국민건강보험 표본코호트 데이터베이스를 이용한 한국인 다빈도 복합만성질환 치료유병율의 변화양상과 유형

Abstract

1. 배경 만성질환의 증가와 인구 고령화 등으로 인해 동시에 2개 이상의 만성질환에 이환된 경우는 더 이상 예외적인 형태가 아니다. 복합만성질환자의 복합적인 의료적 필요에 적절히 대응하는 의료전달체계가 구축되지 못할 경우 다양한 보건의료서비스를 이용할 가능성이 높고, 예방 가능한 합병증으로 인한 입원과 응급의료서비스 이용의 가능성이 증가한다. 보건의료체계에 대한 부담 감소와 더불어 환자들의 삶의 질을 향상시키기 위해서는 복합만성질환의 기본구조를 이해하는 것이 필요하며, 이를 위해 어떤 질환이 어떤 과정으로 복합만성질환을 구성하는지, 복합만성질환들간의 상호작용은 어떠한지 등에 대한 정보가 필요하다. 2. 방법 대규모 상용자료원인 국민건강보험공단 표본코호트 자료에 미국 보건복지부에서 제시한 표준화된 만성질환목록을 적용하여 주요 만성질환과 복합만성질환의 변화양상과 유형을 파악하고자 하였다. 연령표준화 치료유병율, 복합만성질환 치료유병율을 산출하였으며, 연령-기간-코호트 분석을 시행하였다. 복합만성질환의 특정 양상을 확인하기 위하여 다빈도 질환조합의 치료유병율과 변화, 관찰/기대 유병비, 탐색적 및 확인적 요인분석을 시행하여 복합만성질환의 기본구조를 파악하고자 하였다. 3. 결과 연령이 증가할수록 만성질환의 유병률, 복합만성질환의 유병률이 증가하고 있으며, 년도가 경과할수록 그 수준도 증가하였다. 출생코호트별로는 이후 출생코호트일수록 주요한 개별 만성질환의 유병율이 증가하고, 2007년 생애전환기 건강검진 등 만성질환관리를 위한 건강검진의 효과 등이 더해져서 그 증가 정도가 커져서, 이후에도 지속적으로 증가할 가능성이 확인되었다. 복합만성질환조합 양상을 대한 분석한 결과 주로 심혈관질환(관상동맥질환, 뇌졸중)과 그 위험요인(고혈압, 당뇨, 이상지질혈증)을 위주로 하여 호흡기계질환(천식, 만성폐쇄성폐질환), 근골격계-대사질환(관절염, 골다공증)이 함께 발생하는 양상을 확인하였다. 4. 결론 본 연구에서 확인된 질환의 기본구조와 변화양상은 한국사회 보건의료체계의 주요한 도전과제인 복합만성질환을 효과적으로 관리할 수 있는 방법을 모색하는데 주요한 근거자료로 활용이 가능할 것이다. |Background Due to aging population and an increase of chronic disease, People those who suffer from two or more chronic diseases simultaneously are not more exceptional forms. If healthcare delivery and management system for complex medical need of Multi-morbid people has not been built, these people are more likely to use various health services, such as hospital and emergency medical services and to suffer preventable complications, functional impairment, disability and mortality. To decrease the burden on the health care system and to improve the patient's quality of life, it is necessary to understand the basic structure of Multimorbidity. To this end, we need to know what kind of diseases and in what process would lead multimorbidity and the interaction between the chronic diseases. Method Using National Health Insurance Corporation sample cohort database, OASH chronic conditions list and algorithm of chronic conditions warehouse (CCW) for US CMS, We tried to figure out pattern and its change of common multimorbidity in Korea. We estimated Age-standardized Treated prevalence of chronic conditions and multimorbidity, perform age-period-cohort analysis. To understand pattern of multimorbidity, we estimated treated prevalence of common diseases pairs and observed/expected ratio of treated prevalence performed exploratory and confirmatory factor analysis. Result With ages, the treated prevalence of chronic diseases and multimorbidity was increased. With years, the level of increase was also increased. Treated prevalence was much more increased in the subsequent birth cohorts. The extent of the increase in treated prevalence would become larger. In the analyzes of the pattern of multimorbidity, We found that cardiovascular disease (coronary artery disease, stroke) and the risk factors (hypertension, diabetes, dyslipidemia) co-occurred primarily and with/without the respiratory diseases (asthma, chronic obstructive pulmonary disease), musculoskeletal-metabolic disease (osteoarthritis, osteoporosis) Conclusion The basic aspects of the structure and changes in the disease was confirmed in this study could be used for finding for ways to be able to effectively manage multimorbidity, a major challenge in the Korean healthcare system; Background Due to aging population and an increase of chronic disease, People those who suffer from two or more chronic diseases simultaneously are not more exceptional forms. If healthcare delivery and management system for complex medical need of Multi-morbid people has not been built, these people are more likely to use various health services, such as hospital and emergency medical services and to suffer preventable complications, functional impairment, disability and mortality. To decrease the burden on the health care system and to improve the patient's quality of life, it is necessary to understand the basic structure of Multimorbidity. To this end, we need to know what kind of diseases and in what process would lead multimorbidity and the interaction between the chronic diseases. Method Using National Health Insurance Corporation sample cohort database, OASH chronic conditions list and algorithm of chronic conditions warehouse (CCW) for US CMS, We tried to figure out pattern and its change of common multimorbidity in Korea. We estimated Age-standardized Treated prevalence of chronic conditions and multimorbidity, perform age-period-cohort analysis. To understand pattern of multimorbidity, we estimated treated prevalence of common diseases pairs and observed/expected ratio of treated prevalence performed exploratory and confirmatory factor analysis. Result With ages, the treated prevalence of chronic diseases and multimorbidity was increased. With years, the level of increase was also increased. Treated prevalence was much more increased in the subsequent birth cohorts. The extent of the increase in treated prevalence would become larger. In the analyzes of the pattern of multimorbidity, We found that cardiovascular disease (coronary artery disease, stroke) and the risk factors (hypertension, diabetes, dyslipidemia) co-occurred primarily and with/without the respiratory diseases (asthma, chronic obstructive pulmonary disease), musculoskeletal-metabolic disease (osteoarthritis, osteoporosis) Conclusion The basic aspects of the structure and changes in the disease was confirmed in this study could be used for finding for ways to be able to effectively manage multimorbidity, a major challenge in the Korean healthcare system