臺灣的癌症發生率及死亡率有連年增加的趨勢，研究指出原因可能與環境中的污染物質有關，檢測可能的污染源附近是否存在癌症群聚(Cluster)，將有助於未來的癌症防治。在空間統計(Spatial Statistics)有不少方法可用於檢測群聚現象，其中用來檢測某個特定位置周圍是否發生群聚的方法被稱為焦點檢定(Focused Test)，本文介紹及評估常用的焦點檢定方法，並使用較佳方法探討臺灣地區疑似污染源的地區。 首先本文使用電腦模擬，在不同情境假設下比較焦點檢定方法的檢定力(Power)，例如研究區域大小、群聚形狀等不同的情境，以判斷檢定方法之間的優劣。最後本文分析臺灣鄉鎮市(Township)層級癌症死亡資料，應用焦點檢定方法分析石門核一廠、恆春核三廠及麥寮六輕周圍的癌症死亡率，檢定結果發現核一廠及麥寮六輕附近有較高的癌症死亡率。 / The cancer incidence and mortality rate in Taiwan have been increasing over the past 30 years. Previous studies indicate that the pollution sources, especially for those creating air pollution and excess radiation, are one of the potential causes for the increment. Correctly, detecting the location of possible sources of contaminants can help for cancer prevention. In spatial statistics, focused test can be used to determine if the intensity rate are higher around a possible pollution source. We will introduce and evaluate frequently used focused tests and apply them in Taiwan. First we use computer simulation to compare the power of focused tests in different scenarios, such as study region and cluster shape. Next, we apply the focused tests to Taiwan cancer mortality data, in order to decide if the cancer mortality rates are higher around Chinshan nuclear power plant, Maanshan nuclear power plant, and Mailiao sixth naphtha cracker. The results show that the cancer mortality rates around Chinshan nuclear power plant and Mailiao sixth naphtha cracker are significantly higher.

重大傷病是我國全民健康保險的重要特色之一，透過社會保險的風險分擔機制，病患享有免部分負擔等優惠，降低因為罹病帶來的財務負擔，但重大傷病同時也成為全民健保的主要支出項目。民國102年領取重大傷病證明者不過98餘萬人（約總人口的4%），但其一年的醫療費用多達一千五百多億元（接近總支出的27%），平均每位重大傷病患者的醫療費用約為平均值的7.34倍，其中癌症又是重大傷病中人數最多者，大約佔了49%（資料來源：衛生福利部中央健康保險署）。因為許多重大傷病的發生率、盛行率與年齡成正比（黃泓智等人，2004），未來隨著人口老化，全民健保支出也將跟著上升。 　　本文使用全民健保資料庫，探討近十年重大傷病（尤其是癌症）趨勢，估計重大傷病的年齡別發生率、死亡率，評估人口老化對全民健保造成的影響，其中承保資料檔（ID）、重大傷病檔（HV）為本研究主要的依據資料。而由於健保資料庫的資料種類及數量龐雜，在初期資料的偵錯及處理上非常重要但也相當費時，至於發生率、死亡與否的判斷亦十分棘手，因此過程中我們將一一說明資料分析步驟及注意事項。本文發現癌症及重大傷病的盛行率逐年上升，但發生率並沒有明顯變化，加上近年癌症死亡率幾乎不變（但台灣全體國民的死亡率逐年遞降），因為台灣的人口老化，預期未來罹患癌症人數會逐年增加，癌症將繼續蟬聯十大死因之首，但罹癌死亡率的下降也可發現近年醫療進步所造成的影響。此外，我們也考量隨機死亡模型（Lee-Carter Model），發現無論是癌症死亡率、或是罹癌死亡率都有不錯的估計結果。而在文末也提出癌症病患的就醫行為以供後續研究者參考。 / Catastrophic illness (CI) is one of the key features of Taiwan’s National Health Insurance (NHI). Through risk-sharing mechanisms of social insurance, it can reduce the financial burden of the CI patients since treating the CI is usually expensive. However, the CI also becomes a major expenditure item of NHI. The people receiving the CI card are just 0.98 million in 2013 (about 4% of the total population), but their smedical costs are over 150 billion NT dollars (nearly 27% of total expenditures). The average medical cost per CI patient is about 7.34 times of the national average. (Source: Department of Health and National Health Insurance Agency). Because the incidence and prevalence rates increase with age (Huang et al, 2004), the total NHI expenditure is expected to increase in the future due to population aging. This study intends to use the NHI database, including the records of personal identification and out-patient visit from all CI patients, to explore the incidence and mortality rates, for example, of CI patients. Because the NHI database is big and messy, we shall first debug and clean them. Also, since the death of CI patients are not fully reported in the NHI database, we propose a method to identify the deaths and use the official statistics to evaluate. The results show that the prevalence rates of all CI increased every year, but their incidence rates did not change significantly. The mortality rates of cancer patients also did not change much. Based on these findings, we expect the proportion of CI patients and their size will continue to grow. In addition, we applied the Lee-Carter model to the cancer mortality rates, and the fit is pretty good.

張時飛. / 論文(哲學博士)--香港中文大學, 2001. / 參考文獻 (p. 338-366) / 中英文摘要. / Available also through the Internet via Dissertations & theses @ Chinese University of Hong Kong. / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Zhang Shifei. / Lun wen (Zhe xue bo shi)--Xianggang Zhong wen da xue, 2001. / Can kao wen xian (p. 338-366) / Zhong Ying wen zhai yao.

本研究之主要目的在於瞭解癌症病患社會比較行為之現況與相關因素之探討，包括社會比較動機、不同之比較面向與比較模式之對象、社會比較效果，進而探索新癌症病患與舊癌症病患在社會比較行為上的差異性；其次，探討自尊、身心健康情形與社會比較之關係。本研究以問卷調查的方式，訪談全國癌症病友中心的癌症病患，共計134位，包括各50位新、舊乳癌病患與21位新腸癌病患、13位舊腸癌病患。本研究使用社會比較動機量表中文版、自尊量表中文版、一般健康量表中文版以及研究者自編的社會比較問卷，進行相關統計分析與假設考驗。研究結果發現，癌症病患主要社會比較動機是同盟、自我增進、自我彰顯等動機；新、舊癌症病患在社會比較行為上皆有顯著性的差異，包括社會比較動機、社會比較的對象與方式、以及社會比較的負向效果。另一方面，自尊越低與一般健康情形越差的癌症病患，其社會比較的負向效果也越大。最後，根據研究結果與討論，提出對未來相關研究、癌症病患的心理社會介入與臨床應用的建議。 / The main purpose of this study was to explore the social comparison process and its correlates among cancer patients. The first purpose of this study was to understand the differences of social comparison process between new cancer patients and old cancer patients, not only including the source of social comparative information, but the motives, the models, the dimensions, the targets and preferences of social comparison. The second purpose was to understand the influence of self-esteem on social comparison. The third purpose was to asses the relationship between social comparison and individual’s physical and mental health. The Chinese versions of the Social Comparison Motive Scale (Helgeson & Mickelson, 1995), the Chinese versions of Rosenberg Self-Esteem Scale (Rosenberg, 1965), the Chinese versions of General Health Questionnaire (Goldberger, 1978), and two self-constructed scales to measure the informative source, the models, the dimensions, the targets and preferences of social comparison were administered to 100 breast cancer patients and 34 colorectal cancer patients from Changhua Christian Hospital. Finally, the findings of this research were expected to apply to clinical psychooncology so as to help cancer patients have better psychological reaction and to improve their adaptation to illness.