지역별 분만서비스 접근도에 따른 산과적 합병증 비교
Obstetric Complications by the Accessibility to Local Obstetric Service
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참고문헌
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초록
이 연구는 건강보험공단으로부터 획득한 2001 년부터 2008년까지 전국 232개 시군구 지역의분만 및 합병증 청구 자료를 바탕으로 산모가자신의 거주 지역 내·외에서 출산하는 비율과산과적 합병증과의 관련성을 밝히기 위한 생태학적 연구이다. 산모가 본인의 거주 지역 밖에서 출산하는 비율인 관외분만율은 정도에 따라 저도 관외분만율지역, 중등도 관외분만율 지역, 고도 관외분만율지역으로 범주화하였으며, 산과적 합병증은 ‘유산, 자궁외 임신 및 기태임신에 따른 합병증율’, ‘유산율’, ‘자간증율’을 구하였다. 관외분만율에 따른 산과적 합병증의 일원배치분산분석에서 저도 및 중등도 관외분만율 지역보다고도 관외분만율 지역이 ‘유산, 자궁외 임신 및기태임신에 따른 합병증율’과 ‘자간증율’이 통계적으로 의미있게 증가하는 경향을 보였고(p<0.05), 산과적 합병증 각각을 종속변수로 한 다중선형회귀분석에서 ‘유산, 자궁외 임신 및 기태임신에 따른합병증율’은 고도 관외분만율 지역(분만서비스 접근취약지역)이 기타 지역보다 유의하게 높은 것으로나타났으며(p<0.01), ‘자간증율’은 고도 관외분만율지역에서 그리고 1인당 지방세납입액이 낮은 지역에서 더 높은 것으로 나타났다(p<0.01). 이 연구를 통해 분만서비스 접근 취약지역에거주하는 산모에서 산과적 합병증이 높음을 나타냈고 따라서 이에 대한 적절한 대책이 세워져야할 필요성을 시사하고 있다. 특히 응급 대응 및산전관리의 충실성을 높이기 위한 체계적인 대안이정책적으로 고려되어야 함을 보여주고 있다. 한편 이 연구는 시군구를 분석 단위로 한 생태학적 연구이므로 산전관리 수진 및 산과적 합병증발생에 영향을 미치는 개인수준에서의 요인들까지고려되지 못한 점은 이 연구의 한계점으로 가지고있다. 따라서 추후 산전관리 및 산과적 합병증에영향을 미치는 산모 개인수준에서의 요인들까지고려한 후속연구가 필요하겠다.
Abstract
Objectives: Pregnant women in rural areas do not have access to sufficient obstetric services in their own communities due to the shortage of obstetricians. Therefore, most of these women must seek obstetrician outside of their communities. The purpose of this study was to investigate the relationship between obstetric complications and accessibility to local obstetric care in Korea. Methods: This study was an ecological study in which the unit of analysis was an administrative district. Using Korea National Health Insurance Corporation data, the total number of deliveries and the delivery proportion within and outside of the community from 2001 to 2008 were calculated for 232 administrative districts nationwide. Three outflow levels were categorized based on each district’s out-of-community delivery proportion: high outflow (upper one third), moderate outflow (middle one third), and low outflow (lower one third). In addition, three obstetric complication rates (the rate of complications following abortion, ectopic and molar pregnancy, the abortion rate, and the eclampsia rate) were calculated for the 232 districts. One-way ANOVA and multivariate linear regression were used to evaluate obstetric complications among the three outflow levels. Results: The high outflow districts had higher rates of eclampsia and complications following abortion, ectopic, and molar pregnancy compared to the other districts (ANOVA, p<0.05). However, there was no significant difference in the abortion rate among the three groups. Multiple linear regression analysis showed that high outflow districts were statistically significant in the rate of complications following abortion, ectopic and molar pregnancy and eclampsia rate after adjusting for local tax per capita (p<0.01). Conclusion: These results indicate that poor access to local obstetric care correlate with poor obstetric outcomes (delayed or excessive bleeding, embolism, genital tract or pelvic infection, shock or other complications following abortion and ectopic or molar pregnancy, or eclampsia).
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