The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

The Quality of Medical Care Provided to Homeless Diabetes Patients in a General Hospital in Seoul, and the Prevalence of Diabetes Comorbidities

한 종합병원에 입원한 노숙인 당뇨병 환자의 당뇨관리 실태와 동반 질환

  • Beom, Sun Hee (Department of Internal Medicine, Seoul Medical Center) ;
  • Oh, Moo Kyung (Department of Preventive Medicine, Kangwon National University Hospital) ;
  • Ahn, Chul Woo (Department of Internal Medicine, Yonsei University of Collage of Medicine)
  • 범선희 (서울특별시 서울의료원 내과) ;
  • 오무경 (강원대학교병원 예방의학과) ;
  • 안철우 (연세대학교 의과대학 내과학교실)
  • Received : 2013.07.24
  • Accepted : 2013.11.18
  • Published : 2014.05.01
⟨ Previous Next ⟩

Abstract

Background/Aims: As an underprivileged population, homeless people have a higher incidence of morbidity and mortality than do non-homeless people. Diabetes mellitus is a chronic disease associated with high complication rates; its incidence is increasing rapidly and it requires prompt, adequate treatment and care. Therefore, we investigated the quality of medical care provided to homeless diabetics in a general hospital and comorbidities associated with diabetes. Methods: Between March 25, 2011 and December 31, 2012, we retrospectively investigated the medical records of the diabetes patients at a general hospital in Seoul. We assigned the patients into two groups: homeless (n = 82) and non-homeless (n = 242) patients. We subsequently compared the clinical and laboratory findings, comorbidities, and complications between the two groups. Results: The homeless diabetics received treatment less regularly than the non-homeless patients and were diagnosed with diabetes while visiting the hospital for the treatment of other diseases. The homeless patients had higher glycated hemoglobin A1c levels than the non-homeless patients. The homeless patients had a higher rate of other diseases, such as peripheral artery disease, acute infectious disease, intracranial hemorrhage, and pulmonary tuberculosis; a higher incidence of acute infectious disease (odds ratio [OR], 15.671; 95% confidence interval [CI], 5.115-48.070); and a higher prevalence of pulmonary tuberculosis (OR, 6.423; 95% CI, 1.785-23.116) than the non-homeless patients, as determined by multivariate analysis. Conclusions: Comorbid acute infectious disease and pulmonary tuberculosis were found more frequently in homeless diabetes patients presenting to the hospital than in non-homeless diabetes patients. Therefore, attention should be paid to this differentiating factor.

목적: 노숙인은 의료취약계층으로 비노숙인에 비해 질병 발생이 많고 사망률도 더 높다. 최근 급격하게 증가하고 있는 당뇨병은 합병증이 높은 만성 질환으로 치료와 관리가 중요하다. 본 연구의 목적은 병원에 내원한 노숙인 당뇨병 환자의 관리 실태 및 동반 질환을 알아보고 파악하는 데 있다. 방법: 2011년 3월 25일부터 2012년 12월 31일까지 서울시 소재의 한 종합병원에 내원한 노숙인 당뇨병 환자들을 대상으로 후향적 의무기록 조사를 하였다. 노숙인 당뇨병 환자군(n = 82)과 비노숙인 당뇨병 환자군(n = 242)으로 분류하였다. 양 군 간에 임상적 소견, 검사실 소견, 동반 질환과 합병증 등을 비교하였다. 결과: 노숙인 당뇨병 환자는 비노숙인 환자에 비해 당뇨병 치료를 불규칙적으로 받는 경우가 더 많았고 다른 질병으로 병원에 내원한 후에 당뇨병으로 진단된 경우도 더 많았다. 노숙인 당뇨병 환자의 당화혈색소가 비노숙인에 비해 더 높았고 급성 감염병, 두개내출혈, 말초동맥 질환과 폐결핵을 동반하는 경우가 더 많았다. 다변량분석 결과 노숙인 당뇨병 환자에서 비노숙인에 비해 급성 감염병과 폐결핵의 유병률이 유의하게 높은 것으로 나타났다. 결론: 병원에 내원한 노숙인 당뇨병 환자에서 비노숙인 환자에 비해 급성 감염병과 폐결핵의 동반 질환이 더 많이 관찰되었으며 이에 대한 관심이 필요하다.

Keywords

References

  1. Ha SK, Lee SW. IMF and the crisis of the marginalized urban sector in Korea. J Contemp Asia 2001;31:196-213. https://doi.org/10.1080/00472330180000121
  2. Korean Ministry of Health and Welfare. Ministry of Health and Welfare statistical yearbook 2012 [Internet]. Seoul: Korean Ministry of Health and Welfare, c2012 [cited 2012 Nov 28]. Available from: http://stat.mw.go.kr.
  3. Jo WT, Kim HS, Lee HH, Jo J. Social Welfare and Law. 10th ed. Yang Seo Won Press, 2013.
  4. Geddes JR, Fazel S. Extreme health inequalities: mortality in homeless people. Lancet 2011;377:2156-2157. https://doi.org/10.1016/S0140-6736(11)60885-4
  5. Hwang SW. Mortality among men using homeless shelters in Toronto, Ontario. JAMA 2000;283:2152-2157. https://doi.org/10.1001/jama.283.16.2152
  6. Chung SC, You SS, Yang JH, Lee JH, Son HS, Yoon HD. The prevalence and risk factors of diabetes mellitus in people of Hope Village. Korean J Med 2002;62:633-641.
  7. Song HJ, Cho CH, Kang JH, Hwang WS, Han JK. Health status and behavior of homeless in Seoul. J Korean Acad Fam Med 2000;21:357-366.
  8. Salit SA, Kuhn EM, Hartz AJ, Vu JM, Mosso AL. Hospitalization costs associated with homelessness in New York City. N Engl J Med 1998;338:1734-1740. https://doi.org/10.1056/NEJM199806113382406
  9. Kim SM, Lee JS, Lee J, et al. Prevalence of diabetes and impaired fasting glucose in Korea: Korean National Health and Nutrition Survey 2001. Diabetes Care 2006;29:226-231. https://doi.org/10.2337/diacare.29.02.06.dc05-0481
  10. Park IB, Baik SH. Epidemiologic characteristics of diabetes mellitus in Korea: current status of diabetic patients using Korean Health Insurance Database. Korean Diabetes J 2009;33:357-362. https://doi.org/10.4093/kdj.2009.33.5.357
  11. Kim DJ, Kim J, Kim H, et al. Current status of diabetic end-stage renal disease using Korean Health Insurance database. J Korean Diabetes Assoc 2006;30:355-362. https://doi.org/10.4093/jkda.2006.30.5.355
  12. Chung CH, Kim DJ, Kim J, et al. Current status of diabetic foot in Korean patients using National Health Insurance database. J Korean Diabetes Assoc 2006;30:372-376. https://doi.org/10.4093/jkda.2006.30.5.372
  13. Amos AF, McCarty DJ, Zimmet P. The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabet Med 1997;14(Suppl 5):S1-85.
  14. Lee WJ, Hong JP. Disease status of new patients at free homeless clinic in Seoul area. Korean Public Health Res 2012;38:35-43.
  15. Kim DH, You EY, Jung SK, Rhee JE, Suh GJ, Youn YK. The clinical analysis of the homeless visiting emergency medical centers. J Korean Soc Emerg Med 2002;13:294-299.
  16. Kim SG, Choi DS. The present state of diabetes mellitus in Korea. J Korean Med Assoc 2008;51:791-798. https://doi.org/10.5124/jkma.2008.51.9.791
  17. Yoon CH, Lee SJ, Choo S, Moon OR, Park JH. Continuity of care of patient with diabetes and its affecting factors in Korea. J Prev Med Public Health 2007;40:51-58. https://doi.org/10.3961/jpmph.2007.40.1.51
  18. Cryer PE. The barrier of hypoglycemia in diabetes. Diabetes 2008;57:3169-3176. https://doi.org/10.2337/db08-1084
  19. Nielsen SF, Hjorthoj CR, Erlangsen A, Nordentoft M. Psychiatric disorders and mortality among people in homeless shelters in Denmark: a nationwide register-based cohort study. Lancet 2011;377:2205-2214. https://doi.org/10.1016/S0140-6736(11)60747-2
  20. Hahm BJ, Lee DW, Lee JH, et al. Prevalence of psychiatric disorders in male homeless. J Korean Neuropsychiatr Assoc 2003;42:644-653.
  21. Skinner DC. A modified therapeutic community for homeless persons with co-occurring disorders of substance abuse and mental illness in a shelter: an outcome study. Subst Use Misuse 2005;40:483-497. https://doi.org/10.1081/JA-200052429
  22. Kushel MB, Evans JL, Perry S, Robertson MJ, Moss AR. No door to lock: victimization among homeless and marginally housed persons. Arch Intern Med 2003;163:2492-2499. https://doi.org/10.1001/archinte.163.20.2492
  23. Hwang SW, Colantonio A, Chiu S, et al. The effect of traumatic brain injury on the health of homeless people. CMAJ 2008;179:779-784. https://doi.org/10.1503/cmaj.080341
  24. Raoult D, Foucault C, Brouqui P. Infections in the homeless. Lancet Infect Dis 2001;1:77-84. https://doi.org/10.1016/S1473-3099(01)00062-7
  25. Arnaud A, Fagot-Campaqna A, Reach G, Basin C, Laporte A. Prevalence and characteristics of diabetes among homeless people attending shelters in Paris, France, 2006. Eur J Public Health 2010;20:601-603. https://doi.org/10.1093/eurpub/ckp197
  26. Peach G, Griffin M, Jones KG, Thompson MM, Hinchliffe RJ. Diagnosis and management of peripheral arterial disease. BMJ 2012;345:e5208. https://doi.org/10.1136/bmj.e5208
  27. Moy JA, Sanchez MR. The cutaneous manifestations of violence and poverty. Arch Dermatol 1992;128:829-839. https://doi.org/10.1001/archderm.1992.01680160113017
  28. Lee CH, Jeong YJ, Heo EY, et al. Active pulmonary tuberculosis and latent tuberculosis infection among homeless people in Seoul, South Korea: a cross-sectional study. BMC Public Health 2013;13:720. https://doi.org/10.1186/1471-2458-13-720
  29. Haddad MB, Wilson TW, Ijaz K, Marks SM, Moore M. Tuberculosis and homelessness in the United States, 1994-2003. JAMA 2005;293:2762-2766. https://doi.org/10.1001/jama.293.22.2762
  30. Curtis AB, Ridzon R, Novick LF, et al. Analysis of Mycobacterium tuberculosis transmission patterns in a homeless shelter outbreak. Int J Tuberc Lung Dis 2000;4:308-313.
  31. Restrepo BI, Fisher-Hoch SP, Crespo JG, et al. Type 2 diabetes and tuberculosis in a dynamic bi-national border population. Epidemiol Infect 2007;135:483-491. https://doi.org/10.1017/S0950268806006935
  32. Alisjahbana B, Sahiratmadja E, Nelwan EJ, et al. The effect of type 2 diabetes mellitus on the presentation and treatment response of pulmonary tuberculosis. Clin Infect Dis 2007;45:428-435. https://doi.org/10.1086/519841

Cited by

  1. 쉼터거주자의 건강관리실태 및 대안 vol.28, pp.3, 2014, https://doi.org/10.5932/jkphn.2014.28.3.536
  2. 노숙인들의 중독 및 정신건강 실태에 관한 조사 vol.29, pp.5, 2016, https://doi.org/10.5351/kjas.2016.29.5.977