구조방정식 모형을 이용한 사회경제적 수준과 대사증후군의 관련성 분석
The Relationship between Socioeconomic Status and Metabolic Syndrome, Using Structural Equation Modelling
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연구배경: 본 연구는 사회경제적 수준(socioeconomic status), 건강행동, 스트레스와 대사증후군 위험도(metabolic syndrome risks) 사이의 복잡한 관계망을 알아보고자 하였다. 수정된 일반적 개념모델(generalized conceptual model) 을 적용하여 이들 사이의 관련성을 설명하였고 구조방정식모델(structural equational modelling)을 분석에 이용하였다. 방법: 2004-2007년 사이 Korean Health Examinee Cohort (KOEX)에 등록한 24,210명(남자 8,242명, 여자 15,968명) 을 연구 대상으로 하였고 개별 면담을 통하여 사회경제적수준, 건강행동, 스트레스에 대한 자료를 수집하였다. 사회경제적 수준(교육, 소득, 직업), 건강행동(식이, 신체활동량, 흡연, 음주) 및 스트레스를 외생변수로 하였고, 수정된NCEP ATP-III 기준을 참고하여 대사증후군 위험도를 구하였고 이를 내생변수로 하였다. 결과: 모델적합도 검증 결과, 남자에서는 CFI=0.877, IFI= 0.877, TLI=0.757, RMSEA=0.055였고, 여자는 CFI=0.924, IFI=0.924, TLI=0.851, RMSEA=0.050으로 적합하였다. 남자는 사회경제적 수준(β=-0.08), 건강행동(β=-0.25) 및 스트레스(β=-0.25)가 MetS risk와 유의한 관련성이 있었으나, 여자에서는 SES (β=-0.25)만 관련성이 있었다(P<0.05). 결론: 일반적 개념모델은 건강행동, 스트레스 및 대사증후군 위험도에 미치는 사회경제적 수준의 복잡한 관련성을잘 설명하고 있다. 남자에서는 건강행동, 여자에서는 사회경제적 수준이 대사증후군 위험도와의 관련성이 가장 높았다. 또한 사회경제적 수준은 연령, 건강행동, 스트레스와도강한 관련성을 보였다.
Abstract
Background: This study aimed to investigate the complexity of the relationships between socioeconomic status, health behaviors, stress and risks of metabolic syndrome. By applying structural equational modelling, modified generalized conceptual model had described the associations and interactions among them. Methods: 24,210 participants (8,242 men, 15,968 women) registered with the Korean Health Examinee Cohort (KOEX) between 2004 to 2008. This study collected data on the socioeconomic status, health behaviors, and stress through individual interviews. Socioeconomic status (education, house income, occupation), health behaviors (diet, physical activity, smoking, alcohol consumption) and stress level were defined as exogenous factors. Endogenous variables were risks of metabolic syndrome based on modified National Cholesterol Education Program Adult Treatment Panel-lll (NCEP ATP-lll, 2006). Results: According to model fitness test, these proposed model were acceptable in men, comparative fit index= 0.877, incremental fit Index=0.877, Tucker-Lewis index=0.757, root-mean-squared error associated=0.055. These were compatible also in women as comparative fit index=0.924, incremental fit index=0.924, Tucker-Lewis index=0.851, root-mean-squared error associated=0.050. There were sex difference related to risks of metabolic syndrome: in men socioeconomic status (β=-0.08), health behaviors (β=-0.25) and stress (β =-0.25) were relevant, but in women only socioeconomic status (β=-0.25) was relevant (P<0.05). Conclusions: A conceptual model properly explains how Socioeconomic status may influence on health behaviors, stress, and risks of metabolic syndrome. Health behaviors in men and socioeconomic status in women had the strongest associations with risks of metabolic syndrome. In addition, socioeconomic status was strongly associated with health behaviors, stress and age.
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