˃˃ˈ. ˅˃˃ˉ. ˅˃˃ˊ. ˅˃˃ˋ. ˄ˌˌˉ‫ཷسݟࣼࢤߊڣˋ˃˃˅۟ڣ‬ᕴࡴ հ༞ࢤᆭᒆ࿇‫س‬Գᑇ. ቹ ˇˁ˄˃. ˊ˃˃ ˉ˃˃ ˈ˃˃ ˇ˃˃. Գᑇ. ˆ˃˃ ˅˃˃ ˄˃˃ ˃ ˄ˌˌˉ. ˄ˌˌˊ. ˄ˌˌˋ. ˄ˌˌˌ. ˅˃˃˃. ˅˃˃˄. ˅˃˃˅. 49. ˅˃˃ˆ. ˅˃˃ˇ. ˅˃˃ˈ. ˅˃˃ˉ. ˅˃˃ˊ. ˅˃˃ˋ.

(61) ˄ˌˌˉ‫ۯقࣔآ֗הࠡڣˋ˃˃˅۟ڣ‬ᆜ հ༞ࢤᆭᒆ࿇‫س‬Գᑇ. ቹ ˇˁ˄˄ʳ. ˄ʿˇ˃˃ ˄ʿ˅˃˃ ˄ʿ˃˃˃ ˋ˃˃. Գᑇ. ˉ˃˃ ˇ˃˃ ˅˃˃ ˃ ˄ˌˌˉ. ˄ˌˌˊ. ˄ˌˌˋ. ˄ˌˌˌ. ˅˃˃˃. ˅˃˃˄. ˅˃˃˅. ˅˃˃ˆ. ˅˃˃ˇ. ˅˃˃ˈ. ˅˃˃ˉ. ˅˃˃ˊ. ˅˃˃ˋ. ˄ˌˌˉ‫ڣˋ˃˃˅۟ڣ‬ැ֣ທۨิ៣ հ༞ࢤᆭᒆ࿇‫س‬Գᑇ. ቹ ˇˁ˄˅. ˄ʿ˅˃˃ ˄ʿ˃˃˃ ˋ˃˃. Գᑇ. ˉ˃˃ ˇ˃˃ ˅˃˃ ˃ ˄ˌˌˉ. ˄ˌˌˊ. ˄ˌˌˋ. ˄ˌˌˌ. ˅˃˃˃. ˅˃˃˄. ˅˃˃˅. 50. ˅˃˃ˆ. ˅˃˃ˇ. ˅˃˃ˈ. ˅˃˃ˉ. ˅˃˃ˊ. ˅˃˃ˋ.

(62) ቹ ˇˁ˄ˆ. ˅˃˃˅۟˅˃˃ˋ‫ڣ‬Ֆࢤፎ౞֗‫ཷس‬ᕴࡴ ʻ௽ਐ˜˖˗ˌˍ˄ˋˋʿ˄ˋˌʼհ༞ࢤᆭᒆ࿇‫س‬Գᑇ. ˈˋˈ ˈˋ˃ ˈˊˈ. Գᑇ. ˈˊ˃ ˈˉˈ ˈˉ˃ ˈˈˈ ˅˃˃˅. ቹ ˇˁ˄ˇ. ˅˃˃ˆ. ˅˃˃ˇ. ˅˃˃ˈ. ˅˃˃ˉ. ˅˃˃ˊ. ˅˃˃ˋ. ˅˃˃˅‫ࢤߊڣˋ˃˃˅۟ڣ‬ፎ౞֗‫ཷس‬ᕴࡴ ʻ௽ਐ˜˖˗ˌˍ˄ˋˋʿ˄ˋˌʼհ༞ࢤᆭᒆ࿇‫س‬Գᑇ. ˇ˃˃. ˆ˃˃. Գᑇ. ˅˃˃. ˄˃˃. ˃ ˅˃˃˅. ˅˃˃ˆ. ˅˃˃ˇ. ˅˃˃ˈ. 51. ˅˃˃ˉ. ˅˃˃ˊ. ˅˃˃ˋ.

(63) ˄ˌˌˉ ‫ڣ ˋ˃˃˅ ۟ڣ‬ൣტࢤ壄壀ఐ࿇‫س‬Գᑇ. ቹ ˇˁ˄ˈ. ˄ˈ˃˃˃ʳ ˄˃˃˃˃ʳ Գᑇʳ ʳ. ˈ˃˃˃ ˃ʳ. ˄ˌˌˉʳ ˄ˌˌˋ ʳ. ʳ ʳ ʳ ʳ ˅˃˃˃ʳ ˅˃˃˅ʳ ˅˃˃ˇʳ ˅˃˃ˉʳ ˅˃˃ˋʳ. ʳ. ˄ˌˌˉ ‫ڣ ˋ˃˃˅ ۟ڣ‬壄壀ࡴ౨఑࿇‫س‬Գᑇ. ቹ ˇˁ˄ˉ ˅ˈ˃˃˃ ˅˃˃˃˃ ˄ˈ˃˃˃. Գᑇʳ. ˄˃˃˃˃ ˈ˃˃˃ ˃. ˄ˌˌˉ ˄ˌˌˋ ˅˃˃˃ʳ ˅˃˃˅ ˅˃˃ˇʳ ˅˃˃ˉʳ ˅˃˃ˋʳ. ʳ. 52.

(64) ˄ˌˌˉ ‫ڣ ˋ˃˃˅ ۟ڣ‬ᢐढᛒ‫ش‬࿇‫س‬Գᑇ. ቹ ˇˁ˄ˊʳ ˄˅˃˃˃ ˄˃˃˃˃ ˋ˃˃˃ ˉ˃˃˃ ˇ˃˃˃ ˅˃˃˃ ˃. Գᑇ ˄ˌˌˉʳ ˄ˌˌˋʳ ʳ ʳ ʳ ʳ ʳ ˅˃˃˃ʳ ˅˃˃˅ ˅˃˃ˇ ˅˃˃ˉ ˅˃˃ˋʳ. ʳ. ˄ˌˌˉ ‫ڣ ˋ˃˃˅ ۟ڣ‬ʳ. ቹ ˇˁ˄ˋ. ֨෻‫ࢬైڂ‬ીհ‫س‬෻‫פ‬౨؈ᓳ࿇‫س‬Գᑇʳ. ˄˃˃˃˃ ˋ˃˃˃ ˉ˃˃˃. Գᑇ. ˇ˃˃˃ ˅˃˃˃ ˃. ˄ˌˌˉ ˄ˌˌˋ ˅˃˃˃ʳ ˅˃˃˅ʳ ˅˃˃ˇʳ ʳ ʳ ˅˃˃ˉ ˅˃˃ˋ. ʳ. 53.

(65) ˄ˌˌˉ ‫಺ڣ ˋ˃˃˅ ۟ڣ‬壄ᛒ‫ش‬࿇‫س‬Գᑇ. ቹ ˇˁ˄ˌ ˅˃˃˃ ˄ˈ˃˃ ˄˃˃˃. Գᑇ. ˈ˃˃ ˄ˌˌˉʳ ˄ˌˌˋ. ˃. ˅˃˃˃ʳ ˅˃˃˅. ˅˃˃ˇ. ˅˃˃ˉʳ ˅˃˃ˋʳ. ʳ. ˄ˌˌˉ ‫ڣ ˋ˃˃˅ ۟ڣ‬৺ࢤᚘԺ֘ᚨ࿇‫س‬Գᑇʳ. ቹ ˇˁ˅˃ ˄˃˃˃˃ ˋ˃˃˃ ˉ˃˃˃. Գᑇʳ. ˇ˃˃˃ ˅˃˃˃ ˃. ˄ˌˌˉʳ ˄ˌˌˋ ˅˃˃˃ ˅˃˃˅ʳ ˅˃˃ˇ ˅˃˃ˉ ˅˃˃ˋʳ. ʳ. 54.

(66) ˄ˌˌˉ ‫ڣ ˋ˃˃˅ ۟ڣ‬ Բႈࢨ‫א‬Ղ壄壀ఏ൛်ឰ࿇‫س‬Գᑇʳ. ቹ ˇˁ˅˄. ˅ˈ˃˃˃ ˅˃˃˃˃ ˄ˈ˃˃˃. Գᑇ. ˄˃˃˃˃ ˈ˃˃˃ ˃. ˄ˌˌˉʳ ˄ˌˌˋ ʳ ʳ ʳ ʳ ʳ ˅˃˃˃ ˅˃˃˅ʳ ˅˃˃ˇ ˅˃˃ˉʳ ˅˃˃ˋ. ʳ. 55.

(67)