장애인과 비장애인의 건강격차에 미치는 영향 요인 : 주관적 건강수준을 중심으로

최민혁,황인경,윤태호 한국자료분석학회 2018 Journal of the Korean Data Analysis Society Vol.20 No.2

The purposes of this study were to (a) examine disparity in perceived poor health status among people with and without disability, (b) compare the impact of factors, especially income level, on the perceived health status, and (c) determine the impact of disability status on perceived health by income level. The 2014 national survey for the people with disability and the 2013 Korea national health and nutrition examination survey were used to examine the impact of predictors on perceived poor health. logistic regression models were used to estimate the odds ratio of perceived poor health. Among people with disability, 53.7% reported poor self-rated health. People with disability were 3.76 times more likely to report perceived poor health status. The OR of perceived poor health among people with disability was higher in people with severe disability, including brain injury, renal failure, and physical disability. The impact of disability was greater in people with lower income levels. To improve the health status of persons with disability, policies are needed to reduce health disparities among socioeconomic levels. 본 연구는 장애인과 비장애인간의 건강수준에 미치는 요인을 파악하고 특히 장애요인(장애 유무, 정도, 유형)이 미치는 영향과 소득수준에 따른 장애요인의 영향을 살펴보고자 수행되었다. 이를 위해 2014년 장애인실태조사와 2013년 국민건강영양조사 원자료 11,566건을 활용하여 장애인과 비장애인의 주관적 불건강 수준을 산출하였으며, 가중치를 적용한 복합 자료를 위한 로지스틱 회귀분석을 활용하여 장애요인이 주관적 불건강에 미치는 영향을 살펴보았다. 더불어 소득수준에 따라 장애요인이 미치는 영향을 확인하였다. 장애인의 주관적 불건강 수준은 53.7%(95% CI 52.2-55.2%)로 비장애인 14.0%(95% CI 13.0-15.0%)보다 3.8배 높았다. 일반적 요인을 보정한 후 장애인이 비장애인에 비해 주관적으로 불건강할 가능성은 3.76배(OR=3.76) 높았으며, 특히 중증장애를 가진 경우 5.58배 높았다. 장애유형별 영향은 뇌병변장애를 가지고 있는 경우 가장 컸으며(OR=11.17), 다음으로 신장 장애(OR=6.27), 지체 장애(OR=3.63) 및 정신 장애(OR=3.60) 등의 순이었다. 소득수준별로 장애유무의 영향을 살펴보았을 때, 소득수준이 높은 집단에 속한 경우 보다 소득수준이 낮은 집단에 속한 경우에 영향이 더 컸다. 연구결과를 바탕으로 볼 때, 장애인의 사회경제적 수준을 높이는 정책이 필요하다.

장애 유형별 의료서비스 이용의 차이

윤태호 ( Tae Ho Yoon ),정백근 ( Baek Geun Jeong ),강윤식 ( Yune Sik Kang ),이상이 ( Sang Yi Lee ),김철웅 ( Chul Woung Kim ) 한국보건행정학회 2007 보건행정학회지 Vol.17 No.2

The disabled population is a vulnerable group, having very complex medical conditions, but little is known about differences in the level of access by type of disability. This study was performed to investigate the differences of health care utilization by the type of disability. The database was constructed from registry of the disabled and health insurance and medical aid claims data submitted to the Korea Health Insurance Cooperation during in the year 2003. The disability classified three groups according to the Disabled Welfare Act; physically disability with external dysfunction, physically disability with organic disease, and mentally disability. There were huge differences in health care utilization by the type of disability. For the inpatient care, those with a mental disability were more likely to utilize health care services in terms of average visit number of medical facilities and visit days per case, but the treatment amount per case was the highest in physically disabled with organic disease. For the outpatient care, those who the physically disabled with organic disease were more likely to utilize health care services in terms of average visit number of medical facilities, treatment amount per case, and the treatment days per case. Also, those who physically disbled with organic disease were more likely to utilize general hospital for both inpatient and outpatient care, and spent more out-of-pocket expenditure. As the number of persons with disabilities rises, the need to consider new approaches to protecting their health grows increasingly. Especially, Korean health care system should be refined to be more responsive to the needs of the type of disability.

시각 장애인의 예방적 건강검진, 건강행태와 정신 건강에 대한 분석

심종우,한승한,Jong Woo Shim,Seung Han Han 대한안과학회 2012 대한안과학회지 Vol.53 No.12

Purpose: To better understand visual disabilities via preventative health examination, health behavior, and psychological health. Methods: The preventative health examination, health behavior, and psychological health records of 4,724 participants over the age of 40 who completed the third Korean National Health and Nutrition Examination Survey (KNHANES III) were analyzed. The participants were divided into 3 groups for analysis: subjects without disabilities, subjects with disabilities but without visual disabilities, and subjects with visual disabilities. The unadjusted mean and the adjusted mean for which socioeconomic factors were adjusted were calculated. Results: In the preventative health examination there were no differences between the 3 groups except for a statistically significant increase in the number of cholesterol check-ups in the visual disability group. In the health-related behavior analysis, lifetime smoking and routine physical activity were similar between the visual disability and no disability group, however, these factors were greater in the disability without visual disability group. The analysis of psychological health revealed that major depressive symptoms, suicidal ideation, suicidal attempts and psychological consultations were greater in the disability without visual disability and the visual disability groups compared to the participants without disability. However the overall number of psychological consultations was low. Conclusions: There was no difference in the frequency of preventative health examinations between each group. However, there was an increase in the prevalence of psychological problems in subjects with visual disabilities compared to subjects without disabilities and subjects with disabilities but without visual disabilities. Thus, ophthalmologists should consider psychological aspects when dealing with patients with visual disturbances.

장애노인의 장애수용이 주관적 건강상태와 삶의 만족도에 미치는 영향

고민석(Min-Seok, Ko) 한국보건복지학회 2015 보건과 복지 Vol.17 No.-

The purpose of this study is to analyze the relationships among disability acceptance, self-rated health status and life satisfaction of the elderly with disabilities. From the fifth panel survey of employment for the disabled, data for 516 elderly over age of 65were analyzed with SPSS 22.0 and the Sobel test. The results were as follows: First, there were significant differences in sex, age and causes of disabilities. Second, the mean scores of self-rated health status in aging with disability group were higher than those in disability with aging group. Third, disability acceptance of the elderly with disabilities had a positive influence on the self-rated health status and life satisfaction. Also, the self-rated health status had a mediating effect on the relationship between disability acceptance and life satisfaction in elderly with disabilities and aging with disability group. However, the self-rated health status that had a mediating effect was not statistically significant in disability with aging group. This study shows that it is important to provide an integrated health and welfare support program that coincides with a variety of social programs to elderly with disabilities. In addition, a differentiated service support program should be provided to disability with aging group.

장애인 보호자의 구강보건인식 태도

정화영,김윤신,정미애 한국지체.중복.건강장애교육학회 2009 지체.중복.건강장애연구 Vol.52 No.2

The purpose of this study was to examine the oral health awareness of disabled people's guardians in an effort to help promote the oral health of the disabled, as those people were bound to rely on their guardians for oral health care due to their own poor oral health care skills. The subjects in this study were the guardians of students in Ohseong School and Cheonghae School that were respectively located in Gang- neung and Sokcho, Gangweon province. After a survey was conducted from October 6 to 20, 2008, the answer sheets from 255 respondents were gathered, and 214 answer sheets were analyzed with SPSS (Statistical Package for the Social Science) WIN 13.0 program except incomplete ones. Statistical data on frequency and percentage were obtained to find out their general characteristics, and x2(Chi-square) test and frequency analysis were utilized to check into the oral health awareness of the guardians, their use of dental treatment and the oral health care attitude of the disabled students. The findings of the study were as follows: 92.1 percent of the guardians investigated had an interest in the oral health of the disabled, and 52.8 percent considered them to be in a bad oral health. The majority that accounted for 93.5 percent had never received oral health education for the disabled. They were most interested in the dental caries treatment of the disabled and preferred a medical institution adjacent to their residences. They complained of expensive treatment fee(22.4%), and they also complained that some medical institutions rejected to treat disabled people because of prejudice against them. Since the oral health awareness of guardians who are closely linked to disabled people has a huge impact on the dental care of the disabled, disabled people and their guardians should continue to be motivated to wake up to the importance of oral health, and institutional measures should be taken to let them receive oral health education without any difficulties. And oral health education experts should be nurtured.

Analysis of Health Promotion Behaviors according to Physical Activity Participation Patterns of Physically Handicapped People: Application and Supplementation of Health Belief Model

김현륜,백재근 사단법인 한국융합기술연구학회 2022 아시아태평양융합연구교류논문지 Vol.8 No.4

This paper analyzes the health promotion behavior model on the physical activity participation pattern of the physically disabled individuals. To achieve the research purpose, 1,579 people with physical disabilities from five districts (Seoul, Gyeonggi, Chungcheong, Jeolla, and Gyeongsang) were surveyed for 8 weeks from January to March 2021. First, the researcher and assistant researcher directly visited and conducted the athletic meet in order to collect data on the participants in the athletic meet for the physically disabled. Second, in cooperation with welfare centers for the disabled, the size of welfare centers for the disabled by region was identified, and research objectives and research data were collected. For the collected data, K-means cluster analysis, independent t-test, and structural equation model were applied using SPSS 23.0 and AMOS 23.0 programs, and the results are as follows. First, it was found that the full participation group was statistically significantly higher than the incomplete participation group in the participation period, participation frequency, and frequency of participation in the difference according to the cluster classification results according to the physical activity participation type of the physically disabled. Second, the difference in health beliefs according to the physical activity participation type of the physically disabled was statistically significantly higher in the full participation group than in the incomplete participation group in severity(p<.05). Third, in the difference in health promotion behavior according to the physical activity participation type of the physically disabled, the group that did not participate in the health promotion activity was found to be statistically significantly higher than the fully participated group(p<.05). Finally, the relationship between sensitivity and health promotion showed a positive (+)significant effect(p<.01), the relationship between sensitivity and health promotion activity(p<.001), and the relationship between severity and health promotion was significant(p<.001). was found to have an effect(p<.001). In addition, the relationship between benefit and health promotion was found to have a significant effect on benefit (+)(p<.001), benefit and internal/external factors(p<.001), and benefit and health promotion activity(p<.001). Also, the relationship between disability and internal/external factors was found to have a significant positive (+)effect(p<.01). Through the above results, it was possible to know the structural relationship between health beliefs and health promotion behaviors according to the physical activity participation type of the physically disabled.

보건소의 장애인 구강보건사업에 관한 연구

우승희 ( Seung Hee Woo ),김윤정 ( Youn Jung Kim ),곽정숙 ( Jung Suk Gkuk ) 한국치위생학회 2008 한국치위생학회지 Vol.8 No.3

Oral health projects that cater to the disabled should be more prevailing in order to ensure the maintenance and successful promotion of the oral health of disabled people. 70 public dental clinics that conducted oral health projects geared toward the disabled were examined to get a precise grip on their oral health projects. The findings of the study were as follows: 1. 31 out of 70 public dental clinics investigated(44.3%) were equipped with two or more dental hygienists who were professional human resources in charge of the oral health projects for the disabled. As for the age and disability type of the beneficiaries of the oral health projects, adolescents(74.3%) and people with mental retardation(87.1%) benefited most from the oral health projects. Concerning the most common implementation frequency of the projects, the projects were carried out once to three times a week(62.9%). 2. The most dominant oral disease treatment provided to disabled people was amalgam treatment and resin treatment(68.6%), which were the early dental caries treatment. The most common preventive treatment that was offered to improve their oral health was oral prophylaxis (82.9%). As for reform measures for the oral health projects, education of personnels in charge of the projects and their specialization(58.6%) were most emphasized. 3. Regarding factors related to the preventive oral health projects for the disabled, the implementation of oral prophylaxis and toothbrushing education was linked to the age of the beneficiaries. More oral prophylaxis was offered to teens, and more toothbrushing education was provided to preschoolers and adolescents. The age of the beneficiaries and the number of dental hygienists responsible for the projects had something to do with the application of fluorides.4. Concerning the relationship of the preventive oral health projects for the disabled to the number of dental hygienists, one of the personnels in charge of the projects, the application of fluorides(54.4%) and pit & fissure sealing(56.8%) were more prevalent when there were two or more dental hygienists. There was a statistically significant disparity in that regard(p<0.05). The above-mentioned findings illustrated that in order to boost the oral health of the disabled, dental hygienists who are responsible for the oral health projects for the disabled should put ceaseless efforts into fostering their professional knowledge and ability and offering quality service to disabled patients. Every public dental clinic should be equipped with plenty of professional personnels to enlarge the scope of treatment and ensure the efficiency of treatment and the preventive projects.

노인의 장애 및 주관적 건강의 남녀차이와 사회경제적 요인의 영향

전경숙,장숙랑,이선자,Jeon, Gyeong-Suk,Jang, Soong-Nang,Rhee, Seon-Ja 대한예방의학회 2009 예방의학회지 Vol.42 No.3

Objectives : Research on the gender differences of health among older Korean people has been limited compared with the research for other stages of life. This study first examined the patterns and magnitude of the gender differences of health in later life. Second, we examined the gender differences in the health of older men and women that were attributable to differing socioeconomic conditions. Methods : Using the nationally representative 2005 Korean National Health and Nutrition Examination Survey, the gender differences in disability and subjective poor health were assessed by calculating the age adjusted and gender-specific prevalence. Logistic regression analyses were used to assess if the differences between the men and women for health could be explained by differential exposure to socioeconomic factors and/or the differential vulnerability of men and women to these socioeconomic factors. Results : Our results indicated that older women were more likely than the men to report disability and poor subjective health. The health disadvantage of older women was diminished by differential experiences with socioeconomic factors, and especially education. The differences shrink as much as 43.7% in the case of disability and 35.4% in the case of poor subjective health by the differential exposure to educational attainment. Any differential vulnerability to socioeconomic factors was not found between the men and women, which means that socioeconomic factors may have similar effect on health in both genders. Conclusions : Differential socioeconomic experience and exposure between the men and women might cause gender difference in health in old age Koreans.

Do age, gender, and subjective health-related factors influence health-related life satisfaction in people with disabilities who are physically active?: a secondary analysis

조현석,안숙희 한국여성건강간호학회 2024 여성건강간호학회지 Vol.30 No.1

Purpose: This study explored the factors influencing the health-related life satisfaction of people with disabilities who engaged in physical activity, by age and gender.Methods: A secondary analysis was conducted of the 2020 Third Disability and Life Dynamics Panel (2021). The participants were 2,796 people who performed regular physical activity at least once a week. The variables selected were disability-related factors (degree of disability, multiple disabilities, and type of disability), sociodemographic factors (age, gender, living alone, and mean monthly family income), and health-related factors (amount of physical activity, self-esteem, depression, chronic disease, subjective health, and health-related life satisfaction). Descriptive statistics, the chi-square test, the t-test, two-way analysis of variance, and multiple regression analysis were conducted.Results: In total, 58.0% of participants were male, and 42.0% were female. For age groups, 14.4% were children/adolescents (0–19 years), 42.6% were adults (20–59 years), and 43.0% were seniors (≥60 years). The mean score for health-related life satisfaction was 5.0±2.15 out of 10. Adults and seniors whose level of physical activity met or exceeded recommendations had higher subjective health. Moreover, men had better subjective health than women in seniors. Health-related life satisfaction was higher among those who had higher self-esteem, were not depressed, did not have chronic diseases, and had better subjective health.Conclusion: Gender significantly influenced health-related life satisfaction in children/ adolescents and seniors. Disability-related factors were significant in adults, and health-related factors were significant in all age groups. Therefore, these factors should be considered when designing interventions to promote subjective health and health-related life satisfaction of people with disabilities.

Severe Preoperative Disability Is Associated With Greater Mental Health Improvements Following Surgery for Degenerative Spondylolisthesis: A Cohort Matched Analysis

Ishan Khosla,Fatima N. Anwar,Andrea M. Roca,Srinath S. Medakkar,Alexandra C. Loya,Aayush Kaul,Jacob C. Wolf,Vincent P. Federico,Arash J. Sayari,Gregory D. Lopez,Kern Singh 대한척추신경외과학회 2024 Neurospine Vol.21 No.1

Objective: To evaluate preoperative disability’s influence on patient-reported outcomes (PROs) following surgery for degenerative spondylolisthesis (DS). Methods: DS patients who underwent surgical intervention were retrospectively identified from a single-surgeon spine registry. Cohorts based on Oswestry Disability Index (ODI) < 41 (milder disability) and ≥ 41 (severe disability) were created. Demographic differences were accounted for with 1:1 propensity score matching. For the matched sample, perioperative and PRO data were additionally collected. PROs assessed included mental health, physical function, pain, and disability. Pre- and up to 2-year postoperative PROs were utilized. Average time to final follow-up was 15.7 ± 8.8 months. Improvements in PROs and minimal clinically important difference (MCID) rates were calculated. Continuous variables were compared through Student t-test and categorical variables were compared through chi-square tests. Results: Altogether, 214 patients were included with 77 in the milder disability group. The severe disability group had worse postoperative day (POD) 1 pain scores and longer hospital stays (p ≤ 0.038, both). The severe disability group reported worse outcomes pre- and postoperatively (p < 0.011, all), but had greater average improvement in 12-item Short Form health survey mental composite score (SF-12 MCS), 9-Item Patient Health Questionnaire (PHQ-9), visual analogue scale (VAS)-back, and ODI by 6 weeks (p ≤ 0.037, all) and PHQ-9, VAS-back and ODI by final follow-up (p ≤ 0.015, all). The severe disability cohort was more likely to achieve MCID for SF-12 MCS, PHQ-9, and ODI (p ≤ 0.003, all). Conclusion: Patients with greater baseline disability report higher POD 1 pain and discharge later than patients with milder disability. While these patients report inferior physical/mental health before and after surgery, they report greater improvements in mental health and disability postoperatively.