EBM (Evidence Based Medicine) at Industrial Health Service and Hygiene.

[研究目的]成本-效果分析作为医学经济学中的代表性方法，是循证医学中广为人知的应用证据。本研究透过三年的调查期，以成本效益分析法探讨产业健康促进的成效。本研究的目的是通过健康效用的获得、法律的执行等量化数据来评估这些活动的有效性和效果，并试图找到表明工业健康促进有效性的证据。[材料与方法]在前期调查的基础上，采用多元回归分析方法，对医疗费用、工作方式、职业与卫生效用得分进行相关分析。本研究采用回顾性研究设计，探讨十年来全方位健康促进对预防疾病的效果，以及如何将老化的变化降到最低。对6287名职工（多中心）按5年分层调查了年医疗费用、年住院天数、年住院天数、血压、血脂、肝功能、红细胞、白细胞、血红蛋白等健康指标。企业规模按工人人数分为5类，工人人数被视为活动规模。[结果] 20%的被调查企业从事文职工作，其余为工厂工作。健康促进起始年龄平均为38.6±8.4岁，医疗费用随时间推移呈下降趋势。与对照组相比，老年组的血清学检查结果更好，医疗费用和住院率更低。结果表明，在实施全面健康促进的前3年，对疾病群体数量的抑制作用最为显著。我们认为，工业健康促进的积极作用有助于工人的健康。

【Study objective】 Cost effectiveness analysis as a representative method among medical economics are well-known applicable evidence in EBM. We investigate the effectiveness of industrial health promotion by the cost effectiveness approach through three years investigation period. We aimed to evaluate effectiveness and efficacy of those activities with possibly quantitative data such as gain of health utilities, performance of legal activities and try to find the evidence which indicate a validity of industrial health promotion.【Material and methods】 Based on the result from prior investigation, we reported that cost, style of job and occupation are significantly co-related to health utilities score by multiple regression analysis. We investigated to examine how much effect of total health promotion are identified on prevention of disease and can minimize the aging changes for ten years by retrospective study design. 6287 worker (multi-centered) are examined for their health out-comes such as medical expenditure per year, hospital admitted days per year, hospitalization days per year, blood pressure, serum lipid, hepatic function, RBC, WBC, Hb, Ht, by 5 years stratification. Size of enterprises are classified into 5 categories by number of workers, which are considered as the magnitude of the activities.【Results】 20% of investigate enterprise are clerical job and rest of them are factory work. Average age at starting point of health promotion were 38.6±8.4, medical expenditure were decreased by time-course manner. Older age group show better serum examination compared to control group and less medical expenditure and less hospitalization. We indicated that suppression on number of illness group become marked with first 3 years period of total health promotion. We suggested the positive effect of industrial health promotion contributed to wellness of workers.