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自己対照デザイン:ケースクロスオーバーデザイン・ケースタイムコントロールデザイン

38e2af7f8bdad4f2087ab3d42b627e33?s=47 Shuntaro Sato
September 25, 2021

 自己対照デザイン:ケースクロスオーバーデザイン・ケースタイムコントロールデザイン

自己対照デザインの研究は、アウトカムが基準と曝露が基準のデザインに大別できます。このスライドではアウトカムが基準となるデザインとして、ケースクロスオーバーデザイン・ケースタイムコントロールデザイン・ケース・ケースタイムコントロールデザインを解説します。ケースクロスオーバーデザイン用のデータセット作成と解析用プログラムもついています。

38e2af7f8bdad4f2087ab3d42b627e33?s=128

Shuntaro Sato

September 25, 2021
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  1. Ξ΢τΧϜ͕ΞϯΧʔͱͳΔ 
 ࣗݾରরσβΠϯ ྟচӸֶݚڀʹ͓͚Δใࠂͷ࣭޲্ͷͨΊͷ౷ܭֶͷݚڀձ ୈճݚڀूձ ࠤ౻ढ़ଠ࿕ ௕࡚େֶපӃྟচݚڀηϯλʔ TIVOUBSPTBUP!OBHBTBLJVBDKQ

  2. 2 Ξ΢τΧϜ͕ΞϯΧʔͷࣗݾରরσβΠϯͷུ֓ έʔεΫϩεΦʔόʔσβΠϯ έʔελΠϜίϯτϩʔϧσβΠϯ έʔεɾέʔελΠϜίϯτϩʔϧσβΠϯ ಘΒΕΔޮՌ ৚݅ͱԾఆ όΠΞε ऑΈ ऑΈ

    ౷ܭղੳʢέʔεΫϩεΦʔόʔͱέʔελΠϜίϯτϩʔϧʣ ඞཁͳσʔληοτͷܗ ౷ܭղੳํ๏ 0WFSWJFX ܭࢉํ๏ ಘΒΕΔޮՌ ܭࢉํ๏ ಘΒΕΔޮՌ ܭࢉํ๏
  3. έʔεΫϩεΦʔόʔσβΠϯͱ͸ʁ

  4. Ϟνϕʔγϣϯ 4 ৺ے伷࠹ʢ.*ʣͷൃ঱ʹӨڹ͢Δൃ঱௚લͷཁҼΛௐ΂͍ͨʂ ଟ͘ͷ.*͸ɺൃ঱લͷ਺͔࣌ؒΒ਺೔ͷ׆ಈ͕Ҿ͖ۚʹͳͬͯΔͩΖ͏ɻ έʔείϯτϩʔϧݚڀΛܭը͠Α͏ɻ Ͱ΋ɺίϯτϩʔϧ܈ͷ৘ใΛूΊΔͷେมͩΑͶʜɻ έʔείϯτϩʔϧݚڀͰ͸ɺ 
 έʔεͱίϯτϩ—ϧͷݪूஂ͕ಉ͡ඞཁ͕͋Δ έʔεͱಉ͡ݪूஂ͸ʁ

    έʔεࣗ਎ ݪूஂ έʔε ίϯτϩʔϧ έʔεΫϩεΦʔόʔσβΠϯ .BDMVSF.5IFDBTFDSPTTPWFSEFTJHOBNFUIPEGPSTUVEZJOHUSBOTJFOUF ff FDUTPOUIFSJTLPGBDVUFFWFOUT 
 "N+&QJEFNJPM+BO  r $BTFDSPTTPWFSEFTJHO
  5. έʔεΫϩεΦʔόʔσβΠϯͷԿ͕͏Ε͍͔͠ʁ 5 w έʔεͷ৘ใ͚ͩूΊΕ͹ྑ͍ w ࣌ؒͰมಈ͠ͳ͍ҼࢠΛແࢹͰ͖Δ w ະ஌ɾະଌఆͰ͋ͬͯ΋ʢFHҨ఻৘ใʣ

  6. Maclure M. 
 The case-crossover design: a method for studying

    transient effects on the risk of acute events. Am J Epidemiol. 1991 Jan 15;133(2):144–53. έʔεΫϩεΦʔόʔσβΠϯɿ۩ମྫᶃ
  7. 7 .*ൃ঱ ΞϯΧʔ 32 ίʔώʔͷઁऔ͸ɺ.*ൃ঱ͷҾ͖ۚʹͳΔ͔ʁ ର৅ूஂ .*ൃ঱ͨ͠ਓ Ξ΢τΧϜʢΞϯΧʔʣ ৺ے伷࠹ʢ.*.ZPDBSEJBM*OGBSDUJPOʣ മ࿐

    ίʔώʔઁऔ য఺ظؒʢ'PDBMXJOEPXʣ .*ൃ঱௚લͷ࣌ؒ ࢀরظؒʢ3FGFSFOUXJOEPXʣ աڈ೥ؒʢ.*ൃ঱௚લͷ࣌ؒΛআ͘ʣ ղੳ୯Ґ ࣌ؒ ϝϞ ΠϯλϏϡʔௐࠪʢ.*ൃ঱ޙɺதԝ஋೔Ͱฉ͖औΓʣ য఺ظؒ ࢀরظؒ ࣌ؒ ʜ ࣌ؒ ࣌ؒ ࣌ؒ ࣌ؒ ࣌ؒ ࣌ؒ ࣌ؒ ؍࡯ظؒʢ೥ؒʣ έʔεΫϩεΦʔόʔσβΠϯʢ.BDMVSFͷྫʣ
  8. σʔλʢ.BDMVSFͷྫʣ 8 *% .*ൃ঱લͷ࠷ޙͷ 
 ίʔώʔઁऔ ίʔώʔͷઁऔස౓ ࠷ޙͷമ࿐͕ 
 য఺ظؒࢀরظؒ

    ظ଴͞ΕΔ য఺ظؒࢀরظؒ  IPVST EBZ     NJOVUFT EBZ     IPVST NPOUI     IPVST EBZ      IPVST EBZ      IPVST NPOUI     IPVST EBZ     IPVST EBZ     IPVST EBZ      IPVST EBZ    .BDMVSF  ͷදΛվม ೔ճҿΉ͔Β 
 ೥ؒͰɺظ଴͞ΕΔয఺ظؒʢ࣌ؒʣ͸ճº೔࣌ؒ ظ଴͞ΕΔࢀরظؒʢ࣌ؒʣ͸೔º࣌ؒ࣌ؒ ࣌ؒ .BDMVSF.5IFDBTFDSPTTPWFSEFTJHOBNFUIPEGPSTUVEZJOHUSBOTJFOUF ff FDUTPOUIFSJTLPGBDVUFFWFOUT 
 "N+&QJEFNJPM+BO  r  ࣌ؒ
  9. σʔλͷΠϝʔδʢ*%ʣ 9 .*ൃ঱ য఺ظؒ ࢀরظؒ ࣌ؒ ʜ ࣌ؒ ࣌ؒ ࣌ؒ

    ࣌ؒ ࣌ؒ ࣌ؒ ࣌ؒ ຖ೔ճҿΉਓ *% .*ൃ঱લͷ࠷ޙͷ 
 ίʔώʔઁऔ ίʔώʔͷઁऔස౓ ࠷ޙͷമ࿐͕ 
 য఺ظؒࢀরظؒ ظ଴͞ΕΔ য఺ظؒࢀরظؒ  IPVST EBZ     য఺ظؒ ࢀরظؒ ࠷ޙͷമ࿐ظؒ   1FSTPOUJNF   º  
  10. σʔλͷΠϝʔδʢ*%ʣ 10 .*ൃ঱ য఺ظؒ ࢀরظؒ ࣌ؒ ʜ ࣌ؒ ࣌ؒ ࣌ؒ

    ࣌ؒ ࣌ؒ ࣌ؒ ࣌ؒ ϲ݄ʹճҿΉਓ *% .*ൃ঱લͷ࠷ޙͷ 
 ίʔώʔઁऔ ίʔώʔͷઁऔස౓ ࠷ޙͷമ࿐͕ 
 য఺ظؒࢀরظؒ ظ଴͞ΕΔ য఺ظؒࢀরظؒ  IPVST NPOUI    য఺ظؒ ࢀরظؒ ࠷ޙͷമ࿐ظؒ   1FSTPOUJNF  º  
  11. ݁Ռʢ.BDMVSFͷྫʣ 11 *% .*ൃ঱લͷ࠷ޙͷ 
 ίʔώʔઁऔ ίʔώʔͷઁऔස౓ ࠷ޙͷമ࿐͕ 
 য఺ظؒࢀরظؒ

    ظ଴͞ΕΔ য఺ظؒࢀরظؒ  IPVST EBZ     NJOVUFT EBZ     IPVST NPOUI     IPVST EBZ      IPVST EBZ      IPVST NPOUI     IPVST EBZ     IPVST EBZ     IPVST EBZ      IPVST EBZ    33.) 13,517 7,355 = 1.8 য఺ظؒʹ മ࿐͕͋ͬͨέʔεͷ 
 ظ଴ࢀরظؒͷ࿨ ࢀরظؒʹ മ࿐͕͋ͬͨέʔεͷ 
 ظ଴য఺ظؒͷ࿨ .BOUFM)BFOT[FMਪఆྔ 3BUFSBUJP .BDMVSF.5IFDBTFDSPTTPWFSEFTJHOBNFUIPEGPSTUVEZJOHUSBOTJFOUF ff FDUTPOUIFSJTLPGBDVUFFWFOUT 
 "N+&QJEFNJPM+BO  r ίʔώʔઁऔ࣌ؒҎ಺ͷ.*ൃ঱཰ൺ
  12. .BOUFM)BFO[FMਪఆྔʢ3BUFSBUJPʣᶃ 12 য఺ظؒ ࢀরظؒ 5PUBM ࠷ޙͷമ࿐ظؒ "J "J 1FSTPOUJNF 5J

    5J 5 J RRMH = ∑N i=1 A1i T0i /T+i ∑N i=1 A0i T1i /T+i αϯϓϧαΠζ/ Ұͭͷ૚͸ɺҰਓͷݸମͰ׬݁ .BOUFM)BFOT[FMਪఆྔ ҰਓͻͱΓͷݸମΛ૚ͱߟ͑ͯɺ৘ใΛ଍͠ࠐΜͰ͍͘ ݸମ಺ͰɺϚονϯά͍ͯ͠ΔΠϝʔδ
  13. .BOUFM)BFO[FMਪఆྔʢ3BUFSBUJPʣᶄ 13 *% য఺ظؒ ࢀরظؒ ࠷ޙͷമ࿐ظؒ   1FSTPOUJNF 

         *% য఺ظؒ ࢀরظؒ ࠷ޙͷമ࿐ظؒ   1FSTPOUJNF      য఺ظؒ ࢀরظؒ 5PUBM ࠷ޙͷമ࿐ظؒ "J "J 1FSTPOUJNF 5J 5J 5 J RRMH = ∑N i=1 A1i T0i /T+i ∑N i=1 A0i T1i /T+i RRMH = 1 ⋅ 5116/8776 + 0 ⋅ 8730/8776 0 ⋅ 3650/8776 + 1 ⋅ 36/8776 *% *% = 142
  14. ݁Ռͷهࡌʢ.BDMVSFͷྫʣ 14 33.) 13,517 7,360 = 1.8 'PSUIFPOFIPVSQFSJPEBGUFSESJOLJOHDP ff FF

     
 UIFSBUFSBUJPJT QFSDFOU$*  .BDMVSF.5IFDBTFDSPTTPWFSEFTJHOBNFUIPEGPSTUVEZJOHUSBOTJFOUF ff FDUTPOUIFSJTLPGBDVUFFWFOUT 
 "N+&QJEFNJPM+BO  r
  15. Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE.

    Triggering myocardial infarction by marijuana. Circulation. 
 2001 Jun 12;103(23):2805–9. έʔεΫϩεΦʔόʔσβΠϯɿ۩ମྫᶄ
  16. 16 .*ൃ঱ ΞϯΧʔ 32 େຑͷ࢖༻͸ɺ.*ൃ঱ͷҾ͖ۚʹͳΔ͔ʁ ର৅ूஂ .*ൃ঱ͨ͠ਓ Ξ΢τΧϜʢΞϯΧʔʣ ৺ے伷࠹ʢ.*.ZPDBSEJBM*OGBSDUJPOʣ മ࿐

    େຑͷ࢖༻ য఺ظؒʢ'PDBMXJOEPXʣ .*ൃ঱௚લͷ࣌ؒ ࢀরظؒʢ3FGFSFOUXJOEPXʣ աڈ೥ؒʢ.*ൃ঱௚લͷ࣌ؒΛআ͘ʣ ղੳ୯Ґ ࣌ؒ ϝϞ ΠϯλϏϡʔௐࠪʢ.*ൃ঱ޙɺதԝ஋೔Ͱฉ͖औΓʣ য఺ظؒ ࢀরظؒ ࣌ؒ ʜ ࣌ؒ ࣌ؒ ࣌ؒ ࣌ؒ ࣌ؒ ࣌ؒ ࣌ؒ ؍࡯ظؒʢ೥ؒʣ έʔεΫϩεΦʔόʔσβΠϯʢ.BDMVSFͷྫʣ
  17. ౷ܭղੳํ๏ͷهࡌʢ.JUUMFNBOͷྫʣᶃ 17 5IFSBUJPPGUIFPCTFSWFEFYQPTVSFGSFRVFODZJOUIFIB[BSEQFSJPEUPUIF FYQFDUFEGSFRVFODZ GSPNUIFDPOUSPMJOGPSNBUJPO XBTVTFEUPDBMDVMBUF FTUJNBUFTPGUIFPEETSBUJPBTBNFBTVSFPGSFMBUJWFSJTL .JUUMFNBO." -FXJT3" .BDMVSF.

    4IFSXPPE+# .VMMFS+& 5SJHHFSJOHNZPDBSEJBMJOGBSDUJPOCZNBSJKVBOB$JSDVMBUJPO+VO  r য఺ظؒʢGPDBMXJOEPXʣ 5IFBOBMZTJTPGDBTFDSPTTPWFSEBUBJTBOBQQMJDBUJPOPGTUBOEBSENFUIPETGPS TUSBUJ fi FEEBUBBOBMZTJT*OUIJTBOBMZTJT UIFTUSBUJGZJOHWBSJBCMFJTUIFJOEJWJEVBM QBUJFOU BTJOBDSPTTPWFSFYQFSJNFOU  έʔεΫϩεΦʔόʔσβΠϯͷઆ໌  "TTPDJBUJPONFBTVSFͷઆ໌
  18. ౷ܭղੳํ๏ͷهࡌʢ.JUUMFNBOͷྫʣᶄ 18 .JUUMFNBO." -FXJT3" .BDMVSF. 4IFSXPPE+# .VMMFS+& 5SJHHFSJOHNZPDBSEJBMJOGBSDUJPOCZNBSJKVBOB$JSDVMBUJPO+VO  r

    5IFBNPVOUPGQFSTPOUJNFFYQPTFEUPNBSJKVBOBXBTFTUJNBUFECZNVMUJQMZJOH UIFSFQPSUFEVTVBMBOOVBMGSFRVFODZPGFYQPTVSFCZUIFEVSBUJPOPGJUT IZQPUIFTJ[FEQIZTJPMPHJDBMF ff FDU IPVS 6OFYQPTFEQFSTPOUJNFXBTUIFO DBMDVMBUFECZTVCUSBDUJOHUIFFYQPTFEQFSTPOUJNFJOIPVSTGSPNUIFOVNCFSPG IPVSTJOBZFBS  ظ଴͞ΕΔয఺ظؒͱࢀরظؒͷઆ໌ ؍࡯ظؒʢ࣌ؒʣ͔Βظ଴য఺ظؒΛҾ͘ େຑͷޮՌ͕͋ΒΘΕΔͩΖ͏࣌ؒ
  19. ౷ܭղੳํ๏ͷهࡌʢ.JUUMFNBOͷྫʣᶅ 19 .JUUMFNBO." -FXJT3" .BDMVSF. 4IFSXPPE+# .VMMFS+& 5SJHHFSJOHNZPDBSEJBMJOGBSDUJPOCZNBSJKVBOB$JSDVMBUJPO+VO  r

    5IFEBUBXFSFBOBMZ[FEVTJOHNFUIPETGPSDPIPSUTUVEJFTXJUITQBSTFEBUBJO FBDITUSBUVN  ༻ҙͨ͠σʔλͷղੳํ๏ͷઆ໌ w .BOUFM)BFOT[FMਪఆྔ w ৚݅෇͖࠷໬ਪఆྔ Λܭࢉ͢Δ
  20. ݁Ռͷهࡌʢ.JUUMFNBOͷྫʣ 20 .BDMVSF.5IFDBTFDSPTTPWFSEFTJHOBNFUIPEGPSTUVEZJOHUSBOTJFOUF ff FDUTPOUIFSJTLPGBDVUFFWFOUT 
 "N+&QJEFNJPM+BO  r 

    ױऀഎܠͷཁ໿  େຑͷ࢖༻ස౓  "TTPDJBUJPONFBTVSFͷ݁Ռ 0OUIFCBTJTPGBDBTFDSPTTPWFSBOBMZTJTUIBUDPOUSPMMFEGPSEJ ff FSFODFTCFUXFFO QBUJFOUT XFGPVOEUIBUXJUIJOIPVSBGUFSTNPLJOHNBSJKVBOB UIFSJTLPGNZPDBSEJBM JOGBSDUJPOPOTFUXBTFMFWBUFEGPME DPO fi EFODFJOUFSWBM UP1  DPNQBSFEXJUIQFSJPETPGOPOVTF *OUIFTFDPOEIPVSBGUFSTNPLJOH UIFSFMBUJWFSJTLXBT DPO fi EFODFJOUFSWBM  UP1 TVHHFTUJOHBSBQJEEFDMJOFJOUIFDBSEJBDF ff FDUTPGNBSJKVBOB 'JHVSF 
  21. έʔεΫϩεΦʔόʔσβΠϯɿ ޷·͍͠৚݅ͱԾఆ

  22. ޷·͍͠৚݅ 22 ᶄമ࿐͸ɺஅଓతͰ͋Γɺ૝ఆ͞ΕΔ༠ಋظ͕ؒ୹͍ ᶃΞ΢τΧϜ͸ɺٸͳൃ঱ *OEVDUJPOQFSJPE Ξ΢τΧϜ ൃ঱ മ࿐ മ࿐ ༠ಋظؒ

    ༠ಋظؒ ࣌ؒ w )BTIFNJ/B[BSJ44 .BOTPVSOJB."$BTFDSPTTPWFSBOEDBTFUJNFDPOUSPMTUVEJFTDPODFQUT EFTJHO BOEBOBMZTJT+&QJEFNJPM#JPTUBU 0DU  r w (SFFOMBOE4$POGPVOEJOHBOEFYQPTVSFUSFOETJODBTFDSPTTPWFSBOEDBTFUJNFDPOUSPMEFTJHOT&QJEFNJPMPHZ.BZ  r w -BTI5- 7BOEFS8FFMF5+ )BOFVTF4 3PUINBO,+.PEFSOFQJEFNJPMPHZ GPVSUIFEJUJPO8PMUFST,MVXFS
  23. Ծఆ 23 ᶃമ࿐ͷ෼෍͕ɺݚڀظؒத͸Ұఆ ຖ೔ճҿΉਓ ϲ݄ʹճҿΉਓ ᶃ`മ࿐֬཰͕ɺΞ΢τΧϜൃ঱ʹରͯ͠ɺ৚݅෇͖ಠཱ ˠଌఆ͞Εͨɺ࣌ؒมಈͷަབྷҼࢠ͸ௐ੔͠ͳ͚Ε͹ͳΒͳ͍ w .JUUMFNBO." .PTUPGTLZ&&YDIBOHFBCJMJUZJOUIFDBTFDSPTTPWFSEFTJHO*OU+&QJEFNJPM0DU

     r w (SFFOMBOE4$POGPVOEJOHBOEFYQPTVSFUSFOETJODBTFDSPTTPWFSBOEDBTFUJNFDPOUSPMEFTJHOT&QJEFNJPMPHZ.BZ  r w .PTUPGTLZ& $PVMM#" .JUUMFNBO.""OBMZTJTPG0CTFSWBUJPOBM4FMGNBUDIFE%BUBUP&YBNJOF"DVUF5SJHHFSTPG0VUDPNF&WFOUTXJUI "CSVQU0OTFU&QJEFNJPMPHZ/PW  r w -BTI5- 7BOEFS8FFMF5+ )BOFVTF4 3PUINBO,+.PEFSOFQJEFNJPMPHZ GPVSUIFEJUJPO8PMUFST,MVXFS ˠ৚݅෇͖ϩδεςΟοΫճؼϞσϧ͕ඞཁ
  24. Wang SV, Schneeweiss S, Maclure M, Gagne JJ. 
 “First-wave”

    bias when conducting active safety monitoring of newly marketed medications 
 with outcome-indexed self-controlled designs. 
 Am J Epidemiol. 2014 Sep 15;180(6):636–44. έʔεΫϩεΦʔόʔσβΠϯɿ۩ମྫ
  25. 25 .*ൃ঱ ΞϯΧʔ 32 ৽نൢച͞ΕͨΞϦϐϓϥκʔϧ 
 ʢ߅ਫ਼ਆපༀʣͷ෰༻͸ɺ 
 .*ൃ঱ͷҾ͖ۚʹͳΔ͔ʁ ɹࢢൢޙͷ෭࡞༻ௐࠪ

    ର৅ूஂ w .*ൃ঱ͨ͠ਓ w .*ൃ঱ͷϦεΫ͸͋Δະൃ঱ऀ Ξ΢τΧϜ ৺ے伷࠹ 
 ʢ.*.ZPDBSEJBM*OGBSDUJPOʣ മ࿐ ΞϦϐϓϥκʔϧ෰༻ য఺ظؒ .*ൃ঱೔ͷલ೔ʢ೔ؒʣ ࢀরظؒ .*ൃ঱೔ͷલʙ೔ʢ೔ؒʣ ղੳ୯Ґ ਓ ϝϞ OBUJPOBM.FEJDBJE"OBMZUJDF9USBDU อݥͷσʔλʢʙ೥ʣ σβΠϯʢ8BOH47ͷྫɿҰ෦ʣ     ৽نൃച 
 ʢʣ ճ໨ௐࠪ  ճ໨ௐࠪ  ճ໨ௐࠪ  ճ໨ௐࠪ  ʜ ʜ ܧଓతͳϞχλϦϯά 8BOH47 4DIOFFXFJTT4 .BDMVSF. (BHOF++ɹl'JSTUXBWFzCJBTXIFODPOEVDUJOHBDUJWFTBGFUZNPOJUPSJOHPGOFXMZNBSLFUFENFEJDBUJPOT 
 XJUIPVUDPNFJOEFYFETFMGDPOUSPMMFEEFTJHOT"N+&QJEFNJPM4FQ  r
  26. 26 ɹ݁Ռʢ8BOH47ͷྫɿҰ෦ʣᶃ 8BOH47 4DIOFFXFJTT4 .BDMVSF. (BHOF++ɹl'JSTUXBWFzCJBTXIFODPOEVDUJOHBDUJWFTBGFUZNPOJUPSJOHPGOFXMZNBSLFUFENFEJDBUJPOT 
 XJUIPVUDPNFJOEFYFETFMGDPOUSPMMFEEFTJHOT"N+&QJEFNJPM4FQ  r

    έʔεΫϩεΦʔόʔσβΠϯͰղੳ ࢢൢޙ͙͢͸03ߴͯ͘ɺ 
 ࣌ؒܦͭͱ௿͘ͳΔʁ
  27. ༀࡎӸֶͰى͜Γ΍͍͢όΠΞε 27 ৽نༀࡎ͸ɺമ࿐֬཰͕ҰఆͰ͸ͳ͍ ࣌ؒ ༀࡎͷྲྀ௨ྔ  ఆৗঢ়ଶ ༀࡎͷྲྀ௨ྔ͕ఆৗঢ়ଶʹࢸΔ·Ͱ͸ɺ 
 έʔεΫϩεΦʔόʔσβΠϯ͔Β

    
 ಘͨਪఆ஋͸όΠΞε͞ΕΔ 'JSTUXBWFCJBT ඇఆৗঢ়ଶ
  28. 28 ूஂϨϕϧͷമ࿐܏޲͕มΘΔͱ͖ɺͲ͏͢Δ͔ʁ έʔελΠϜίϯτϩʔϧσβΠϯ $BTFUJNFDPOUSPMEFTJHO ඇఆৗঢ়ଶ

  29. έʔελΠϜίϯτϩʔϧσβΠϯ

  30. 30 .*ൃ঱ ΞϯΧʔ 32 ৽نൢച͞ΕͨΞϦϐϓϥκʔϧ 
 ʢ߅ਫ਼ਆපༀʣͷ෰༻͸ɺ 
 .*ൃ঱ͷҾ͖ۚʹͳΔ͔ʁ ɹࢢൢޙͷ෭࡞༻ௐࠪ

    ର৅ूஂ w .*ൃ঱ͨ͠ਓ w .*ൃ঱ͷϦεΫ͸͋Δະൃ঱ऀ Ξ΢τΧϜ ৺ے伷࠹ 
 ʢ.*.ZPDBSEJBM*OGBSDUJPOʣ മ࿐ ΞϦϐϓϥκʔϧ෰༻ য఺ظؒ .*ൃ঱೔ͷલ೔ʢ೔ؒʣ ࢀরظؒ .*ൃ঱೔ͷલʙ೔ʢ೔ؒʣ ղੳ୯Ґ ਓ ϝϞ OBUJPOBM.FEJDBJE"OBMZUJDF9USBDU อݥͷσʔλʢʙ೥ʣ σβΠϯʢ8BOH47ͷྫɿҰ෦ʣ     ৽نൃച 
 ʢʣ ճ໨ௐࠪ  ճ໨ௐࠪ  ճ໨ௐࠪ  ճ໨ௐࠪ  ʜ ʜ ܧଓతͳϞχλϦϯά 8BOH47 4DIOFFXFJTT4 .BDMVSF. (BHOF++ɹl'JSTUXBWFzCJBTXIFODPOEVDUJOHBDUJWFTBGFUZNPOJUPSJOHPGOFXMZNBSLFUFENFEJDBUJPOT 
 XJUIPVUDPNFJOEFYFETFMGDPOUSPMMFEEFTJHOT"N+&QJEFNJPM4FQ  r
  31. 31 .*ൃ঱ ΞϯΧʔ έʔελΠϜίϯτϩʔϧσβΠϯʢ8BOH47ͷྫʣ     8BOH47 4DIOFFXFJTT4

    .BDMVSF. (BHOF++ɹl'JSTUXBWFzCJBTXIFODPOEVDUJOHBDUJWFTBGFUZNPOJUPSJOHPGOFXMZNBSLFUFENFEJDBUJPOT 
 XJUIPVUDPNFJOEFYFETFMGDPOUSPMMFEEFTJHOT"N+&QJEFNJPM4FQ  r έʔε     ίϯτϩʔϧ ONBUDI w ೥ྸɺੑผͰέʔεͱϚονϯά w Ϛονϯάର৅ͷέʔεͷΞ΢τΧϜൃ঱೔ʢج४೔ʣʹ.*ͷϦεΫ͕͋Δ w ج४೔͔Β೔Ҏ্લ͔ΒҩྍอݥʹՃೖ͍ͯ͠Δ w য఺ظؒͱࢀরظؒ͸ɺϚονϯάͨ͠έʔεͱἧ͑Δ ORCCO(cases) ORCCO(controls) മ࿐ޙͷ 
 Ξ΢τΧϜൃ঱ͷΦοζൺ ࢀরظؒʹର͢Δ 
 য఺ظؒͷമ࿐Φοζൺ മ࿐֬཰্͕͕Δ മ࿐֬཰͕Լ͕Δ ௐ੔ ORCCO(cases) ORCCO(controlss) ΞϦϐϓϥκʔϧ ΞϦϐϓϥκʔϧ ج४೔
  32. 32 ɹ݁Ռʢ8BOH47ͷྫɿҰ෦ʣᶄ 8BOH47 4DIOFFXFJTT4 .BDMVSF. (BHOF++ɹl'JSTUXBWFzCJBTXIFODPOEVDUJOHBDUJWFTBGFUZNPOJUPSJOHPGOFXMZNBSLFUFENFEJDBUJPOT 
 XJUIPVUDPNFJOEFYFETFMGDPOUSPMMFEEFTJHOT"N+&QJEFNJPM4FQ  r

    ࣌ؒΛ௨ͯ͠OVMM
  33. ౷ܭղੳํ๏ͷهࡌʢ8BOH47ͷྫʣᶃ 33 'PSFBDIFYBNQMF XFDPOEVDUFEDBTFDSPTTPWFSTUVEJFTUIBUDPNQBSFEUIF FYQPTVSFPEETEVSJOHBOJOEFYXJOEPXPGEBZTQSJPSUPUIFEBUFPG PVUDPNFUPUIFFYQPTVSFPEETEVSJOHBSFGFSFODFXJOEPXPGrEBZT QSJPSUPUIFEBUFPGUIFPVUDPNF 1BUJFOUTXFSFJODMVEFEJGUIFZFYQFSJFODFEUIFFWFOUPGJOUFSFTUGPMMPXJOHB XBTIPVUQFSJPEPGBUMFBTUEBZTEVSJOHXIJDIUIFQBUJFOUTXFSF FOSPMMFEJOUIFIFBMUIDBSFQMBOBOEEJEOPUIBWFUIFPVUDPNFPGJOUFSFTU

    B EBZHBQJOFOSPMMNFOUXBTBMMPXFE ʙ8FUIFOEF fi OFEBOJOEJWJEVBMBT FYQPTFEEVSJOHUIFJOEFYPSSFGFSFODFXJOEPXJGUIFSFXFSF BUNJOJNVN  EBZTTVQQMZPGNFEJDBUJPOBWBJMBCMFEVSJOHUIBUUJNFXJOEPX  έʔεɾΫϩεΦʔόʔσβΠϯͷઆ໌ 8BOH47 4DIOFFXFJTT4 .BDMVSF. (BHOF++ɹl'JSTUXBWFzCJBTXIFODPOEVDUJOHBDUJWFTBGFUZNPOJUPSJOHPGOFXMZNBSLFUFENFEJDBUJPOT 
 XJUIPVUDPNFJOEFYFETFMGDPOUSPMMFEEFTJHOT"N+&QJEFNJPM4FQ  r w "TTPDJBUJPONFBTVSF w য఺ظؒͱࢀরظؒ w য఺ظؒͱࢀরظؒͷଥ౰ੑ
  34. ౷ܭղੳํ๏ͷهࡌʢ8BOH47ͷྫʣᶄ 34 'PSFBDIFYBNQMF XFVTFEOWBSJBCMFSBUJPNBUDIJOHPGDBTFTUPTBNQMFT PGQFSTPOUJNFBNPOHDPOUSPMT*OEJWJEVBMTXFSFFMJHJCMFBTDPOUSPMTGPSB DBTFJGUIFZXFSFBUSJTLGPSUIFPVUDPNFPOUIFDBTFTJOEFYEBUFBOEXFSF FOSPMMFEJOUIFIFBMUIQMBOGPSBUMFBTUEBZTQSJPSUPUIFJOEFYEBUF B EBZHBQJOFOSPMMNFOUXBTBMMPXFE 5IFTBNQMFEDPOUSPMQFSTPOUJNF

    XBTNBUDIFEUPUIFDBTFPOBHF TBNFZFBSPGCJSUI DBMFOEBSUJNF TBNF JOEFYEBUF BOETFY5IFEF fi OJUJPOTPGJOEFYXJOEPXT SFGFSFODFXJOEPXT  BOEFYQPTVSFTXFSFUIFTBNFGPSDBTFTBOENBUDIFEDPOUSPMQFSTPOUJNF  έʔελΠϜίϯτϩʔϧσβΠϯͷઆ໌ 8BOH47 4DIOFFXFJTT4 .BDMVSF. (BHOF++ɹl'JSTUXBWFzCJBTXIFODPOEVDUJOHBDUJWFTBGFUZNPOJUPSJOHPGOFXMZNBSLFUFENFEJDBUJPOT 
 XJUIPVUDPNFJOEFYFETFMGDPOUSPMMFEEFTJHOT"N+&QJEFNJPM4FQ  r w OϚονϯά w ίϯτϩʔϧͷ 
 য఺ظؒͱࢀরظؒ w ίϯτϩʔϧͷద֨ج४ w Ϛονϯάม਺  ܧଓతϞχλϦϯάͷઆ໌
  35. ౷ܭղੳํ๏ͷهࡌʢ8BOH47ͷྫʣᶅ 35 5IFDBTFDSPTTPWFSQBSBNFUFSPGJOUFSFTUJTUIFFYQPTVSFPEETSBUJP &03  GPSUIFOFXMZNBSLFUFENFEJDBUJPOEVSJOHUIFJOEFYQFSJPEWFSTVTUIF SFGFSFODFQFSJPE5IFQBSBNFUFSPGJOUFSFTUGPSUIFDBTFUJNFDPOUSPM FTUJNBUFJTUIF&03GPSUIFOFXMZNBSLFUFENFEJDBUJPOBNPOHDBTFTBGUFS BEKVTUNFOUGPSUIF&03GPSUIFOFXMZNBSLFUFENFEJDBUJPOBNPOH NBUDIFEDPOUSPMQFSTPOUJNF

     &TUJNBOEͷઆ໌ 8BOH47 4DIOFFXFJTT4 .BDMVSF. (BHOF++ɹl'JSTUXBWFzCJBTXIFODPOEVDUJOHBDUJWFTBGFUZNPOJUPSJOHPGOFXMZNBSLFUFENFEJDBUJPOT 
 XJUIPVUDPNFJOEFYFETFMGDPOUSPMMFEEFTJHOT"N+&QJEFNJPM4FQ  r w έʔεΫϩεΦʔόʔͷ 
 &TUJNBOE w έʔελΠϜίϯτϩʔϧͷ 
 &TUJNBOE ORCCO(cases) ORCCO(controlss)
  36. 36 έʔελΠϜίϯτϩʔϧσβΠϯͷ՝୊ έʔεɾέʔελΠϜίϯτϩʔϧσβΠϯ $BTFDBTFUJNFDPOUSPMEFTJHO w έʔεͷσʔλ͔͠ͳ͍ w Ϛονϯάͯ͠΋ɺέʔεͱίϯτϩʔϧͰഎܠ৘ใͷͣΕ͸͋Δ

  37. έʔεɾέʔελΠϜίϯτϩʔϧσβΠϯ

  38. 38 32 ߅ਫ਼ਆපༀͷ෰༻͸ɺ 
 ڏ݂ੑ೴ଔதൃ঱ͷҾ͖ۚʹͳΔ͔ʁ ର৅ूஂ ڏ݂ੑ೴ଔத͕ൃ঱ͨ͠ਓ Ξ΢τΧϜ ڏ݂ੑ೴ଔத മ࿐

    ߅ਫ਼ਆපༀ෰༻ য఺ظؒ ڏ݂ੑ೴ଔதൃ঱೔ͷલ೔ʢ೔ؒʣ ࢀরظؒ ڏ݂ੑ೴ଔதൃ঱೔ͷલʙ೔ʢ೔ؒʣ ղੳ୯Ґ ਓ ϝϞ ୀ໾܉ਓ݈߁ிͷσʔλʢʙ೥ʣ έʔεɾέʔελΠϜίϯτϩʔϧσβΠϯʢ8BOH4ͷྫɿҰ෦ʣᶃ 8BOH4 -JOLMFUUFS$ %PSF% .PS7 #VLB4 .BDMVSF."HF BOUJQTZDIPUJDT BOEUIFSJTLPGJTDIFNJDTUSPLFJOUIF7FUFSBOT)FBMUI "ENJOJTUSBUJPO4USPLF+BO  r
  39. 39 ڏ݂ੑ೴ଔதൃ঱ ΞϯΧʔ έʔεɾέʔελΠϜίϯτϩʔϧσβΠϯʢ8BOH4ͷྫʣᶄ     έʔε 

       ORCCO(cases) ORCCO(controls) മ࿐ޙͷ 
 Ξ΢τΧϜൃ঱ͷΦοζൺ ࢀরظؒʹର͢Δ 
 য఺ظؒͷമ࿐Φοζൺ ௐ੔ ORCCO(cases) ORCCO(controlss) ߅ਫ਼ਆපༀ ߅ਫ਼ਆපༀͰͳ͍ॲํༀ ؔ৺ͷ͋Δༀࡎͷമ࿐܏޲ͱ ଞͷίϯτϩʔϧͱ͢Δༀࡎͷമ࿐܏޲͕ಉ͡ Ծఆ 8BOH4 -JOLMFUUFS$ %PSF% .PS7 #VLB4 .BDMVSF."HF BOUJQTZDIPUJDT BOEUIFSJTLPGJTDIFNJDTUSPLFJOUIF7FUFSBOT)FBMUI "ENJOJTUSBUJPO4USPLF+BO  r w 03͸৚݅෇͖ϩδεςΟοΫճؼ෼ੳͰਪఆ w $*͸ϒʔτετϥοϓ๏Ͱਪఆ
  40. 40 ɹ݁Ռʢ8BOH4ͷྫɿҰ෦ʣ 8BOH4 -JOLMFUUFS$ %PSF% .PS7 #VLB4 .BDMVSF."HF  BOUJQTZDIPUJDT

    BOEUIFSJTLPGJTDIFNJDTUSPLFJOUIF7FUFSBOT)FBMUI "ENJOJTUSBUJPO4USPLF+BO  r 8FQSFTFOUFTUJNBUFTGPSUIFTUSFOHUIPGUIFSFMBUJPOTIJQCFUXFFO FYQPTVSFUPBOUJQTZDIPUJDTBOETUSPLFBGUFSBEKVTUJOHGPSUIFF ff FDUPG UJNFJOWBSJBOUXJUIJOQFSTPODPOGPVOEFSTBTXFMMBTFYQPTVSFUJNF USFOET5IFPEETPGTUSPLFXFSF $* r UJNFTHSFBUFS XIFOFYQPTFEUPBOUJQTZDIPUJDTGPSBUMFBTUPGUIFMBTUEBZTUIBO XIFOUIFSFXFSFEBZTPGBOUJQTZDIPUJDFYQPTVSFXJUIJOEBZT"HF TUSBUJ fi FEFTUJNBUFTTVHHFTUBHSFBUFSUSJHHFSJOHF ff FDUPGBOUJQTZDIPUJDT POTUSPLFXJUIJODSFBTJOHBHF w ࣌ؒෆมͷަབྷҼࢠͱ 
 മ࿐܏޲Λௐ੔ͨ͠ਪఆ w ͢΂ͯͷݚڀର৅ʹର͢Δਪఆ w ೥ྸ૚͝ͱʹਪఆɿޮՌम০ͷ֬ೝ
  41. σβΠϯͷ·ͱΊ 41 έʔεΫϩεΦʔόʔ έʔελΠϜίϯτϩʔϧ έʔεɾέʔελΠϜίϯτϩʔϧ ࢖༻͢Δ ৘ใ έʔεʢΞ΢τΧϜൃ঱ྫͷΈʣ w έʔεʢΞ΢τΧϜൃ঱ྫʣ

    w ίϯτϩʔϧ 
 ʢΞ΢τΧϜඇൃ঱ྫʣ έʔεʢΞ΢τΧϜൃ঱ྫͷΈʣ ղੳํ๏ w .BOUFM)BFOT[FMਪఆ w ৚݅෇͖ϙΞιϯճؼ w ৚݅෇͖ϩδεςΟοΫճؼ w Ϛονϯά w ৚݅෇͖ϩδεςΟοΫճؼ ৚݅෇͖ϩδεςΟοΫճؼ Ծఆ w മ࿐܏޲͕Ұఆ w മ࿐ͱΞ΢τΧϜൃ঱͕৚݅෇͖ಠཱ w έʔεͱ 
 ίϯτϩʔϧͷമ࿐܏޲͕ಉ͡ w മ࿐ͱΞ΢τΧϜൃ঱͕৚݅෇͖ಠཱ w έʔεͱରԠ͢Δέʔε಺ͷ 
 ίϯτʔϧͷമ࿐܏޲͕ಉ͡ w മ࿐ͱΞ΢τΧϜൃ঱͕৚݅෇͖ಠཱ ௕ॴ Ξ΢τΧϜൃ঱ྫͷ৘ใͷΈͰྑ͍ മ࿐܏޲Λௐ੔Ͱ͖Δ w മ࿐܏޲Λௐ੔Ͱ͖Δ w Ξ΢τΧϜൃ঱ྫͷ৘ใͷΈͰྑ͍ ୹ॴ മ࿐܏޲͕ఆৗঢ়ଶͰͳ͚Ε͹ͳΒͳ͍ ద੾ͳίϯτϩʔϧͷ৘ใ͕ඞཁ ద੾ͳέʔε಺ͷίϯτʔϧͷ৘ใ͕ඞ ཁ
  42. έʔεΫϩεΦʔόʔσβΠϯɿ σʔλͷܗͱ3Λ࢖ͬͨ౷ܭղੳ

  43. ࢝఺ͱͳΔղੳ༻σʔλʢ.BDMVSFͷྫʣ 43 *% .*ൃ঱લͷ࠷ޙͷ 
 ίʔώʔઁऔ ίʔώʔͷઁऔස౓ ࠷ޙͷമ࿐͕ 
 য఺ظؒ

    ࠷ޙͷമ࿐͕ ࢀরظؒ ظ଴͞ΕΔ য఺ظؒ ظ଴͞ΕΔ ࢀরظؒ ݚڀظؒ JE MBTU@FY@UJNF GSFR@FY GSFR@FY@VOJU GPDBM@FY SFG@FY 5@GPDBM 5@SFG 5  IPVST  EBZ  E         NJOVUFT  EBZ  E         IPVST  NPOUI  N         IPVST  EBZ  E          IPVST  EBZ  E          IPVST  NPOUI  N         IPVST  EBZ  E         IPVST  EBZ  E         IPVST  EBZ  E          IPVST  EBZ  E        .BDMVSF.5IFDBTFDSPTTPWFSEFTJHOBNFUIPEGPSTUVEZJOHUSBOTJFOUF ff FDUTPOUIFSJTLPGBDVUFFWFOUT 
 "N+&QJEFNJPM+BO  r ೖྗ ೖྗ ೖྗ ܭࢉ ೖྗ
  44. ऴ఺ͱͳΔղੳ༻σʔλʢ.BDMVSFͷྫʣ 44 *% য఺ظؒ  PSࢀরظؒ  Ξ΢τΧϜͷൃ঱ JE FYQPTVSF

    DBTF                                                             ᶃ*%͝ͱͷFYQPTVSF   ͕ରԠ͢Δظؒͷ਺͚ͩߦ͕͋Δ  ߦ ߦ  ߦ ߦ ᶄDBTFʹ͸ɺ·ͣ͢΂ͯΛೖΕΔ ᶅ֤JEɺ֤FYQPTVSFͷߦ໨ͷΈ 
 ֤ظؒͷമ࿐ͷ༗ແʹରԠ͢ΔΑ͏ʹDBTFʹΛೖΕΔ Ξ΢τΧϜൃ঱͸ɺJE͝ͱʹճͷΈ͔ͩΒ ߦ  ߦ
  45. ղੳ༻σʔλ࡞੒ίʔυᶃ 45  ४උ  σʔλೖྗ

  46. ղੳ༻σʔλ࡞੒ίʔυᶄ 46  ੨͍෦෼ͷܭࢉ

  47. ղੳ༻σʔλ࡞੒ίʔυᶅ 47  ऴ఺σʔληοτΛ࡞੒ ᶃ*%͝ͱͷFYQPTVSF   ͕ରԠ͢Δظؒͷ਺͚ͩߦ͕͋Δ ᶄDBTFʹ͸ɺ·ͣ͢΂ͯΛೖΕΔ ᶅ֤JEɺ֤FYQPTVSFͷߦ໨ͷΈ

    
 ֤ظؒͷമ࿐ͷ༗ແʹରԠ͢ΔΑ͏ʹDBTFʹΛೖΕΔ
  48. ౷ܭղੳίʔυ 48

  49. έʔελΠϜίϯτϩʔϧσβΠϯɿ σʔλͷܗͱ3Λ࢖ͬͨ౷ܭղੳ ࣗ৴͕ͳ͍ͷͰɺޙ΄Ͳ഑෍౳͍ͤͯͩ͘͞͞

  50. ֶश͢ΔͨΊͷಓඪᶃɹʢ˒͸ಛʹ͓͢͢Ίʣ 50  ֓؍Λ͔ͭΉʢೖ໳ʣ w ˒$BEBSFUUF4. .BDMVSF. %FMBOFZ+"$ 8IJUBLFS)+ )BZFT,/

    8BOH47 FUBM$POUSPMZPVSTFMG*41&FOEPSTFE HVJEBODFJOUIFBQQMJDBUJPOPGTFMGDPOUSPMMFETUVEZEFTJHOTJOQIBSNBDPFQJEFNJPMPHZ1IBSNBDPFQJEFNJPM%SVH4BG +VO  rɹʲༀࡎӸֶͷཱ৔͔Βͷ·ͱΊʳ w -BTI5- 7BOEFS8FFMF5+ )BOFVTF4 3PUINBO,+.PEFSOFQJEFNJPMPHZ GPVSUIFEJUJPO8PMUFST,MVXFSɹʲϖ ʔδͰ·ͱ·͍ͬͯΔʳ w ˒$BSSBDFEP.BSUÍOF[& 5BSBDJEP. 5PCJBT" 4BF[. 'JHVFJSBT"$BTFDSPTTPWFSBOBMZTJTPGBJSQPMMVUJPOIFBMUI F ff FDUTBTZTUFNBUJDSFWJFXPGNFUIPEPMPHZBOEBQQMJDBUJPO&OWJSPO)FBMUI1FSTQFDU"VH  rɹ ʲͲ͏ͳྖҬͰ࢖ΘΕ͍ͯΔ͔ɺͳΜͱͳ͘௫Ήʳ w ˒)BTIFNJ/B[BSJ44 .BOTPVSOJB."$BTFDSPTTPWFSBOEDBTFUJNFDPOUSPMTUVEJFTDPODFQUT EFTJHO BOEBOBMZTJT +&QJEFNJPM#JPTUBU0DU  rɹʲํ๏࿦ͷ·ͱΊͱͯ͠Θ͔Γ΍͘͢ஸೡɻ؆୯͕ͩ਺ࣜ΋σʔλͷܗ΋ࡌͬ ͍ͯΔɻͨͩ͜͠ͷ··Ͱ͸ղੳͰ͖ͳ͍ʳ w .PTUPGTLZ& $PVMM#" .JUUMFNBO.""OBMZTJTPG0CTFSWBUJPOBM4FMGNBUDIFE%BUBUP&YBNJOF"DVUF5SJHHFSTPG 0VUDPNF&WFOUTXJUI"CSVQU0OTFU&QJEFNJPMPHZ/PW  rɹʲෳ਺ͷσβΠϯͷํ๏࿦ϨϏϡʔͱͯ͠͸ ࠷΋ৄ͍͠ɻ͔͠͠೉͍͠ɻ֤࿦Λษڧ͠ͳ͕ΒɺԿ౓΋ৼΓฦΔ΂͠ʳ
  51. ֶश͢ΔͨΊͷಓඪᶄ 51  έʔεΫϩεΦʔόʔσβΠϯ w ˒4IJPTBLBJ, ,BHJNVSB5$BTF$SPTTPWFS4UVEZ+BQBOFTF+PVSOBMPG1IBSNBDPFQJEFNJPMPHZ:BLV[BJFLJHBLV   rɹʲ೔ຊޠจݙʳ

    w ˒.BDMVSF.5IFDBTFDSPTTPWFSEFTJHOBNFUIPEGPSTUVEZJOHUSBOTJFOUF ff FDUTPOUIFSJTLPGBDVUFFWFOUT"N+ &QJEFNJPM+BO  rɹʲΞ΢τΧϜ͕ΞϯΧʔͷࣗݾରরσβΠϯͷىݯͱͳΔ࿦จɻදͷ਺஋ʹͱ͜ΖͲ ͜Ζϛε͕͋ΔͷͰ஫ҙʳ w .JUUMFNBO." -FXJT3" .BDMVSF. 4IFSXPPE+# .VMMFS+&5SJHHFSJOHNZPDBSEJBMJOGBSDUJPOCZNBSJKVBOB $JSDVMBUJPO+VO  rɹʲέʔεΫϩεΦʔόʔσβΠϯΛ࢖ͬͨݚڀͷ۩ମྫɻΘ͔Γ΍͍͢ʳ w .JUUMFNBO." .PTUPGTLZ&&YDIBOHFBCJMJUZJOUIFDBTFDSPTTPWFSEFTJHO*OU+&QJEFNJPM0DU  rɹ ʲόΠΞεͷߏ଄Λཧղ͢Δɻ%"(Λ͍ࣔͯ͠ΔͷͰཧղ͠΍͍͢ʳ w ;IBOH;$BTFDSPTTPWFSEFTJHOBOEJUTJNQMFNFOUBUJPOJO3"OO5SBOTM.FE4FQ  ɹʲ3Λ࢖ͬͨղੳ νϡʔτϦΞϧ࿦จɻίʔυ͸ݹ͘ɺ෼͔ΓͮΒ͍ɻ͜ͷࢿྉͷίʔυݟͯʳ
  52. ֶश͢ΔͨΊͷಓඪᶅ 52  έʔελΠϜίϯτϩʔϧσβΠϯ w ˒8BOH47 4DIOFFXFJTT4 .BDMVSF. (BHOF++l'JSTUXBWFzCJBTXIFODPOEVDUJOHBDUJWFTBGFUZNPOJUPSJOHPGOFXMZ NBSLFUFENFEJDBUJPOTXJUIPVUDPNFJOEFYFETFMGDPOUSPMMFEEFTJHOT"N+&QJEFNJPM4FQ

     rɹ ʲέʔεΫϩεΦʔόʔͷऑΈΛཧղ্ͨ͠ͰɺέʔελΠϜίϯτϩʔϧσβΠϯͷϞνϕʔγϣϯ͕෼͔Δ۩ମྫɻʳ w 4VJTTB45IFDBTFUJNFDPOUSPMEFTJHO&QJEFNJPMPHZ.BZ  rɹʲέʔελΠϜίϯτϩʔϧσβΠϯͷى ݯͱͳΔ࿦จʳ w (SFFOMBOE4$POGPVOEJOHBOEFYQPTVSFUSFOETJODBTFDSPTTPWFSBOEDBTFUJNFDPOUSPMEFTJHOT&QJEFNJPMPHZ .BZ  rɹʲ(SFFMBOE͔ΒέʔελΠϜίϯτϩʔϧσβΠϯ͕͏·͍͔͘ͳ͍ྫͷఏࣔʳ w 4VJTTB45IFDBTFUJNFDPOUSPMEFTJHOGVSUIFSBTTVNQUJPOTBOEDPOEJUJPOT&QJEFNJPMPHZ+VM  rɹ ʲ(SFFOMBOEͷ࿦จʹର͢Δ4VJTTBͷ੾Γฦ͠࿦จʳ  έʔεɾέʔελΠϜίϯτϩʔϧσβΠϯ w ˒8BOH4 -JOLMFUUFS$ %PSF% .PS7 #VLB4 .BDMVSF."HF BOUJQTZDIPUJDT BOEUIFSJTLPGJTDIFNJDTUSPLFJOUIF 7FUFSBOT)FBMUI"ENJOJTUSBUJPO4USPLF+BO  rʲέʔεɾέʔελΠϜίϯτϩʔϧσβΠϯͷ۩ମྫɻ୹͘ ͯαΫοͱಡΊΔʳ w 8BOH4 -JOLMFUUFS$ .BDMVSF. %PSF% .PS7 #VLB4 FUBM'VUVSFDBTFTBTQSFTFOUDPOUSPMTUPBEKVTUGPSFYQPTVSF USFOECJBTJODBTFPOMZTUVEJFT&QJEFNJPMPHZ+VM  rɹʲέʔεɾέʔελΠϜίϯτϩʔϧσβΠϯͷى ݯͱͳΔ࿦จʳ
  53. ͝ਗ਼ௌ͋Γ͕ͱ͏͍͟͝·ͨ͠ɻ 53 έʔεΫϩεΦʔόʔ έʔελΠϜίϯτϩʔϧ έʔεɾέʔελΠϜίϯτϩʔϧ ࢖༻͢Δ ৘ใ έʔεʢΞ΢τΧϜൃ঱ྫͷΈʣ w έʔεʢΞ΢τΧϜൃ঱ྫʣ

    w ίϯτϩʔϧ 
 ʢΞ΢τΧϜඇൃ঱ྫʣ έʔεʢΞ΢τΧϜൃ঱ྫͷΈʣ ղੳํ๏ w .BOUFM)BFOT[FMਪఆ w ৚݅෇͖ϙΞιϯճؼ w ৚݅෇͖ϩδεςΟοΫճؼ w Ϛονϯά w ৚݅෇͖ϩδεςΟοΫճؼ ৚݅෇͖ϩδεςΟοΫճؼ Ծఆ w മ࿐܏޲͕Ұఆ w മ࿐ͱΞ΢τΧϜൃ঱͕৚݅෇͖ಠཱ w έʔεͱ 
 ίϯτϩʔϧͷമ࿐܏޲͕ಉ͡ w മ࿐ͱΞ΢τΧϜൃ঱͕৚݅෇͖ಠཱ w έʔεͱରԠ͢Δέʔε಺ͷ 
 ίϯτʔϧͷമ࿐܏޲͕ಉ͡ w മ࿐ͱΞ΢τΧϜൃ঱͕৚݅෇͖ಠཱ ௕ॴ Ξ΢τΧϜൃ঱ྫͷ৘ใͷΈͰྑ͍ മ࿐܏޲Λௐ੔Ͱ͖Δ w മ࿐܏޲Λௐ੔Ͱ͖Δ w Ξ΢τΧϜൃ঱ྫͷ৘ใͷΈͰྑ͍ ୹ॴ മ࿐܏޲͕ఆৗঢ়ଶͰͳ͚Ε͹ͳΒͳ͍ ద੾ͳίϯτϩʔϧͷ৘ใ͕ඞཁ ద੾ͳέʔε಺ͷίϯτʔϧͷ৘ใ͕ඞ ཁ
  54. ͓·͚ έʔεΫϩεΦʔόʔσβΠϯɿ όΠΞε

  55. ަབྷ 55 ੑަব େຑ ৺ے伷࠹ ަབྷҼࢠ മ࿐ม਺ Ξ΢τΧϜ ᄶଉ૿ѱ ᄶଉͷༀ

    ࢮ๢ ަབྷҼࢠ മ࿐ม਺ Ξ΢τΧϜ w .PTUPGTLZ& $PVMM#" .JUUMFNBO.""OBMZTJTPG0CTFSWBUJPOBM4FMGNBUDIFE%BUBUP&YBNJOF"DVUF5SJHHFSTPG0VUDPNF&WFOUTXJUI "CSVQU0OTFU&QJEFNJPMPHZ/PW  r ᄶଉ૿ѱ ӡಈ ৺ے伷࠹ ަབྷҼࢠ മ࿐ม਺ Ξ΢τΧϜ ੑަব͸େຑͷ࢖༻Λଅ͠ɺ ৺ے伷࠹ͷϦεΫΛߴΊΔ͔΋͠Εͳ͍ ᄶଉ૿ѱ͸ༀͷ࢖༻Λଅ͠ɺ ࢮ๢ͷϦεΫΛߴΊΔ͔΋͠Εͳ͍ ᄶଉ૿ѱ͸ӡಈͷ཈੍ʹಇ͖ɺ ৺ے伷࠹ͷϦεΫΛߴΊΔ͔΋͠Εͳ͍
  56. ߹ྲྀ఺όΠΞε 56 ҧ๏ༀ෺ 
 ࢖༻ ৺ے伷࠹ ࢀՃऀ മ࿐ม਺ Ξ΢τΧϜ w

    .PTUPGTLZ& $PVMM#" .JUUMFNBO.""OBMZTJTPG0CTFSWBUJPOBM4FMGNBUDIFE%BUBUP&YBNJOF"DVUF5SJHHFSTPG0VUDPNF&WFOUTXJUI "CSVQU0OTFU&QJEFNJPMPHZ/PW  r બ୒ w ҧ๏ༀ෺࢖༻͸ݴ͍ʹ͍͘ͷͰࢀՃऀ͸ߜΒΕΔ w ৺ے伷࠹ͷױऀ͔͠ࢀՃ͠ͳ͍ ӡಈ ৺ے伷࠹ ੜଘ മ࿐ม਺ Ξ΢τΧϜ બ୒ w ӡಈ͢Δਓ͸ɺ͠ͳ͍ਓΑΓࢮ๢֬཰͸௿͍ w ৺ے伷࠹Λܦݧ͠ੜଘͨ͠ױऀ͔͠ࢀՃ͠ͳ͍
  57. മ࿐ͱΞ΢τΧϜͷ࣌ؒτϨϯυͱόΠΞεᶃ 57 w .PTUPGTLZ& $PVMM#" .JUUMFNBO.""OBMZTJTPG0CTFSWBUJPOBM4FMGNBUDIFE%BUBUP&YBNJOF"DVUF5SJHHFSTPG0VUDPNF&WFOUTXJUI "CSVQU0OTFU&QJEFNJPMPHZ/PW  r ࣌ؒ

    େຑ ৺ے伷࠹ ࢀরظؒ w മ࿐֬཰͕࣌ؒͰมಈ͢Δ৔߹ɺ w ࣌ؒ͸େຑͷ࢖༻ʹӨڹ w ৺ے伷࠹ൃ঱ྫͷࢀরظؒΛબ୒ w બ୒͞Εͨࢀরظؒ͸࣌ؒʹΑͬͯ 
 മ࿐֬཰͕มΘ͍ͬͯΔ w ߹ྲྀ఺όΠΞεͷൃੜ ࣌ؒ ௟௧ༀ ৺ے伷࠹ ࢀরظؒ w മ࿐֬཰͕࣌ؒͰมಈͤͣɺ 
 Ξ΢τΧϜൃ঱֬཰͕࣌ؒʹΑΓมಈ͢Δ w ॲํᝦͷ͍Βͳ͍௟௧ༀͷ࢖༻֬཰͸҆ఆ͠ ͍ͯΔ w ͕࣌ؒܦͯ͹ܦͭ΄Ͳɺ.*ͷϦεΫ͸্͕Δ w ৺ے伷࠹ൃ঱ྫͷࢀরظؒΛબ୒ w ަབྷ΋߹ྲྀ఺όΠΞε΋ൃੜͤͣ
  58. മ࿐ͱΞ΢τΧϜͷ࣌ؒτϨϯυͱόΠΞεᶄ 58 w .PTUPGTLZ& $PVMM#" .JUUMFNBO.""OBMZTJTPG0CTFSWBUJPOBM4FMGNBUDIFE%BUBUP&YBNJOF"DVUF5SJHHFSTPG0VUDPNF&WFOUTXJUI "CSVQU0OTFU&QJEFNJPMPHZ/PW  r ࣌ؒ

    ίʔώʔ ৺ے伷࠹ ࢀরظؒ w മ࿐֬཰΋Ξ΢τΧϜൃ঱֬཰΋ 
 ࣌ؒʹΑΓมಈ͢Δ w .*ͷ֓೔पظͷϐʔΫ͸ே w ίʔώʔ΋ேଟ͘ҿΉ܏޲͕͋Δ w ࢀরظؒ͸ɺίʔώʔઁऔ֬཰͕௿͍͔΋͠ Εͳ͍ w ަབྷ΋߹ྲྀ఺όΠΞε΋ൃੜ