시각장애인에서 장애 등록 시점 전후 만성 및 외상질환 발생 변화에 관한 연구
Changes in Incidences of Chronic and Traumatic Diseases before and after Registration as Visually Disabled
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목적: 만성 대사질환과 외상질환의 시각장애 등록 전후 발생 변화를 분석해보고자 한다. 대상과 방법: 2005년부터 2013년까지 시각장애인으로 등록된 환자들과 연령, 성별, 보험료 분위수, 거주 지역 분포에 대하여 1:1 성향점수매칭을 통해 선정한 대조군에서 질병 발생 비율과 위험도를 비교하였다. 국민건강보험공단 자료를 이용하였으며, 관찰 기간은 시각장애 등록 시점을 기준으로 2년 전부터 5년 후까지로 정하였다. 관심 시점에서 질환의 발생 비율(%)은 장애 등록 연도별 발생 비율의 평균으로 구하였고, 위험도는 조건부 로지스틱 회귀분석을 이용해 측정하였다. 결과: 총 131,434명의 시각장애 환자군과 동일한 수의 대조군이 포함되었다. 만성 대사질환과 낙상 관련 부상의 발생 비율은 장애 등록 이전에는 시각장애인에서 더 높았으나, 장애 등록 이후에는 점차 감소하여 대조군과 유사하게 변화하였다. 또한 장애 등록 후 2년까지 시각장애인에서 만성 질환의 발생 위험이 더 높았던 반면, 낙상 관련 부상의 발생 위험은 시각장애인에서 관찰 기간 동안 지속적으로 높았다. 고관절 골절은 시각장애인에서 장애 등록 이전 약 1년 전부터 점차 증가하여 대조군에 비해 발생 비율과 위험이 지속적으로 높았다. 결론: 시각장애인은 비장애인보다 만성 질환의 발생 빈도가 높고, 고관절 골절이나 낙상 등 외상질환에 노출될 위험이 크다. 시각장애인 환자들뿐만 아니라 장애 등록 예정인 환자들에서 각종 질환들의 발생을 예방하고 조기에 치료할 수 있도록 지역사회 인프라를 확충하고, 복지 서비스를 확대 실시해야 할 것이다.
Abstract
Purpose: To analyze changes in the incidences of chronic and traumatic diseases before and after registration as visually disabled. Methods: The incidence and risk of chronic and traumatic diseases were compared between patients registered as visually disabled from 2005 to 2013 and a control group, selected through 1:1 propensity score matching for age, sex, premium quantile, and residential area distribution. Data from the National Health Insurance Service were used and the observation period was set from 2 years before to 5 years after the time of registration as visually disabled. The incidences (%) of chronic and traumatic diseases at the point of interest were determined as the mean values according to year of registration, and the risk was measured by conditional logistic regression analysis. Results: 131,434 visually disabled patients and the same number of non-visually impaired controls were included. The incidences of chronic disease and fall-related injury were higher in the visually disabled group before registration, but gradually decreased and became similar to the control group after registration. In addition, the risk of developing chronic diseases was higher in the visually disabled group until 2 years after registration, while the risk of fall-related injury remained consistently higher in the visually disabled group during the observation period. The incidence and risk of hip fracture in the visually disabled group increased gradually from approximately 1 year before registration and remained consistently higher than in the control group. Conclusions: People with visual disability have higher incidences of chronic diseases than do non-visually impaired people and are at greater risk of traumatic injuries, such as hip fractures or falls. There is a need to establish community infrastructure and expand welfare services for the prevention and early treatment of comorbidities, both for patients with registered visual disabilities and for patients who have not yet registered.
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