성인 인플루엔자 예방접종 실태와 사회경제적 및 의료적요인과의 관련성
Influenza Vaccination Status in Korean Adult Population in Relation with Socioeconomic and Medical Factors
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연구배경: 인플루엔자는 질병의 이환과 사망을 일으키고, 의료비와 사회경제적 비용을 발생시킨다. 본 연구에서는 대상자를 19-64세 성인과 무료접종이 가능한 65세 이상 노인두 그룹으로 나누어 사회경제 및 의료적 관련 요인을 알아보고자 하였다. 방법: 국민건강영양조사 제6기 1차년도(2013) 자료를 이용하여 인플루엔자 예방접종 항목에 응답한 19세 이상 성인 1,412명을 대상으로 하였다. 설문에는 예방접종 여부, 접종 횟수, 접종 시기, 접종 장소를 포함하였다. 관련 요인은사회경제적 요인으로 나이, 성별, 교육수준, 결혼상태 등을, 의료적 요인으로 질환 여부, 건강검진 여부, 음주, 흡연 등을 고려하였다. 접종률과 변수의 상관관계를 평가하기 위해단변량 분석을 실시하였고, 통계적으로 유의한 변수를 보정하여 다변량 분석을 실시하였다. 결과: 인플루엔자 접종률은 19-64세 24.9%, 65세 이상80.5%로 크게 차이가 있었다. 다변량 분석 결과 19-64세는의료이용을 하는 경우 1.37배(1.03-1.83), 만성질환자 2.21배(1.43-3.40), 기초수급 대상자 2.21배(1.03-4.78)로 높았고, 검진을 안 받는 군 0.70배(0.52-0.94), 고위험음주를 하는 경우0.41배(0.24-0.70)로 낮았다. 65세 이상에서는 의료이용을할 때 1.82배(1.28-2.59), 암 4.79배(1.07-21.54)로 높았고, 기초수급을 받는 경우는 0.33배(0.14-0.76), 검진을 안 받는 경우 0.37배(0.19-0.73)로 낮았다. 결론: 65세 미만에서는 검진을 안 받거나 고위험음주자등 건강행태가 나쁜 군에서 접종률이 낮았고, 질환자나 의료이용군에서는 높았지만 목표치에는 못 미쳤다. 의료진의권고와 관심을 높이고, 무료접종을 확대 실시함으로써 접종 상승을 기대할 수 있을 것이다. 65세 이상에서는 의료적접근성이 떨어지는 취약계층의 개별적인 관리가 필요할 것으로 생각된다.
Abstract
Background: Influenza causes morbidity and mortality, resulting in the medical and socioeconomic costs. We aimed to analyse whether socioeconomic and medical factors may affect influenza vaccination status divided into 2 groups; one aged 19 to 64 years old and the other aged 65 or over who are eligible for free vaccination. Methods: The study included 1,412 individuals aged 19 and over who responded to influenza vaccination survey, based on 2013 National Health and Nutrition Examination Survey. Related factors were categorized into socioeconomic factors and medical factors. Univariate analyses were conducted to examine the correlations between vaccination rate and each variables. Multivariate analysis was obtained after adjusting variables which were statistcally significant. Results: Influenza vaccination rate was significantly different in the population aged 19 to 64 (24.9%) and the population aged 65 or over (80.5%). In the former population, high vaccination rate was associated with healthcare usage (odds ratio [OR]=1.37, 95% confidence interval [CI]=1.03-1.83), underlying chronic diseases (OR=2.21, 95% CI=1.43-3.40), and public assistance recipient households (OR＝2.21, 95% CI=1.03-4.78), while low vaccination rate was correlated with no use of medical check up (OR＝0.70, 95% CI=0.52-0.94) and heavy alcoholics (OR＝0.41, 95% CI=0.24-0.70). In the latter population aged 65 or over, high vaccination rate was associated with healthcare usage (OR＝1.82, 95% CI=1.28-2.59), and underlying malignancies (OR＝ 4.79, 95% CI=1.07-21.54), whereas low vaccination rate was associated with public assistance recipient households (OR＝0.33, 95% CI=0.14-0.76), and no use of medical check up (OR＝0.37, 95% CI=0.19-0.73). Conclusions: In the population below 65 years old, vaccination rate would be expected to rise by the recommendation of medical care providers and expanding the coverage of free vaccination. In elderly, individualized care for those who have less access to medical care and high susceptibility is highly recommended.
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