개인 건강행태 및 지역보건의료 수준이 고혈압 의사진단에 미치는 영향

국문 초록 (Abstract)

본 연구는 의사로부터 고혈압으로 진단받은 사람들을 대상으로 개인 건강행태 및 지역 보건의료수준이 고혈압의사 진단에 미치는 영향을 파악하고자 실시하였다. 연구는 2010년도 지역사회건강조사대상 만 19세 이상 성인 229,229명을 대상으로 개인특성에 따른 고혈압 의사진단의 차이 비교는 카이제곱 검정을 사용하였으며, 개인 및 지역수준 변수를 고려한 고혈압 의사진단의 관련지표의 지역 간 변이 파악은 다수준 로지스틱회귀분석를 실시하였다. 연구결과 개인건강행태수준에서 연령수준이 높을수록, 최종학력이 높을수록, 기초생활수급이 무일 때, 체질량지수가 높을수록, 일회음주량이 많을수록 고혈압 의사진단 경험률이 높았다. 또한 보건의료기관을 이용한 사람이, 한 달 동안 혈압측정횟수가 높을수록, 주관적 스트레스 수준이 높을수록, 우울감 경험이 있을 때 고혈압 의사진단 경험률이 높았다. 반면에 고용형태가 임금근로자인 경우, 고용주 및 자영업자에서, 걷기일수가 많을수록, 현재 흡연여부 경험이 적을수록, 민간의료보험에 가입한 사람에서 고혈압 의사진단 경험률이 낮았다. 건강행태 및 지역의 보건의료수준에 따라, 고혈압의사진단에 미치는 영향이 크다는 것을 알 수 있었으며, 추후 많은 연구에서 지역수준을 고려한 다수준 분석이 필요할 것으로 사료된다.

다국어 초록 (Multilingual Abstract)

This study was conducted to investigate the effects of individual patient behavior regarding health and medical care level on doctor"s diagnoses of hypertension. A X2-test was used to compare therapeutic compliance in individual characteristics and two-stage multilevel logistic regression to identify community variance of the related index of high blood pressure therapeutic compliance using data from 229,229 adults over the age of 19 in a community health survey conducted in 2010. The experience rate of doctors" diagnoses of hypertension was higher for people of older age, higher level of education, higher BMI, and among heavy drinkers (no recipients of basic living). Furthermore, there was a higher rate for those visiting health and medical institutions, having more frequent checks of blood pressure in a month, having a higher stress level, and having depression. Among paid workers, the ratio was lower for employers and owner/operators with more daily exercise (such as walking), infrequent smokers, and private health insurance holders. Doctor"s diagnoses of hypertension was affected by individual health behavior and health and medical care level. Further studies employing multilevel analyses considering regional level data should be conducted in the future.

목차 (Table of Contents)

• 요약
• Abstract
• 1. 서론
• 2. 연구대상 및 방법
• 3. 자료처리 및 통계분석
• 4. 결과
• 5. 고찰
• 6. 결론
• References

참고문헌 (Reference)

1 배상근, "지역사회 노인 고혈압 환자들의 약물 순응도와 관련요인" 대한임상건강증진학회 15 (15): 121-128, 2015

2 석향숙, "고혈압 이환율의 지역 간 변이 요인에 관한 연구" 한국보건사회연구원 33 (33): 210-236, 2013

3 왕성배, "건강검진 수검자들의 비만도와 고혈압, 고혈당 및 고콜레스테롤혈증과의 관련성" 한국산학기술학회 12 (12): 2677-2684, 2011

4 Amara E. Ezeamama, "The influence of socioeconomic factors on cardiovascular disease risk factors in the context of economic development in the Samoan archipelago" Elsevier BV 63 (63): 2533-2545, 2006

5 I. H. Yen, "The Social Environment and Health: A Discussion of the Epidemiologic Literature" Annual Reviews 20 (20): 287-308, 1999

6 Aram V. Chobanian, "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood PressureThe JNC 7 Report" American Medical Association (AMA) 289 (289): 2560-2572, 2003

7 "Statistics Korea"

8 "Statistics Korea"

9 Sun Ha Jee, "Smoking and Atherosclerotic Cardiovascular Disease in Men With Low Levels of Serum Cholesterol" American Medical Association (AMA) 282 (282): 2149-2155, 1999

10 Suh I, "Risk of death in men with normal of high-normal blood pressure" 106 (106): 760-, 2002

11 Gaston K. Kapuku, "Relationships among socioeconomic status, stress induced changes in cortisol, and blood pressure in african american males" Springer Nature 24 (24): 320-325, 2002

12 Sharma S, "Racial, ethnic and socioeconomic disparities in the clustering of cardiovascular disease risk factors" 14 : 43-48, 2004

13 Park W. W., "Procedures and Methods of Multilevel Analysis: With a Focus on WABA" 39 (39): 59-90, 2005

14 World Health Organization, "Primary Care" 2001

15 Park A.P., "Pattern and determinants of health services utilization in Korea adult" 1 (1): 59-67, 2007

16 Le C, "Multilevel analysis of the determinants of prehypertension and hypertension in rural southwest China" 126 : 420-426, 2011

17 K E Pickett, "Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review" BMJ 55 (55): 111-122, 2001

18 Department of Health and Human Services, "Korea institude for health and school affairs, 2008 Patient surveys in-depth analysis" 2010

19 Jennifer J. McGrath, "Individual versus neighborhood socioeconomic status and race as predictors of adolescent ambulatory blood pressure and heart rate" Elsevier BV 63 (63): 1442-1453, 2006

20 J. L. Izzo, "Hypertension primer : the essentials of high blood pressure" Lippincott Williams & Wilkins 1999

21 Schober SE, "Health insurance affects diagnosis and control of hypercholesterolemia and hypertension among adults aged 20-64" NCHS 2011

22 Charles Agyemang, "Ethnic differences in the effect of environmental stressors on blood pressure and hypertension in the Netherlands" Springer Nature 7 (7): 118-, 2007

23 Lee K. S., "Community-based hypertension and diabetes management model development for improving adherence and compliance"

24 HR Roohafza, "Cardiovascular Risk Factors in Iranian Adults according to Educational Levels: Isfahan Healthy Heart Program" SAGE Publications 17 (17): 9-14, 2005