Annals of Occupational and Environmental Medicine

The Korean Society of Occupational & Environmental Medicine (대한직업환경의학회)
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Influencing Factors in Approving Cerebrovascular and Cardiovascular Diseases as Occupational Disease in Seoul

서울지역의 업무상 뇌.심혈관질환 인정 여부에 영향을 미치는 요인

  • Lee, Tae-Kyung (Department of Occupational and Environmental Medicine, Hallym University Scared Heart Hospital) ;
  • Kim, Soo-Geun (Department of Occupational and Environmental Medicine, Sungkyunkwan University School of Medicine) ;
  • Won, Jong-Uk (Institute for Occupational Health, Yonsei University College of Medicine) ;
  • Jang, Tae-Won (Department of Occupational and Environmental Medicine, Hangang Sacred Heart Hospital) ;
  • Cho, Seong-Sik (Department of Occupational and Environmental Medicine, Incheon Medical Center) ;
  • Ju, Young-Su (Department of Occupational and Environmental Medicine, Hallym University Scared Heart Hospital) ;
  • Kwon, Young-Jun (Department of Occupational and Environmental Medicine, Hallym University Scared Heart Hospital) ;
  • Im, Hyoung-June (Department of Occupational and Environmental Medicine, Hallym University Scared Heart Hospital)
  • 이태경 (한림대학교성심병원 산업의학과) ;
  • 김수근 (성균관대학교 의과대학 산업의학과학교실) ;
  • 원종욱 (연세대학교 의과대학 산업보건연구소) ;
  • 장태원 (한강성심병원 산업의학과) ;
  • 조성식 (인천광역시 의료원 산업의학과) ;
  • 주영수 (한림대학교성심병원 산업의학과) ;
  • 권영준 (한림대학교성심병원 산업의학과) ;
  • 임형준 (한림대학교성심병원 산업의학과)
  • Received : 2010.07.07
  • Accepted : 2010.09.13
  • Published : 2010.09.30
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Abstract

Objectives: This study was performed to analyze the factors that affected the decision making process in approving workers' compensation claims for cerebrovascular and cardiovascular diseases cases that occurred just before refoming approval standards of Industrial Accident Compensation Insurance Act on 1 July 2008 and to provide fundamental information in preparing better standards. Methods: We examined 283 claims cases involving cerebrovascular and cardiovascular diseases that occurred between 1 January, 2006 and 31 December, 2007 and collected data based on the worker's compensation records from 3 Seoul Regional Centers of the Workers' Compensation & Welfare Service. We analyzed the approval rates and odds ratios according to the general characteristics, injury information, past medical histories, and work related information using chi-square or univariate logistic regression. In addition, we identified the factors affecting the approval using multivariate logistic regression. Results: Overall, 101 of the 283 cases were approved and approval rate was 35.7%. Approval rates differed significantly according to type of disease, survival, accident site, accident time, the presence of associated disease and overwork (p-value <0.05). In the multivariate logistic regression analysis with adjusted for age and sex, approval rate of death cases with associated disease was lower than cases without associated disease (OR 0.22, 95% CI 0.12~0.42). Approval rate of cases occurred in worksite was higher than others (OR 4.81, 95% CI 2.22~10.40). Cases of accepted overwork had a higher approval rate significantly than cases of not accepted (OR 28.53, 95% CI 9.74~83.52). Conclusion: Factors in approving cases of cerebrovascular and cardiovascular disease as cases involving occupational disease included conditions of overwork, high rate of accidents in the workplace and the presence of associated disease. It is necessary to investigate further behaviors of work and chronic workrelated stress.

목적: 본 연구는 2008년 뇌 심혈관질환의 산업재해보상보험법 업무상 재해 인정 기준 개정 직전 뇌 심혈관계질환으로 업무상 질병 요양 신청한 사례들을 분석하여 업무상 재해 승인 여부에 영향을 미쳤던 요인들을 파악하고 보다 합리적인 인정기준을 마련하는데 기여하고자 하였다. 방법: 2006년 1월 1일부터 2007년 12월 31일까지 서울지역의 3개 근로복지공단 지사에 뇌 심혈관질환이 발생하여 산재요양신청이 이루어진 사례 283건을 대상으로 조사하였다. 카이제곱 검정과 단변량 로지스틱 회귀분석으로 재해자 관련 기본특성과 발병경위 및 상병관련 사항, 동반질환, 업무관련 사항에 대해 각 요인별 승인율의 차이 및 대응비를 구하였고, 다변량 로지스틱 회귀분석을 이용하여 업무상 질병 승인에 기여하는 요인들을 확인하였다. 결과: 전체 연구대상 283명 중 승인받은 경우는 101명(승인율 35.7%)이었다. 질환별, 사망여부, 질환 발생장소, 질환 발생시기, 업무상 과중부하 여부에 따라 승인율에 차이가 있었다(p-value<0.05). 성별과 연령을 보정한 다변량 로지스틱 회귀분석에서 동반질환이 있는 경우는 없는 경우에 비해 승인율이 낮았다(OR 0.22, 95% CI 0.12~0.42). 작업장내에서 질환이 발생한 경우 그렇지 않은 경우에 비해 승인율이 높았다(OR 4.81, 95% CI 2.22~10.40). 업무상 과중부하가 있다고 인정된 경우(OR 28.53 95% CI 9.74~83.52)가 승인율에 유의한 영향을 미쳤음을 확인하였다.(수정) 결론: 뇌 심혈관계 질환의 업무상질병 인정에 영향을 주었던 요인들은 업무상 과중부하 여부와 질병 발생 시간, 동반 질환 여부 등 이었다. 업무의 행태나 만성적인 스트레스에 대한 고려가 더 필요할 것으로 보인다.

Keywords

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