한국 성인의 치주질환과 우울증상과의 관련성 - 2014년 국민건강영양조사 자료 분석 -

Abstract

한국 성인을 대상으로 구강건강과 우울증상과의 관련성을 살펴본 연구가 있었으나 국민건강영양조사 자료를 활용한 연구는 많지 않다. 대부분의 기존 연구는 구강건강에 잠재적 위험 지표인 치주질환에 대해 고찰로, 특정 인구집단을 대상으로 한다거나 흡연, 심장질환, 대사질환 등과 같은 일부 위험요인과 치주질환과의 관련성만을 보았기 때문에 다양한 요인에 대한 연구는 드문 실정이다. 또한 국민건강영양조사자료(1기-5기)의 우울변수를 종속변수로 사용한 논문은 2-3편으로 매우 적었고, 국민건강영양조사 2013년도까지는 우울증상경험률을 예, 아니오로 이분형으로 나눠 분석함으로써 설명력이 매우 낮다고 볼 수 있다. 그러나 제 6기 2차년도 2014년도에서는 기존 우울조사 설문문항의 단점을 보완한 우울증선별도구(PHQ9)로 조사하여 신뢰성이 높아져 종속변수로 활용 가치가 있다고 본다. 따라서 이 연구에서는 제6기 2차년도(2014) 국민건강영양조사 자료를 활용하여 한국 성인남녀를 층별화하여 치주낭 형성과 관련한 인구사회학적, 건강행태적, 구강건강행태적요인과 우울과의 관련성에 대해 조사하고자 하였다. 또한 치주질환에 관련된 구강건강 위험요인들을 파악하며 구강건강을 증진시킬 수 있는 구강보건 관리 및 우울증상 관리를 중재하고 의료정책 방안 모색 등에 기여하고자 한다.

본 연구의 주요 결과는 다음과 같다.

‘치주질환 유병률’ 은 남녀 모두 연령이 높아질수록, 학력과 소득수준이 낮을수록, 만성질환을 한 개 이상 보유할수록 치주질환의 유병률이 높았으며, 남성에게서는 흡연경험자일수록 여성에게서는 음주경험자일수록, 스트레스가 많을수록 치주질환 유병률이 높게 나타났다. 구강관련특성에서는 남녀에서 점심 후 및 취침 전 양치 여부 , 치간칫솔 및 치실사용여부, 본인인지 구강건강상태, 저작 불편과 발음 불편 할수록 치아우식증이 있을 경우 치주질환 유병률이 높았다. ‘우울증상 유병률’ 은 남녀모두 연령이 낮을수록, 흡연경험자일수록, 소득수준이 낮을수록, 스트레스가 많을수록 우울증의 유병률이 높게 나타났다. 여성에게서는 학력이 낮을수록, 만성질환을 한 개 이상 보유하고 있을수록 우울증의 유병률이 더 높게 나타났다. 대상자의 구강관련특성에서는 남녀에서는 본인인지 구강건강상태는 나쁠수록, 저작 불편과 발음 불편을 호소할수록, 치아우식증이 있을수록 우울증의 유병률이 더 높게 나타났다. 로지스틱 회귀분석의 결과 남성의 경우 치주질환은 정상보다 치은염에서 1.7배(OR=1.70, 95%CI 1.10-2.63) 높았으며, 연령은 19-39세 보다 40-59세에서 약 2배(OR=1.97, 95%CI 1.20-3.25) 높았고, 학력은 대졸보다 초졸에서 1.7배(OR=1.73, 95%CI 1.03-2.91) 높았으며, 소득수준은 낮을수록 약 2.5배(OR=2.47, 95%CI 1.51-4.02) 높게 나타났다. 흡연은 비흡연자에서보다 흡연자에서 1.8배(OR=1.86, 95%CI 1.39-2.50) 높았고, 스트레스는 스트레스를 느끼지 않는 경우보다 스트레스를 느낄수록 8배(OR=8.04, 95%CI 4.00-16.16) 높았으며, 발음 불편은 발음 불편을 호소하는 그룹에서 1.5배(OR=1.53, 95%CI 1.06-2.22) 유의하게 높게 나타났다. 로지스틱 회귀분석의 결과 여성의 경우 치주질환은 정상보다 치은염에서 약 1.4배(OR=1.37, 95%CI 1.99-1.82), 치주염에서 1.5배(OR=1.56, 95%CI 1.20-2.03) 높게 나타났다. 연령은 19-39세 보다 40-59세에서 약 2.3배(OR=2.28, 95%CI 1.51-3.42), 60세 이상에서 1.4배(OR=1.44, 95%CI 1.03-2.03) 높았고, 소득수준은 낮을수록 약 2.1배(OR=2.11, 95%CI 1.51-2.96) 높게 나타났다. 흡연은 비흡연자에서보다 흡연자에서 2.3배(OR=2.35, 95%CI 1.53-3.61) 높았고, 스트레스는 스트레스를 느끼지 않는 경우보다 스트레스를 느낄수록 6.7배(OR=6.74, 95%CI 4.34-10.46) 높았으며, 만성질환 수는 하나도 보유하고 있지 않은 사람에 비해 만성질환을 3개 이상 보유하고 있는 사람에게서 1.8배(OR=1.86, 95%CI 1.28-2.72) 높게 나타났다. 본인인지 구강건강상태는 자신의 구강건강상태가 나쁘다고 인지할수록 약 1.4배(OR=1.381, 95%CI 1.12-1.71) 높았고, 저작불편은 저작 불편을 호소하는 그룹에서 1.7배(OR=1.72, 95%CI 1.31-2.25) 유의하게 높게 나타났다. 성인의 치주질환과 우울증상은 인구사회학적특성, 건강행태적, 구강건강행태적요인에 유의한 차이가 있었으며, 특히 남녀 모두 치주질환과 우울증상에 유의한 관련성이 있었지만 그중에서도 남성보다 여성에게서 치주질환이 우울증상과 더 깊은 관련이 있었다. 이에 따라 구강건강을 유지·증진 시키는 체계적이고 지속할 수 있는 중재 프로그램이 요구된다. 또한 치주질환을 겪고 있는 여성들에게서 우울증상 예방과 정신건강 증진을 위한 자료를 제공하고, 성별에 따라 개인별 맞춤형 보건교육을 실시하여 구강건강 및 정신건강을 높이려는 노력이 필요하다.

핵심어: 성인, 치주질환, 우울증상, 2014년 국민건강영양조사

|Abstract

The Relationship Depressive symptoms and Periodontal Disease in Korean Adults 2014 Korea National Health and Nutrition Examination Survey

JIN YEONG KANG Dept. of Department of Public Health Graduate School of Hanyang University

Purpose : The present study aimed to investigate the association between periodontal pocket formation-related sociodemographic, health behavioral, and oral health behavioral factors and depression in stratified male and female adults. The present study also aimed to identify the oral health risk factors related with periodontal disease and to contribute to the development of interventions for oral health management that can promote oral health and for the management of depressive symptoms and exploring related health policies.

Method : In the present study, a total of 3,992 Korean male and female adults aged ≥19 years, excluding those with missing values, were stratified and finally analyzed using data from the 6th National Health and Nutrition Examination Survey, 2014.Descriptive statistical analyses were performed to calculate the frequency and percentage of general, health-related, and oral-related characteristics. Chi-square tests were used to analyze the differences in the distributions of the general, health-related, and oral-related characteristics by the presence of periodontal disease and depressive symptoms. Multiple logistic regression analysis was performed to finally determine the sex-stratified association between periodontal disease and depressive symptoms. All statistical significance levels were set at p < 0.05, and statistical analyses were performed using SPSS WIN 22.0 (IBM Corp., Armonk, NY).

Result : For male adults, the prevalence of periodontal disease was 1.7 times higher (OR = 1.70, 95% CI 1.10-2.63) in those with gingivitis, about 2 times higher (OR = 1.97, 95% CI 1.20-3.25) in those aged 40-59 years than in those aged 19-39 years, 1.7 times higher (OR = 1.73, 95% CI 1.03-2.91) in elementary school graduates than in university graduates, and about 2.5 times higher (OR = 2.47, 95% CI 1.51-4.02) with lower income levels. The prevalence of periodontal disease was 1.8 times higher (OR = 1.86, 95% CI 1.39-2.50) in smokers, 8 times higher (OR = 8.04, 95% CI 4.00-16.16) with greater stress, and 1.5 times higher (OR = 1.53, 95% CI 1.06-2.22) with complaints of pronunciation discomfort. For female adults, the prevalence of periodontal disease was about 1.4 times higher (OR = 1.37, 95% CI 1.99-1.82) in those with gingivitis, 1.5 times higher (OR = 1.56, 95% CI 1.20-2.03) in those with periodontics, about 2.3 times higher (OR = 2.28, 95% CI 1.51-3.42) in those aged 40-59 years than in those aged 19-39 years, and 1.4 times higher (OR = 1.44, 95% CI 1.03-2.03) in those aged ≥60 years. The prevalence was about 2.1 times higher (OR = 2.11, 95% CI 1.51-2.96) with lower income levels, 2.3 times higher (OR = 2.35, 95% CI 1.53-3.61) in smokers, and 6.7 times higher (OR = 6.74, 95% CI 4.34-10.46) with greater stress. The prevalence was 1.8 times higher (OR = 1.86, 95% CI 1.28-2.72) in those with ≥3 chronic diseases, about 1.4 times higher (OR = 1.381, 95% CI 1.12-1.71) in those who recognized that they had poor oral health, and 1.7 times higher (OR = 1.72, 95% CI 1.31-2.25) in those who complained of masticatory discomfort.

Conclusion: The present study found that, although periodontal disease was significantly associated with depressive symptoms in both men and women, periodontal disease was more closely associated with depressive symptoms in women than in men. Therefore, the epidemiologic significance of the study is the provision of baseline data for oral health and mental health interventions. Oral health education programs including the prevention of periodontal disease and regular oral examinations in adults should be developed, and future mental health programs should also consider sex and age.

Key words: Adults, Periodontal disease, Depressive symptom, the National Health and Nutrition Examination Survey, 2014.; Abstract

The Relationship Depressive symptoms and Periodontal Disease in Korean Adults 2014 Korea National Health and Nutrition Examination Survey

JIN YEONG KANG Dept. of Department of Public Health Graduate School of Hanyang University

Purpose : The present study aimed to investigate the association between periodontal pocket formation-related sociodemographic, health behavioral, and oral health behavioral factors and depression in stratified male and female adults. The present study also aimed to identify the oral health risk factors related with periodontal disease and to contribute to the development of interventions for oral health management that can promote oral health and for the management of depressive symptoms and exploring related health policies.

Method : In the present study, a total of 3,992 Korean male and female adults aged ≥19 years, excluding those with missing values, were stratified and finally analyzed using data from the 6th National Health and Nutrition Examination Survey, 2014.Descriptive statistical analyses were performed to calculate the frequency and percentage of general, health-related, and oral-related characteristics. Chi-square tests were used to analyze the differences in the distributions of the general, health-related, and oral-related characteristics by the presence of periodontal disease and depressive symptoms. Multiple logistic regression analysis was performed to finally determine the sex-stratified association between periodontal disease and depressive symptoms. All statistical significance levels were set at p < 0.05, and statistical analyses were performed using SPSS WIN 22.0 (IBM Corp., Armonk, NY).

Result : For male adults, the prevalence of periodontal disease was 1.7 times higher (OR = 1.70, 95% CI 1.10-2.63) in those with gingivitis, about 2 times higher (OR = 1.97, 95% CI 1.20-3.25) in those aged 40-59 years than in those aged 19-39 years, 1.7 times higher (OR = 1.73, 95% CI 1.03-2.91) in elementary school graduates than in university graduates, and about 2.5 times higher (OR = 2.47, 95% CI 1.51-4.02) with lower income levels. The prevalence of periodontal disease was 1.8 times higher (OR = 1.86, 95% CI 1.39-2.50) in smokers, 8 times higher (OR = 8.04, 95% CI 4.00-16.16) with greater stress, and 1.5 times higher (OR = 1.53, 95% CI 1.06-2.22) with complaints of pronunciation discomfort. For female adults, the prevalence of periodontal disease was about 1.4 times higher (OR = 1.37, 95% CI 1.99-1.82) in those with gingivitis, 1.5 times higher (OR = 1.56, 95% CI 1.20-2.03) in those with periodontics, about 2.3 times higher (OR = 2.28, 95% CI 1.51-3.42) in those aged 40-59 years than in those aged 19-39 years, and 1.4 times higher (OR = 1.44, 95% CI 1.03-2.03) in those aged ≥60 years. The prevalence was about 2.1 times higher (OR = 2.11, 95% CI 1.51-2.96) with lower income levels, 2.3 times higher (OR = 2.35, 95% CI 1.53-3.61) in smokers, and 6.7 times higher (OR = 6.74, 95% CI 4.34-10.46) with greater stress. The prevalence was 1.8 times higher (OR = 1.86, 95% CI 1.28-2.72) in those with ≥3 chronic diseases, about 1.4 times higher (OR = 1.381, 95% CI 1.12-1.71) in those who recognized that they had poor oral health, and 1.7 times higher (OR = 1.72, 95% CI 1.31-2.25) in those who complained of masticatory discomfort.

Conclusion: The present study found that, although periodontal disease was significantly associated with depressive symptoms in both men and women, periodontal disease was more closely associated with depressive symptoms in women than in men. Therefore, the epidemiologic significance of the study is the provision of baseline data for oral health and mental health interventions. Oral health education programs including the prevention of periodontal disease and regular oral examinations in adults should be developed, and future mental health programs should also consider sex and age.

Key words: Adults, Periodontal disease, Depressive symptom, the National Health and Nutrition Examination Survey, 2014.