有鑑於大腸直腸癌對健康之威脅，2010年台灣將糞便潛血檢查納入預防保健服務。本研究將探討影響糞便潛血篩檢陽性者診斷結果之相關因素。研究數據資料庫源自衛生福利資料科學中心之大腸癌篩檢檔，採回溯性研究設計，研究對象為2010年至2013年期間，50-75歲之糞便潛血篩檢陽性並完成追蹤檢查者。以卡方獨立性檢定與多類別邏輯斯迴歸進行資料分析。本研究之糞便潛血篩檢陽性並完成追蹤檢查者為89,046人，在人口特性、癌症篩檢因素、追蹤檢查方法、平均追蹤期間與診斷結果具顯著關聯性（p < 0 .001）。在預測影響糞便潛血篩檢陽性者之診斷結果的模式中，在非大腸直腸癌組，其疾病風險為：追蹤檢查之醫療機構在北部等區域者，皆低於東部區域（p < 0 .001）；50至60歲之族群低於71至75歲組（p < 0.001, p = 0.05）；追蹤檢查之醫療單位為門診者，低於住院者0.497倍（p < 0.001, 95% CI: 0.455-0.543）。在大腸直腸癌組，其疾病風險為：追蹤檢查之醫療院所在北部等區域者，皆低於東部區域（p = 0.013）；50至65歲之族群低於71至75歲組（p < 0.001, p = 0.016）；追蹤檢查之醫療單位為門診者，低於住院者0.565倍（p < 0.001, 95% CI: 0.493-0.647）。影響糞便潛血篩檢陽性者之診斷結果為性別、追蹤檢查之醫療機構所在區域與醫療單位、年齡、篩檢地點、家族史、追蹤檢查方法與平均追蹤期間。因此，掌握陽性者特色因素與積極追蹤診斷，為大腸直腸癌重要之防治策略。

Due to the threat of colorectal cancer (CRC) to health, Taiwan included the fecal occult blood test (FOBT) under preventive health services in 2010. In this study, we examined the factors that influence the diagnosis of people with positive FOBT results. Data was obtained from the colorectal cancer screening database developed by the Health and Welfare Data Science Center, Ministry of Health and Welfare (HWDC, MOHW), and the study had a retrospective study design. The subjects were 50 to 75 years old with positive FOBT results obtained whose underwent follow-up examination between 2010 and 2013. The chi-square test of independence and multinomial logistic regression were used for data analysis. In this study, there were 89,046 subjects with positive FOBT results who underwent follow up examination; their demographic characteristics, cancer screening factors, follow-up examinations, and follow-up time were significantly correlated with their diagnosis (p < 0.001). In the model predicting factors that influence the diagnosis of people with positive FOBT results, the risks of disease in the non-colorectal cancer group were lower in medical institutions that conducted follow-up examinations in regions such as Northern Taiwan compared to that in Eastern Taiwan (p < 0.001); lower in the age group of 50 to 60 years than that in the age group of 71 to 75 years (p < 0.001, p = 0.05); and lower in the outpatient medical units that conducted follow-up examinations than that in the inpatient medical units by 0.497 times (p < 0.001, 95% confidence interval (CI): 0.455–0.543). In the colorectal cancer group, the risks of disease were lower in medical institutions that conducted follow-up examinations in regions such as Northern Taiwan compared to that in Eastern Taiwan (p = 0.013); lower in the age group of 50 to 65 years than that in the age group of 71 to 75 years (p < 0.001, p = 0.016); and lower in the outpatient medical units that conducted follow-up examinations than that in the inpatient medical units by 0.565 times (p < 0.001, 95% CI: 0.493–0.647). Factors influencing the diagnosis of patients with positive FOBT results were gender, regions where the medical institutions were based at, medical unit where follow-up examinations were conducted, age, screening site, family history, type of follow-up examinations, and follow-up time. Therefore, the identification of characteristic factors of patients with positive results and active follow-up diagnosis are important prevention strategies for colorectal cancer.

目 錄
論文審定書-------------------------------------------------------------------------------------------- ⅰ
致謝----------------------------------------------------------------------------------------------------- ⅱ
中文摘要----------------------------------------------------------------------------------------------- ⅲ
英文摘要----------------------------------------------------------------------------------------------- ⅳ
目錄----------------------------------------------------------------------------------------------------- ⅵ
圖次----------------------------------------------------------------------------------------------------- ⅷ
表次----------------------------------------------------------------------------------------------------- ⅸ
第一章 緒論------------------------------------------------------------------------------------------ 1
第一節 研究背景與動機------------------------------------------------------------------------ 1
第二節 研究目的與問題------------------------------------------------------------------------ 4
第二章 文獻探討------------------------------------------------------------------------------------ 5
第一節 大腸直腸癌疾病發展趨勢------------------------------------------------------------ 5
第二節 台灣大腸直腸癌篩檢政策與實施成效--------------------------------------------- 16
第三節 糞便潛血篩檢陽性者之追蹤檢查方法與診斷結果說明------------------------ 22
第四節 影響糞便潛血篩檢陽性者之診斷結果之相關因素------------------------------ 31
第三章 研究材料與方法--------------------------------------------------------------------------- 40
第一節 研究設計與研究架構------------------------------------------------------------------ 40
第二節 研究假設--------------------------------------------------------------------------------- 42
第三節 研究材料與對象------------------------------------------------------------------------ 43
第四節 研究變項操作型定義------------------------------------------------------------------ 45
第五節 資料處理與分析------------------------------------------------------------------------ 48
第四章 研究結果------------------------------------------------------------------------------------ 51
第一節 50-75歲糞便潛血篩檢族群相關人口學資訊------------------------------------- 51
第二節 糞便潛血篩檢陽性並完成追蹤檢查者之相關人口學資訊--------------------- 53
第三節 糞便潛血篩檢陽性並完成追蹤檢查者與診斷結果之關聯性------------------ 56
第四節 影響糞便潛血篩檢陽性並完成追蹤檢查者其診斷結果之因素--------------- 59
第五章 研究結果討論------------------------------------------------------------------------------ 61
第一節 50-75歲糞便潛血篩檢族群相關人口學資訊------------------------------------- 61
第二節 糞便潛血篩檢陽性並完成追蹤檢查者之相關人口學資訊--------------------- 63
第三節 糞便潛血篩檢陽性並完成追蹤檢查者與診斷結果之關聯性------------------ 65
第四節 影響糞便潛血檢陽性並完成追蹤檢查者其診斷結果之因素------------------ 68
第六章 結論與建議--------------------------------------------------------------------------------- 71
第一節 結論與建議------------------------------------------------------------------------------ 71
第二節 研究限制--------------------------------------------------------------------------------- 73
第三節 研究貢獻--------------------------------------------------------------------------------- 75
參考文獻----------------------------------------------------------------------------------------------- 77

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