Journal of Digital Convergence (디지털융복합연구)

The Society of Digital Policy and Management (한국디지털정책학회)
권호 표지
DOI QR코드

DOI QR Code

Maternal Age and Infant Mortality in Korea

산모 연령과 영아 사망과의 관련성 연구

  • Hong, Jae-Seok (Dept. of Healthcare Management, Cheongju University College of Health Sciences)
  • 홍재석 (청주대학교 보건의료대학 의료경영학과)
  • Received : 2016.07.25
  • Accepted : 2016.09.20
  • Published : 2016.09.28
Download PDF
⟨ Previous Next ⟩

Abstract

The purpose of this study was to examine the relationship between maternal age and infant mortality in Korea(n=617,867). Data of Korean vital statistics linked National Infant Mortality Survey conducted on births in 1999 were used in this study. The odds ratios (ORs) of infant death by maternal age were estimated with the multiple logistic regression model, adjusting for gender, plurality, birth order, low birth weight, and congenital malformation. After adjusting for the relevant variables, the odds of infant death in the group of maternal age with less than 20 years(Odds ratio [OR], 5.29, 95% confidence interval [CI], 3.51-7.98), 20-24 years(OR, 1.44, 95% CI, 1.23-1.69), 35-39 years(OR, 1.28, 95% CI, 1.11-1.46), and more than 40 years(OR, 1.94, 95% CI, 1.53-2.45) was higher than that of reference group(25-29 years). In conclusion, the higher infant mortality in the group of maternal age with less than 25 years and more than 35 years in Korea appears to be due to higher proportion of low birth weight and pre-term birth. Prenatal care intervention programs which tackle biological factors for advanced maternal age and address socio-economic problems and social stigma for early maternal age should be devised.

본 연구는 우리나라 출생아 전수(n=617,867)를 대상으로 산모 연령과 영아 사망과의 관련성을 파악하고자 시행하였다. 연구자료는 인구동태통계자료와 영아사망조사자료를 연계하여 사용하였고, 산모 연령에 따른 영아 사망 위험을 파악해 보기 위해 출생아의 성별과 다태 여부, 출생순위, 저체중아 여부, 선천성기형 여부를 보정한 다중 로지스틱 회귀분석을 시행하였다. 여러 혼란요인을 보정한 분석 결과, 25-29세 산모에 비해 20세 미만 산모(Odds ratio [OR], 5.29, 95% confidence interval [CI], 3.51-7.98)와 20-24세 산모(OR, 1.44, 95% CI, 1.23-1.69), 35-39세 산모(OR, 1.28, 95% CI, 1.11-1.46), 40세 이상 산모(OR, 1.94, 95% CI, 1.53-2.45)에서 영아 사망 오즈가 통계적으로 유의하게 높았다. 결론적으로, 이번 연구를 통해 35세 이상 고 연령 산모와 25세 미만의 저 연령 산모에서 영아 사망 위험이 높은 것을 확인할 수 있었고, 이들에서 영아 사망 위험이 높은 이유는 저체중아나 미숙아의 출산이 많기 때문으로 보인다. 산전관리 시 고령 산모의 경우 생물학적인 문제를 극복할 수 있는 관리정책이 만들어져야 할 것으로 보이고, 저 연령 산모의 경우 사회경제적인 부분과 사회적 편견 문제를 해결할 수 있는 관리정책이 만들어져야 할 것으로 보인다.

Keywords

References

  1. K. H. Cho, H. S. Jo, S. I. Cho, Y. H. Eom, S. K. Rhie, K. H. Lee, "Advanced maternal age and weight at birth in newborn infants: Distribution and clinical characteristics" Korean Journal of perinatology, Vol. 25, No. 4, pp.276-283, 2014. https://doi.org/10.14734/kjp.2014.25.4.276
  2. J. H. Choi, H. J. Han, J. H. Hwang, S. R. Chung, H. Moon, M. I. Park, K. J. Cha, H. S. Choi, J. E. Oh, Y. S. Park, "Meta analysis of clinical studies of pregnancy and delivery in elderly gravida," Obstetrics & Gynecology Science, Vol. 49, No. 2, pp.293-308, 2006.
  3. Y. K. Yang, B. W. Jung, J. K. Jung, M. J. Lee, K. H. Yoon, S. K. Shin. "A clinical and statistical study in pregnant women over the age of 35," Obstetrics & Gynecology Science, Vol.41, No.3, pp.34-41, 1998.
  4. H. K. Kim, S. W. Lim, R. R. Lee, S. H. Park, D. S. Go, H. N. Na, K. S. Lee, H. S. Rhee, "The Survey Research on Pregnant Woman's recognition about GP-UN-MAN CARD OF Childbirth Promotion Policy", Journal of Digital Convergence, Vol. 10, No. 3, pp. 241-250, 2012. https://doi.org/10.14400/JDPM.2012.10.3.241
  5. M. S. Jang, H. S. Yang, "Study on the Influence of Child Birth Promotion Policy Due to postpartum care and Maternity Leave to Economical Activities in the Era of Convergence", Journal of Digital Convergence, Vol. 13, No. 10, pp. 245-254, 2015.
  6. Statistics Korea, Korean Statistical Information Service, "available from: http://kosis.kr/statisticsList/statisticsList_01List.jsp?vwcd=MT_ZTITLE&parentId=A#SubCont"
  7. C. S. Jung, "Aging Society and Labor Market", Journal of Digital Convergence, Vol. 10, No. 1, pp. 185-194, 2012. https://doi.org/10.14400/JDPM.2012.10.1.185
  8. S. C. Tough, C. Newburn-Cook, D. W. Johnston, L. W Svenson, S. Rose, J. Belik. "Delayed childbearing and its impact on population rate changes in lower birth weight, multiple birth, and pre-term delivery," Pediatrics, Vol.109, No.3, pp.399-403, 2002. https://doi.org/10.1542/peds.109.3.399
  9. B. Jacobsson, L. Ladfors, I. Milsom. "Advanced maternal age and adverse perinatal outcome," Obstet Gynecol, Vol.104, No.4, pp.727-733, 2004. https://doi.org/10.1097/01.AOG.0000140682.63746.be
  10. J. Cleary-Goldman, F. D. Malone, J. Vidaver, R. H. Ball, D. A. Nyberg, C. H. Comstock, G. R. Saade, K. A. Eddleman, S. Klugman, L. Dugoff, I.E. Timor-Tritsch, S.D. Craigo, S.R. Carr, H.M. Wolfe, D.W. Bianchi, M. D'Alton. "Impact of maternal age on obstetric outcome," Am J Obstet Gynecol, Vol.105, No.5, pp.983-990, 2005. https://doi.org/10.1097/01.AOG.0000158118.75532.51
  11. W. Yuan, F. H. Steffensen, G. L. Nielsen, M. Moller, J. Olsen, H. T. Sorensen. "A population-based cohort study of birth and neonatal outcome in older primipara," Int J Gynaecol Obstet, Vol.68, No.2, pp.113-118, 2000. https://doi.org/10.1016/S0020-7292(99)00181-2
  12. S. M. Ziadeh, "Maternal and perinatal outcome in nulliparous women aged 35 and older," Gynecol Obstet Invest, Vol.54, No.1, pp.6-10, 2002. https://doi.org/10.1159/000064689
  13. M. S. Kang, J. Y. Lee, S. H. Lee, E. H. Oh, C. W. Lee, B. Choi, Y. D. Shin, D. J. Kim. "The Obstetrical and Statistical aspects of the unmarried mother," Obstetrics & Gynecology Science, Vol. 45, No. 8, pp.1347-1353, 2002.
  14. B. S. Koo, C. Lee, J. C. Shin, T. Kim, J. Song, M. H. Hong, Y. J. Park., "Sexuality of adolescent," Obstetrics & Gynecology Science, Vol. 39, No. 6, pp.1007-1016, 1996.
  15. A. J. Satin, K, J. Leveno, M. L. Sherman, N. J. Reedy, T. W. Lowe, D. D. McIntire. "Maternal youth and pregnancy outcomes: middle school versus high school age groups compared with women beyond the teen years," Am J Obstet Gynecol, Vol.171, No.1, pp.184-187, 1994. https://doi.org/10.1016/0002-9378(94)90467-7
  16. S. Kumbi, A. Isehak. "Obstetric outcome of teenage pregnancy in northwestern Ethiopia," East Afr Med J, Vol.76, No.3, pp.138-140, 1999.
  17. Y. J. Han, S. W. Lee, Y. J. Chang, D. J. Kim, S. W. Yi, "An Analysis of the 1999 Infant Mortality Rate in Korea,", Korea Institute for Health and Social Affairs, 20002
  18. J. S. Hong, H. C. Kang, S. W. Yi, Y. J. Han, C. M. Nam, B. Gombojav, H. Ohrr, "A comparison of perinatal mortality in Korea on holidays and working days," BJOG, Vol.113, No.3, pp.1235-1238, 2006. https://doi.org/10.1111/j.1471-0528.2006.01054.x
  19. J. S. Hong, S. W. Yi, Y .J Han, Y. W. Park, C. M. Nam, H. C. Kang, H. Ohrr, "Fetal growth and neonatal mortality in Korea," Paediatr Perinat Epidemiol, Vol.21, No.5, pp.397-410, 2007. https://doi.org/10.1111/j.1365-3016.2007.00850.x
  20. Z. C. Luo, S. Liu, R. Wilkins, M. S. Kramer, "Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. Risks of stillbirth and early neonatal death by day of week," CMAJ, Vol.170, No.3, pp.337-341, 2004.
  21. Y. J. Han. "A Study of Infant Mortality Rate in Korea," International Statistical Institute 53rd Session, Seoul, 2001. Voorburg: Bulletin of the International Statistical Institute, 2002; pp. 514-516.
  22. S. H. Park, J. H. Han, S. M. Kim, S. Y. Koo, S. H. Kim, "Risk factors of pre-term delivery in pregnant women aged 35 years or older: Analysis of birth certificate data in 1996," Obstetrics & Gynecology Science, Vol. 42, No. 7, pp.1416-1421, 1999.
  23. S. Kim, Y. Cho, "Impact of Delayed Childbearing on Infant Mortality by Maternal Education," Health and Social Science, Vol. 6, pp.69-97, 2011.
  24. R. A. Bobrowski, S. F. Bottoms, "Underappreciated risks of the elderly multipara," Am J Obstet Gynecol, Vol.172, No.6, pp.1764-1767, 1995. https://doi.org/10.1016/0002-9378(95)91409-9
  25. J. H. Park, J. Y. Lee, S.J. Park, "Effect of delayed first childbearing on low birth weight and pre-term birth," J Korean Soc Matern Child Health, Vol. 8, No. 1, pp.7-15. 2004.
  26. S. J. An, M. Son, Y. J. Kim, "Social Inequality in Child Mortality according to Maternal Age, Education Level and Parity", Journal of the Korean Data Analysis Society, Vol. 16, No. 6, pp. 3073-3081, 2014.
  27. J. S. Choi, "A Study on Cause Analysis for Infant Death", Issue & Focus, Vol. 112, pp. 1-8, 2011.
  28. J. Y. Moon, W. H. Hahn, K. S. Shim, J. Y. Chang, C. W. Bae, "Changes of Maternal Age Distribution in Liver Births and Incidence of Low Birth Weight Infants in Advanced Maternal Age Group in Korea" Korean J Perinatol, Vol. 22, No. 1, pp. 30-36, 2011
  29. Y. Cho, R. A. Hummer, Y. J. Choi, S. W. Jung, "Late Childbearing and Changing Risk of Adverse Birth Outcomes in Korea", Matern Child Health J, Vol. 15, No. 4. pp. 431-437, 2011. https://doi.org/10.1007/s10995-010-0611-x
  30. X. Liu, L. Zou, Y. Chen, Y. Ruan, Y. Liu, W. Zhang, "Effects of maternal age on pregnancy: a retrospective cohort study", Zhonghau Yi Xue Za Zhi, Vol. 94, No. 25, pp.1984-1988, 2014.
  31. M. Laopaiboon, P. Lumbiganon, N. Intarut, R. Mori, T. Ganchimeg, J. P. Vogel, J. P. Souza, A. M. Gulmezoglu, "Advanced maternal age and pregnancy outcomes: a multicountry assessment", BJOG. Vol. 121, Suppl. 1, pp. 49-56, 2014 https://doi.org/10.1111/1471-0528.12659
  32. G. Y. Choi. "Fertility according to maternal age," The Korean Society of Maternal and Child Health. pp.41-47, 2005.
  33. M. Milner, C. Barry-Kinsetta, A. Unwin. "The impact of maternal age on pregnancy and its outcome," Int J Obstet Gynecol, Vol.38, No.4, pp.281-286, 1992. https://doi.org/10.1016/0020-7292(92)91019-K
  34. J. J. Lee, "Effect of women's first childbearing age on the risk of low birth weight," Korean Journal of Pediatrics, Vol. 50, No. 12, pp.1206-1211, 2007. https://doi.org/10.3345/kjp.2007.50.12.1206
  35. C. V. Katwijk, L.L. Peeters. "Clinical aspects of pregnancy after the age of 35 years; a review of the literature," Hum Reprod Update, Vol.4, No.2, pp.185-194, 1998. https://doi.org/10.1093/humupd/4.2.185
  36. Y. A. Hur, K. H. Lee, "A Study on Countermeasures of Convergence for Big Data and Security Threats to Attack DRDoS in U-Healthcare Device", Journal of the Korea Convergence Society, Vol. 6, No. 4, pp. 243-248, 2015. https://doi.org/10.15207/JKCS.2015.6.4.243
  37. J. H. Kim, J. Y. Go, K. H. Lee, "A Scheme of Social Engineering Attacks and Countermeasures Using Big Data based Conversion Voice Phishing", Journal of the Korea Convergence Society, Vol. 6, No. 1, pp. 85-91, 2015. https://doi.org/10.15207/JKCS.2015.6.1.085
  38. S. S. Kim, "Study on Big Data Utilization Plans of Medical Institutions", Journal of Digital Convergence, Vol. 12, No. 2, pp. 397-407, 2012. https://doi.org/10.14400/JDC.2014.12.2.397
  39. S. Kim, D. Kim, "The Effect of Parental Socioeconomic Position on the Association between Birth Outcomes and Infant Mortality in Korea: Focusing on Early and Late 2000's", Korea Journal of Population Studies, Vol. 35, No. 1, pp.131-149, 2012.
  40. Y. H. Kim, "A Study of the Development of a National Financial Health Maintenance in Response to Economic Crisis", Journal of Digital Convergence, Vol. 11, No. 1, pp. 23-26, 2014.