한국 성인의 건강 및 구강건강관련 삶의 질 평가에 관한 연구

Abstract

평균수명의 연장은 인간의 삶의 질에 영향을 미치는 전신건강과 구강건강의 중요성에 대한 인식을 증가시키고 있고, 유병률의 증가는 질병으로 인한 고통과 건강관리에 따른 경제적 부담을 가중시키고 있으므로, 본 연구는 일반건강 및 구강건강관련 삶의 질 수준을 평가하기 위한 측정도구를 검증하고 삶의 질에 영향을 미치는 요인을 규명하여 삶의 질에 영향을 미치는 전신건강과 구강건강의 중요성을 인식시켜 효과적인 보건의료정책과 건강증진프로그램의 마련에 도움이 될 수 있는 자료를 제시하여 국민의 삶의 질 향상에 기여하고자 시도하였다. 2006년 3월~6월까지 전국의 만 65세 이하 성인을 대상으로 한국통신 전화번호부상의 인명을 난수표로 추출하고, 우편으로 설문지를 발송하여 자기기입식 설문조사를 실시하였으며, 구강건강실태조사는 치과의사나 치과의사의 지도하에 치과위생사에게 구강검진을 의뢰하였다. 배부한 설문지 1500부 중 39%인 총 586부를 분석한 결과, 구강건강관련 삶의 질 측정도구인 OHIP-49의 7개 하부영역의 신뢰도계수는 0.8~0.9의 분포였고, 일반건강관련 삶의 질 측정도구인 SF-36의 8개 하부영역의 신뢰도계수는 0.7~0.9의 분포로 측정도구의 모든 영역에서 신뢰할만한 수준의 측정도구였다. 연구대상자의 일반적 특성은 여자가 53.8%로 절반 이상을 차지하였고, 40대가 33.8%로 가장 많았으며, 교육수준은 81.1%가 고졸이상이었고, 월평균수입은 82%정도가 100만원이상이었다. 구강건강상태는 94.3%가 부정교합이었고, 79.3%가 중등도 이상의 치석침착자였으며, 평균 우식치 1.64개, 평균 상실치 1.84개, 평균 충전치 2.70개, 평균 보철치 2.54개였다. 구강건강상태에 따른 일반건강 및 구강건강관련 삶의 질 수준은 교합상태가 정상이고, 치석침착은 적을수록, 상실치와 보철치의 개수가 적을수록 높았고, 통계적으로도 유의하였다. 일반건강 및 구강건강관련 삶의 질 측정에서 구강 내 상실치의 비율은 30%이상일 때 각 영역별로 12~15점 정도가 낮았다. 보철치는 개수에 상관없이 구강건강관련 삶의 질이 비슷하였으나 고정보철물을 장착한 자와 의치장착자와의 구강건강관련 삶의 질의 차이는 각 영역별로 의치장착자가 17~29점정도 낮았다. 구강건강상태가 일반건강관련 삶의 질 점수에 영향을 미침으로써 집중타당도와 판별타당도가 확인되었고, 구강건강관련 삶의 질에 구강건강상태가 영향을 미침으로써 내용타당성과 구성타당성이 확인되어 한국어버전의 OHIP-49와 SF-36의 객관성이 확보되었다. 일반적 특성에 따른 일반건강 및 구강건강관련 삶의 질 수준은 여자에 비해 남자가, 연령이 적을수록, 교육수준이 높을수록, 월평균수입이 많을수록 높았다. 일반건강관련 삶의 질에 영향을 주는 요인은 성별, 연령, 보철치 개수, 상실치 개수, 월평균 수입의 순이었고, 설명력은 28%이었으며, 구강건강관련 삶의 질에 영향을 주는 요인은 연령, 성별, 월평균 수입, 상실치 개수, 충전치 개수, 우식치 개수의 순이었고 설명력은 17%였다. 구강건강관련 삶의 질과 일반건강관련 삶의 질과의 관계는 전체 연구대상자 중 60.5%가 구강건강관련 삶의 질이 높을 때(80점 이상) 일반건강관련 삶의 질도 높았으므로(80점 이상), 일반건강관련 삶의 질 평가에 구강건강관련 삶의 질 점수가 유효함으로써 변별타당성이 확인되었다. 이상으로 구강건강상태가 삶의 질에 영향을 미치는 것으로 보아 더 이상 구강건강을 제외한 건강은 언급할 수 없으며, 구강건강상태에 따라서 삶의 질은 확연히 달라질 수 있으므로 건강한 치아와 구강조직의 중요성이 더욱 부각되었다. 이에 삶의 질 향상을 위해서는 일반건강뿐만 아니라 구강건강관리까지도 병행해야하고 대상별 특성에 맞는 보다 구체적이고 좀 더 세분화된 보건교육에 대한 연구와 개발이 이루어져야 하며, 다양한 대상자에 대한 연구를 통해 보다 타당성 있는 도구의 개발과 검증이 요구된다. 또한 구강건강을 합리적으로 관리하도록 유도할 수 있는 구강보건교육과 성인대상의 계속구강건강관리제도를 활성화시킬 수 있는 다양한 구강보건정책이 필요한 것으로 시사되었다.; An extended life span has made people in general pay more attention to the importance of health and oral health as what affects the quality of life, and that also has contributed to having their health-related financial burden and pain compounded. The purpose of this study was to assess the quality of the general health- and oral health-related lives of adults in an attempt to help formulate more efficient health-care policies and programs, to improve the general and oral health care of adults and ultimately to further their quality of life. The subjects in this study were adults who were under 65 across the nation in Western age. They were selected by using a table of random numbers from a KTF directory, and a self-administered survey was conducted by mail from March through June, 2006. Their answer sheets were gathered by mail, too. Dental hospitals and clinics that the selected people used were asked to provide information on their oral health status. Those who didn't use any dental hospitals or clinics were helped by this researcher to be tested by dentists or by dental hygienists under the supervision of dentists after dental institutions that were accessible to them were selected. 1,500 questionnaires were handed out, and the answer sheets from 586 people were gathered(response rate 39%). The collected data were analyzed with SPSS/PC WIN 12.0 program. The major findings of the study were as follows: 1. As for the reliability of SF-36, an inventory of evaluating the quality of health-related life, Cronbach's alpha of it ranged from 0.7 to 0.9. Concerning the reliability of its oral health-related life, Cronbach's alpha of it was between 0.8 and 0.9, which indicated that the instrument was highly reliable. 2. Concerning relations between their oral health state and the quality of life related to general health and oral health, a higher quality of life was led by those whose occlusal conditions were normal, whose dental calculus was less and who had a less number of missing teeth and prosthetic tooth. And the gap between them and the others was statistically significant. Missing teeth made a difference to the quality of life related to oral health by approximately 12 to 15 scores when the rate of missing teeth accounted for 30 percent or less. The number of prosthetic teeth made little difference to the quality of life, but the denture wearers were different from the others in the quality of life related to oral health by about 17 to 29 scores. 3. As for connections between oral health state and the quality of life related to general health, those whose occlusal conditions were normal were in good shape, and dental calculus was closely tied into general health in five subcategories except for that of physical pain. Missing teeth made a difference by about 12 to 15 scores to the quality of life related to general health, except for vitality and mental health, when the rate of missing teeth represented 30 percent or less. 4. Regarding connections between the general characteristics of the subjects and their quality of life related to general health and oral health, those who were male, who were younger, who were better educated and who had a larger monthly mean income, led a higher-quality of life in association with general health and oral health. And the gap between them and the others was statistically significant. 5. Their gender had the biggest impact on their quality of life related to general health, followed by age, the number of prosthetic tooth, the number of missing teeth and monthly mean income. Their quality of life related to oral health was under the greatest influence of age, followed by gender, monthly mean income, the number of missing teeth, the number of filled teeth and the number of decayed teeth. The influence of all the factors was statistically significant. 6. Concerning relations between the quality of life related to oral health and that related to general health, those whose oral and general health scores were both above 80 made up 60.5 percent of the subjects. The higher quality of life related to oral health was concurrent with the higher quality of life related to general health, and investigating into the former is one of useful ways to find out about the quality of life related to general health. The above-mentioned findings lent credibility to the reliability of the Korean versions of SF-36 and OHIP-49. One's health cannot be complete without a good oral health, and the quality of life definitely hinge on oral health status. So the importance of existing teeth shouldn't be overlooked. Intensive research efforts should be directed into providing successful health education for different group of learners to improve their quality of life, and a larger number of subjects from different backgrounds should be examined to prepare more valid instruments. Improved health education is expected to promote the health of people, to let them stay away from diseases and to help them live a better quality of life, and efficient health-care policies should be prepared to urge them to keep taking care of themselves.