흡연이 구강질환관련 의료이용에 미치는 영향

Abstract

[한글]

본 연구의 목적은 흡연으로 인한 구강질환 발생으로 진료비 증가가 경제적 부담이 되는 상황에서 구강질환과 구강질환관련 진료비의 상호 관련성을 파악하여 금연사업 등 국민건강증진에 기초 자료를 제공하고자 한다. 이 연구는 단면연구와 후향적 코흐트 연구를 통하여 흡연여부에 따른 구강질환 유병률과 발생률, 진료비 지출과의 관련성을 파악하였다. 연구대상은 2000년 인천지역 구강검진자 중 138,448명을 대상으로 구강질환 유병률과 진료비 지출 관련성을 분석하였고, 2000년과 2006년 연속 구강검진자 54,696명을 대상으로 구강질환 발생률 관련성을 연구하였다.연구결과는 다음과 같다.1. 연구대상자의 성별 분포는 남자 73%(101,095명), 여자 27%(37,353명)이였으며, 평균연령은 38.9세였다. 성별 흡연율을 보면 남자 현재흡연자는 57.4%, 여자 현재흡연자는 2.1%였다. 연령별 남성 흡연율은 20-29세 64.3%, 30-39세 60.5%, 40-49세 55.4%, 50-59세 48.3%, 60세 이상은 38.1%로 연령이 증가할수록 흡연율이 감소하였다.2. X2-test 분석을 통해 남자 치아우식증 유병률은 비흡연자 26.9%, 과거흡연자 25.7%, 현재흡연자 31.5%로 현재흡연자가 통계적으로 유의하게 높았다.남자 치주질환 유병률은 비흡연자 58.4%, 과거흡연자 58.8%, 현재흡연자 68.8%로 현재흡연자가 통계적으로 유의하게 높았다.남자 결손치 유병률은 비흡연자 16.6%, 과거흡연자 18.3%, 현재흡연자 19.8%로 현재흡연자가 통계적으로 유의하게 높았다.3. 단면연구에서 로지스틱 분석을 통해 치아우식증, 치주질환, 결손치 유병률을 분석하였다.치아우식증은 비흡연자에 비해 현재흡연자가 1.21배로 높았고, 연령이 증가할수록 치아우식증 유병률이 낮았다.치주질환은 비흡연자에 비해 현재흡연자가 1.58배 높았으며 통계적으로 유의하였다.결손치는 비흡연자에 비해 현재흡연자가 1.44배 높았으며 통계적으로 유의하였다.4. 2000년 정상군 중 2006년 구강검진결과 치아우식증, 치주질환, 결손치 발생률을 분석하였다.치아우식증은 비흡연자에 비해 현재흡연자가 1.22배, 두갑 이상은 1.96배로 높았으며, 연령이 증가할수록 치아우식증 발생률이 낮았다.치주질환은 비흡연자에 비해 현재흡연자가 1.36배, 두갑 이상은 2.69배 높았으며 통계적으로 유의하였다.결손치는 비흡연자에 비해 과거흡연자 1.22배, 현재흡연자 1.66배, 두갑 이상은 2.85배 높았으며 통계적으로 유의하였다.5. 다중회귀분석을 통한 구강질환관련 진료비 지출 관련성을 분석하였다. 구강질환 총진료비는 비흡연자에 비해 과거흡연자는 10,078원, 현재흡연자는 14,963원 높게 지출되었다.치아우식증 진료비는 비흡연자에 비해 과거흡연자는 1,009원 높게 지출되었으나 현재흡연자는 -1,442원 낮게 지출되었으며 통계적으로 유의하였다.치주질환 진료비는 비흡연자에 비해 과거흡연자 8,499원, 현재흡연자 15,872원 높게 지출되었으며 통계적으로 유의하였다.결론적으로 흡연은 치아우식증, 치주질환, 결손치 이환율을 증가시켰고, 구강질환관련 진료비 지출을 증가 시켰다. 흡연으로 인한 구강질환으로 개인의 삶의 질 저하와 진료비 증가에 따른 경제적 부담을 낮추기 위해 금연사업의 활성화가 더욱 필요하다.

[영문]

The purpose of this study was to provide basic data on promoting public health such as smoking cessation campaign by identifying association between oral diseases and medical costs for treating oral diseases under a circumstance that rising dental health costs due to smoking has become the economic burden on an individual patient.The study conducted cross-sectional study and retrospective cohort study to identify association between prevalence and incidence of oral diseases caused by smoking and dental health costs.The study analyzed association between prevalence of oral diseases and medical costs for treating oral diseases based on the population (n=138,448) in Incheon city who received dental health check-up in 2000. The study also investigated association between incidence of oral diseases and medical costs for treating oral diseases based on the population (n=54,696) who received dental health check-up consecutively in 2000 and 2006.The following are the results;1. Regarding sexual distribution of the subjects, 73% (n=101,095) and 27% (n=37,353) of the subjects were male and female respectively. The average age of the subjects was 38.9 years old. The smoking rate of current male smokers by sex was 57.4% and that of current female smokers was 2.1%. The smoking rates in male by age groups were 64.3% in 20-29 years old, 60.5% in 30-39 years old, 55.4% in 40-49 years old, 48.3% in 50-59 years old, and 38.1% in 60 years old or older, meaning that the smoking rate of the older was lower than that of the younger.2. A chi-square test revealed that the incidence rates of dental caries in male were 26.9% in non-smokers, 25.7% in past smokers and 31.5% in current smoker, indicating that the incidence of dental caries in current smokers was significantly high.The test also revealed that the incidence rates of periodontal disease in male were 58.4% in non-smokers, 58.8% in past smokers and 68.8% in current smokers. The incidence of periodontal diseases in male current-smokers was significantly high.The incidence rates of missing teeth in male were 16.6% in non-smokers, 18.3% in past-smokers, and 19.8% in current-smokers. The incidence of missing teeth in current male smokers was significantly high.3. The study used logistic analysis in cross sectional study to analyze the prevalence of dental caries, periodontal disease, and missing teeth.The prevalence of dental caries in current-smokers was 1.21 times higher than that in non-smokers and the prevalence of dental caries was lower in older group than that in younger group.The prevalence of periodontal diseases in current-smoker was 1.58 times higher than that in non-smokers and the result was statistically significant.The prevalence of missing teeth was 1.44 times higher in smokers than that in non-smokers and the result was statistically significant.4. The study analyzed the incidence of newly developed dental caries, periodontal diseases, and missing teeth in 2006 among persons who were normal in oral health check-up in 2000.The incidence of dental caries in current smokers was 1.22 times higher than that in non-smokers and the incidence in heavy smokers who smoke more than two packs a day was 1.96 times higher than that in non-smokers. The incidence of dental caries was lower in older group than that in younger group.The incidence of periodontal diseases in current smokers was 1.36 times higher than that in non-smokers and the incidence in heavy smokers who smoke more than two packs a day was 2.96 times higher than that in non-smokers. The result was statistically significant.The incidence of missing teeth in current smokers was 1.22 times higher than that in non-smokers and the incidence in heavy smokers who smoke more than two packs a day was 2.85 times higher than that in non-smokers. The the result was statistically significant.5. The study used multiple regression analysis to investigate association between incidence of oral diseases and medical costs for treating oral diseases. Total dental health costs for past smokers and current smokers were 10,078 won and 14,963 won higher respectively than those for non-smokers.Medical costs for treating dental caries of past smokers were 1,009 won higher but those of current smokers were 1,442 won lower than those of non-smokers. The result was statistically significant.Dental health costs for past smokers and current smokers were 8,499 won and 15,872 won higher respectively than those for non-smokers and the result was statistically significant.In conclusion, smoking increased dental health costs and morbidity rate of dental caries, periodontal disease and missing teeth. Additionally, smoking also increased dental health costs. To reduce the economic burden of patients and to prevent their quality of life from being decreased due to dental problem and increasing dental health costs caused by smoking, it is desirable to encourage smoking cessation campaign.