제조업 종사 근로자의 호흡기질환으로 인한 의료이용에 영향을 미치는 요인

Factors Affecting the Use of Medical Services by Workers with Respiratory Diseases

  • 송재석 (연세대학교 의과대학 예방의학교실) ;
  • 강성규 (한국산업안전공단 산업안전보건연구원) ;
  • 정호근 (한국산업안전공단 산업안전보건연구원) ;
  • 안연순 (한국산업안전공단 산업안전보건연구원)
  • Song, Jae-Seok (Department of Preventive Medicine, College of Medicine, Yonsei University) ;
  • Kang, Seong-Kyu (Institute for Occupational Safety and Health, Korea Occupational Safety and Health Agency) ;
  • Chung, Ho-Keun (Institute for Occupational Safety and Health, Korea Occupational Safety and Health Agency) ;
  • Ahn, Yeon-Soon (Institute for Occupational Safety and Health, Korea Occupational Safety and Health Agency)
  • 발행 : 2002.03.01

초록

Objectives : To identify the relationship between the use of medical services by workers with three types of respiratory diseases(total respiratory diseases, acute upper respiratory infections and chronic lower respiratory diseases) and exposure to hazardous agents after controlling for other factors affecting medical services use, such as characteristics of the enterprises(scale, industry type) and employee demographics (sex, age). Methods : The study population comprised 28,882 workers who had undergone general or special medical examinations at the industrial health center at least once between Jan 1995 and Dec 1997 and had possessed medical insurance during the period. We combined medical examination data with medical insurance data in order to analyze the relationship between exposure to hazardous agents and respiratory diseases, Results : Among the 28,882 study subjects, 17,454 employees(60.4%) used medical services more than once during 3-year study period, owing to more than one kind of respiratory diseases. In logistic regression analysis, sex, age and the size of the enterprises proved to be significant variables on the use of medical services for all three types of respiratory disease; The use of medical services increased with employee age. Women used more medical services than men and the employees in the large-scale enterprises used more services than employees in small-scale enterprises. However, exposure to dust or organic solvents did not affect medical service use due to total respiratory diseases or acute upper respiratory infections. Only in the case of chronic lower respiratory diseases did workers exposed to dusts(OR=1.12, 95% CI=1.01-1.24) or organic solvents(OR=1.19, 95% CI=1.05-1.35) use more medical services than those not exposed. Conclusions : Workers exposed to dusts or organic solvents are particularly apt to suffer from chronic lower respiratory diseases and use medical services more often than those not exposed. That is, chronic exposure to hazardous agents such as dusts and organic solvents is believed to be harmful and to cause respiratory symptoms and diseases.

키워드

참고문헌

  1. Lorimer WV, Litis R, Nicholson WJ, et al.. Clinical findings of styrene workers: initial findings. Environ Health Perspect 1976; 100:293-306 https://doi.org/10.2307/3431535
  2. Lebowiz MD. Occupational exposures in relation to symptomatology and lung function in a community population. Environ Res 1977; 14: 59-67 https://doi.org/10.1016/0013-9351(77)90066-4
  3. Sabroe S and Olsen J. Health complaints and work conditions among lacquerers in the Danish furniture industry. Scan J Soc Med 1979; 7: 97-104 https://doi.org/10.1177/140349487900700301
  4. Alexandersson R, Hedenstierna G and Kolmodin-Hedman B. Exposure to formaldehyde: effect on pulmonary function. Arch Environ Health 1982; 37: 279-284 https://doi.org/10.1080/00039896.1982.10667579
  5. Jedrychowski W. Styrene and methyl methacrylate in the industrial environment as a risk factor of chronic obstructive lung disease. Int Arch Occup Environ health 1982; 51: 151-157 https://doi.org/10.1007/BF00378159
  6. Bakinson MA and Jones RD. Gassings due to methylene chloride, xylene, toluene, and styrene reported to Her Majesty's Factory Inspectorate 1961-1980. Br J Ind Med 1985; 42: 184-190
  7. Jonson AJ, Chan-Yeong M, MacLean L, et al., Respiratory abnormalities among workers in an iron and steel foundry. Br J Ind Med 1985; 42: 94-100
  8. Heederik D, Pouwels H, Kromhout H, and Kroumhout D. Chronic non-specific lung disease and occupational exposures estimated by means of a job exposure matrix: the Zutphen study. Int J Epidemiol 1989; 18: 382-389 https://doi.org/10.1093/ije/18.2.382
  9. Heederik D, Kromhout H, Burema J, Biersteker K, and Kromhout D. Occupa-tional exposure and 25-year incidence rate of non-specific lung disease: the Zutphen study. Int J Epidemiol 1990; 19:945-952 https://doi.org/10.1093/ije/19.4.945
  10. Nunn Aj, craigen AA, Venables KM, and Newman-Taylor AJ. Six year follow up of lung function in men occupationally exposed to formaldehyde. Br J Ind Med 1990; 47: 747-752
  11. Wieslander G, Norback D, Eding C, et al. Emission of volatile organic compounds(VOC) from water based paints: a contributing cause of respiratory symptoms and bronchial hyperrespon-siveness? In Proceedings of the interna-tionalconference on volatile organic compounds in the environment. London: Lonsdale Press; 1993.p447-453
  12. Le Moual N, Orlowski E, Schenker MB, et al.. Occupational exposures estimated by means of job exposure matrices in relation to lung function in the PAARC survey. Abstract presented at Tenth International Symposium Epidemiology in Occupational Health, September 1994, Como, Italy
  13. Post WK, Heederik D, Kromhout H, and Kroumhout D. Occupational exposure estimated by population specific job exposure matrix and 25-year incidence rate of chronic non-specific lung disease(CNSLD): the Zutphen study. Eur Resp J 1994; 7: 1048-1055
  14. The Korean Statistical Association. Korean Standard Industrial Classification, 2000
  15. Shin EC, Park YM, Park YG, et al.. Estimation of disease code accuracy of national medical insurance data and related factors. Korean J Prev Med 1998; 31(3): 471-480(Korean)
  16. Institute for Environmental Medicine in Korea University. Risk assessment and management of environment pollutants: Surveillance system for environmental diseases, Department of Environment,1997
  17. Ha MN, Kwon HJ, Kang DH, et al.. Completeness estimation of the korean medical insurance data in childhood asthma: using capture-recapture method. Korean J Prev Med 1997; 30(2): 428-436(Korean)
  18. Andersen RA. Behavioral model of families use of health services. University of Chicago Research Services 1968; 25
  19. Ahn YS, Kim RO, Lee JY, and Jung HK. Characteristics of occupational skin disease reported by surveillance system. Korean J Prev Med 1999; 32(2): 130-140(Korean)
  20. Song KY and Kim HS. Report on health need and health care utilization in Korea. Korea Institute for Health and Social Affairs, 1982. p13-159
  21. Han DS, Kwon SH, Kwon SW, and Whang SJ: Health care utilization and its determinants in Chun-cheon area. Institute for Social Medicine in Han-lim University, 1986.p50-90
  22. Yu SH, Cho WH, Park CY, and Lee MK. Health care utilization and its determinants among Island inhabitants. Korean J Prev Med 1987; 20(2): 287-300( Korean)
  23. Kim SB and Kang BS. Health careutilization and its determinants in Taegu area. Korean J Prev Med 1989; 22(1):29-44(Korean)
  24. Song KY, Kim YI, and Lee YK. Report on national health survey in Korea. Korea Institute for Health and Social Affairs,1990.pl-140
  25. Yu SH, Lee YR, Cho WH, et al..A Study on the health care utilization in Korea. Korean J Prev Med 1986; 19(1): 137-145(Korean)
  26. Joo KS, Kim HJ, Lee SH, and Min HY. A Comparative study on medical utilization between urban and rulal Korea. Korean J Prev Med 1996; 29(2): 311-329(Korean)
  27. Ahn YS, Song JS, Won JU and Roh JH. Health care utilization of workers with skin disease in Inchon. Korean J Prev Med 1999; 32(2): 206-214(Korean)
  28. Anderson RM and Aday LA. Access to medical care in the U. S.: Realized and potential. Med Care 1978; 16(7): 533-46 https://doi.org/10.1097/00005650-197807000-00001
  29. Nathanson CA. Sex, illness and medical care: A Review of data, theory, and method. Soc. Sci. Med. 1975; 10: 229
  30. Kim SK and Park JI. Factors related to post-management performance of workers with general disease in small and medium sized enterprises. Korean J Occup Med 1993; 5(2): 274-282(Korean)
  31. Kim SG, Roh JR, and Ahn YS. A post-examination health care status of workers with pneumoconiosis in manufacturing factories. Korean J Occup Med 1994; 6(2): 421-428(Korean)
  32. Han CH, Kam S, and Park JY. Health care utilization and its determinants of workers with non-occupational disease. Korean J Occup Med 1995; 7(2): 282-294(Korean)
  33. Choi JS, Song JS, Won JU, et al.. A Post-examination health care status of workers with noise induced hearing loss in manufacturing factories. Korean J Occup Med 1996; 8(2): 272-281(Korean)
  34. Park JS, Paek DM, Lee KB, Rhee KY, Yi KH. Shift work and sickness absence in Korean manufacturing industries. Korean J Prev Med 1994; 27(3): 475-486( Korean)
  35. Paek DM, Kim EH, Kim JY, et al.. Appraisal of the government-funded subsidiary occupational health program for small scale industries. Industrial Health Research Institute, Korea Industrial Safety Corporation, 1997