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題名：非接觸傳染性疾病之政治經濟暨社會因素探討
作者：李政道
作者(外文)：Jenq-DawLee
校院名稱：國立成功大學
系所名稱：政治經濟學研究所
指導教授：謝文真
學位類別：博士
出版日期：2010
主題關鍵詞：社會流行病學；心血管疾病；憂鬱症；自殺；Social Epidemiology；Cardiovascular Disease；Depression；Suicide
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本論文以生物心理社會模式 (biopsychosocial model) 出發，探討影響非接觸傳染性疾病 (non-contagious diseases)的原因。根據文獻顯示，心血管疾病、憂鬱症和自殺最容易受到社會因子影響而發病，本論文因此選擇這三個疾病做為標的進行研究，實證結果顯示這些疾病確實受到社會風險因子之影響。本論文所探討之社會因子主要包括失業率、可支配所得等經濟面向，社會資本、社會關懷、社會犯罪暴力等社會面向，以及政治衝突與族群對立等政治面向之解釋變數。以下是探討三個社會流行疾病影響因子議題的摘要：
1.「政經環境變遷對心血管疾病看診的影響-以台灣1998-2007年為例」：台灣政治選情激烈程度常可透過大選影響個人的情緒行為。因此，本研究即以實證計量分析來驗證政治衝突、失業率、可支配所得、受高等教育比率與政府對醫療的支出是否會影響心血管疾病看診率的增加。實證發現選舉的政治衝突確實對心血管疾病的看診增加率具有顯著影響，於2004年總統大選更是明顯。此外，受高等教育比率、失業率與就看診增加率有正向的統計顯著關係。
2. 「影響中老年人憂鬱症狀的社經因素分析-以台灣1989-2003年為例」：本研究以台灣國民健康局在1989-2003年共五次調查「台灣地區中老人保健與生活問題長期追蹤調查系列研究」中，分別出生於日治時期、二次大戰時期與台灣由中華民國政府接管後時代的三個世代的追蹤資料進行分析。實證結果顯示：台灣的不同世代與族群 (閩南人、客家人與外省人）在憂鬱症狀上並無顯著差異；性別上則是女性顯著高於男性。至於年齡方面則存在著年齡效果，有越老越憂鬱的傾向，但它亦具有2次方的關連性，即憂鬱症狀會先隨年齡遞增，到了75歲左右又會呈現遞減的現象。失偶與憂鬱症狀呈現顯著性的負向關係。家人關懷程度與自評健康均與憂鬱症具有顯著的負向關係。
3. 「自殺的社經因子分析－以台灣1998-2008年為例」：本研究利用台灣自1971-2008年的自殺死亡檔與1998-2008年各縣市統計資料，分析影響自殺行為的影響因子。實證結果顯示自殺行為於研究期間與失業率具有顯著的負相關；而與喪偶率、粗離婚率和暴力犯罪發生率則呈現顯著正相關。本研究認為台灣自殺率的提高可能來自景氣的驟然蕭條或繁榮，致使社會約束力量也突然消失，符合Durkheim所描述的社會脫序型自?情境現象。
Based on the biopsychosocial model, we explore the factors that impact non-contagious diseases. According to the literature, cardiovascular disease, depression and suicide are most vulnerable to social risk factors. Therefore, these three diseases were chosen as the three topics of this thesis dissertation. Social risk factors including unemployment rate, disposable income, social capital, social care, criminal violence, as well as political conflict and ethnic conflict. The following is the summary of three topics in this dissertation.
1. "The Impact of Political and Economic Changes on the Number of Clinical Visits for Cardiovascular Disease – A Case of Taiwan during 1998-2007":
The intensity of the political elections in Taiwan often affects the emotional behavior of individuals. This study uses the empirical econometric analysis to verify whether the political conflicts, unemployment rate, disposable income, the ratio of population with higher education, and the government spending on health care will affect the increasing rate of cardiovascular disease check-ups. Evidence is found that the political conflict does cause the increase of clinical visits due to cardiovascular diseases. In addition, the ratio of higher education and the unemployment rate have a positive statistically significant relationship with the rate of clinical visits for cardiovascular diseases.
2. "The Study on the Impact of Socio-Economic Factors on Depressive Symptoms in the Middle-Aged and Elderly – A Case of Taiwan during 1989-2003":
In this study, we analyze the data of 5 surveys between 1989 and 2003 from "Survey of Health and Living Status of the Middle Aged and Elderly in Taiwan" published by Taiwan's National Health Board. The surveys contain follow-up data of the 3 cohorts, respectively, born during the Japanese occupation, born during World War II, and born after the rule by the ROC government in Taiwan. The empirical results show that there is no significant difference in depressive symptoms among these 3 cohorts, and the 3 ethnic groups - Taiwanese, Hakka, and Mainlanders. Females show more significant depressive symptoms than do males. The age in linear form as well as in quadratic form are both significant and positively correlates to the depressive symptoms. That is, depressive symptoms become more significant in the aging process prior to age 75; afterwards the symptoms mitigate. The marital status of widowers and widows, as well as the caring by the family members, and self-assessed health are negatively correlated to the depressive symptoms.
3. "The Analysis of the Socio-Economic Factors of Suicide – A Case of Taiwan during 1998-2008":
This study analyzes of the relationship between the socio-economic factors and suicide using the data of suicide deaths of cities and counties in Taiwan from 1998 to 2008. Empirical results show that suicide rate is negatively correlated with unemployment rate, and is positively correlated to widow and widower rate, crude divorce rate, and crime rate. This study suggests that the increase of suicide rate in Taiwan may come from a sudden economic downturn or upturn, and in turn, the strength of social restraint would suddenly disappear. These findings are in line with the phenomenon of Durkheim’s anomic suicide.
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