시공간 분석을 이용한 외래 의료이용의 지역적 차이 분석 = Regional Disparity of Ambulatory Health Care Utilization

다국어 초록 (Multilingual Abstract)

The purpose of this study was to examine the regional disparity of ambulatory health care utilization considering spatio-temporal variation in South Korea during 1996-2008(precisely, in 1996, 1999, 2002, 2005, and 2008) using bayesian hierarchial spatio-temporal model. The spatial pattern uses an intrinsic gaussian conditional autoregressive (CAR) error component. Ornstein-Uhlenbeck method was applied to detect the temporal patterns. The results showed that substantial temporalgeographical variation depending on diseases exists in Korea. On the Contrary to the pattern of total outpatient utilizations, for example, the areas that chronic diseases distributed relatively high were most in rural where the proportion of elderly population was higher than in the urban. Chungcheongnam-do, Junlabuk-do, and Kyeongsangbuk-do had higher risks in hypertension, whereas arthritis was higher risk in the Kyeonggi-do, Chungcheongbuk-do, Junlanam-do, and Junlabuk-do. The results of this study suggested that the effective health intervention programmes needed to alleviate the regional variation of health care utilization. These outcomes also provided the foundation for further investigation of risk factors and interventions in these high-risk areas.

참고문헌 (Reference)

1 신호성, "표준화사망비와 지역결핍지수의 상관관계: 지역사회 통합결핍지수 개발" 대한예방의학회 42 (42): 392-402, 2009

2 박은옥, "지역사회 보건사회지표를 이용한 지역사회 건강수준과 관련 요인 분석" 지역사회간호학회 19 (19): 13-26, 2008

3 김양균, "지역별 의료이용수준에 영향을 미치는 요인분석" 延世大學校 大學院 1995

4 신의균, "지역간 의료이용수준의 차이와 요인에 관한 연구" 경희대학교 대학원 2005

5 이용재, "지역간 건강보험이용의 형평성과 요인에 관한 연구" 중앙대학교 대학원 2006

6 강호제, "시공간분석기법: 시공간분석의변화와 응용" 309 : 104-111, 2007

7 박건희, "비의도적 손상 사망의 시공간적 분포와 이에 영향을 미치는 요인" 서울대학교 보건대학원 2009

8 남광우, "부산시 응급의료서비스의 시공간적 분포특성" 한국지리정보학회 10 (10): 113-123, 2007

9 김광구, "공간 자기상관의탐색과 공간회귀분석의 활용" 한국정책분석평가학회 13 (13): 273-306, 2003

10 Hayward, K., "The tides of change addressing inequity and chronic disease in Atlantic Canada" 51-65, 2003

11 Besag, J., "The detection of clusters in rare diseases" 154 (154): 143-155, 1991

12 Galauzi, G., "Social inclusion as a determinant of health" 1-6, 2002

13 Booth, G.L, "Neighbourhood Environments an Resources for Healthy Living: A Focus on Diabetes in Toronto" Institute for Clinical Evaluative Sciences 299-307, 2007

14 Doreian, P., "Linear models with spatially distributed data : spatial disturbances or spatial effects?" 9 (9): 29-60, 1980

15 Doreian, P., "Estimating Linear models with spatially distributed data. in Samuel Leinhardt(2d.). Sociological methodology" The Jossey-Bass Publishers 1981

16 Evans, T., "Challenging Inequalities in Health from Ethics to Action" Oxford University Press 2001

17 Branscum, A.J, "Bayesian spatiotemporal analysis of foot-andmouth disease data from the Republic of Turkey" 136 (136): 833-842, 2008

18 Bivand, R.S., "Applied Spatial Data Analysis with R" Springer 237-272, 2008