Journal of dental hygiene science (치위생과학회지)

The Korean Society of Dental Hygiene Science (한국치위생과학회)
권호 표지
DOI QR코드

DOI QR Code

Effects of Periodontal Disease on Cardio-Cerebrovascular Disease: A Focus on Personal Income and Social Deprivation

치주질환이 심뇌혈관질환 발생에 미치는 영향: 지역결핍과 개인소득을 중심으로

  • Kim, Min-Young (Department of Social and Humanity in Dentistry, Dental College, Wonkwang University School of Dentistry) ;
  • Shin, Hosung (Department of Social and Humanity in Dentistry, Dental College, Wonkwang University School of Dentistry)
  • 김민영 (원광대학교 치과대학 인문사회치의학교실) ;
  • 신호성 (원광대학교 치과대학 인문사회치의학교실)
  • Received : 2017.06.29
  • Accepted : 2017.08.03
  • Published : 2017.08.31
Download PDF
⟨ Previous Next ⟩

Abstract

The study aimed to investigate the effects of differences between personal income and social deprivation on the association between cardio-cerebrovascular disease (hypertension, stroke) and periodontal disease. This study used 12 years of cohort data from the Korea National Health Insurance Service covering the years 2002 to 2013. Among the patients aged more than 40 years who had received treatment for periodontal disease 224,067 and 284,730 who had not received treatment for hypertension and stroke, respectively, were included in the analysis. The Kaplan-Meier analysis revealed differences in the rate of treatment for cardio-cerebrovascular disease (hypertension, stroke) according to regional differences, the rate of treatment increased as the composite deprivation index value increased. The difference in treatment rates for cardio-cerebrovascular disease (hypertension, stroke) according to income was found to be higher in the treatment group with low income. This study empirically proved that the association between systemic disease and periodontal disease varies depending on personal income and the regional socioeconomic deprivation level. This shows that the clinical influence of periodontal illness on systemic disease differs according to the personal socio-demographic characteristic and residential area and that an individual's characteristic (income and the regional) needs to be considered along with the patient's clinical intervention in the disease treatment process.

2002~2013년도 국민건강보험공단 표본 코호트자료를 활용하여 만 40세 이상 치주질환 환자를 대상으로 CVD 누적 치료 경험률 및 개인의 소득과 지역의 CDI의 차이에 따른 치료 경험률을 파악한 본 연구의 결론은 다음과 같다. 첫째, 치주질환이 있는 대상자에서 고혈압은 34.3%, 뇌졸중은 12.6%의 누적 치료 경험률이 확인되었다. 둘째, 치주질환이 있는 대상자에서 지역적 차이(CDI)에 따른 고혈압의 치료 경험률의 차이는, CDI가 높은 집단이 낮은 집단에 비해 치료 경험률이 높은 것으로 나타났다(p<0.001). 셋째, 치주질환이 있는 대상자에서 소득분위에 따른 고혈압 치료 경험률의 차이는, 소득분위가 낮은 집단에서 치료 경험률이 높은 것으로 확인되었다(p<0.001). 넷째, 치주질환이 있는 대상자에서 지역적 차이(CDI)에 따른 뇌졸중 치료 경험률의 차이는, CDI가 높을수록 뇌졸중 치료 경험률이 높은 것으로 나타났다(p<0.001). 다섯째, 치주질환이 있는 대상자에서 소득분위에 따른 뇌졸중 치료 경험률의 차이는, 소득분위가 높아질수록 뇌졸중의 치료 경험률이 낮은 것으로 조사되었다(p<0.001). CVD와 치주질환의 관계에 지역의 CDI와 개인의 소득은 역의 관계를 보이는 것으로 나타났다. 향후 국민의 구강 및 보건의료 소비에 있어 사회경제적, 지역간 격차 해소에 대한 정책적 대안으로, 사회경제적 취약계층에 대한 보건의료서비스 제공으로 보건의료에 대한 접근성 개선과, 공공의료기관의 확충으로 보건의료서비스의 지리적 접근성 취약지를 해결하고 동시에 보건의료서비스의 이용 가능성을 높이는 등 다각적 노력을 기울여야 할 것으로 생각된다.

Keywords

References

  1. Park YH: Research and review the implementation decree for the act on prevention and management of cardiovascular disease. Korea Centers for Disease Control and Prevention, Seoul, pp.8-10, 2016.
  2. Clinical Research Center For Stroke: Clinical practice guidelines for stroke. 2nd ed. Clinical Research Center For Stroke, Seoul, pp.1-24, 2013.
  3. Dave S, Van Dyke T: The link between periodontal disease and cardiovascular disease is probably inflammation. Oral Dis 14: 95-101, 2008. https://doi.org/10.1111/j.1601-0825.2007.01438.x
  4. Jepsen S, Kebschull M, Deschner J: Relationship between periodontitis and systemic diseases. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 54: 1089-1096, 2011. https://doi.org/10.1007/s00103-011-1348-4
  5. Sfyroeras GS, Roussas N, Saleptsis VG, Argyriou C, Giannoukas AD: Association between periodontal disease and stroke. J Vasc Surg 55: 1178-1184, 2012. https://doi.org/10.1016/j.jvs.2011.10.008
  6. Kawabata Y, Ekuni D, Miyai H, et al.: Relationship between prehypertension/hypertension and periodontal disease: a prospective cohort study. Am J Hypertens 29: 388-396, 2016.
  7. Joshipura KJ, Hung HC, Rimm EB, Willett WC, Ascherio A: Periodontal disease, tooth loss, and incidence of ischemic stroke. Stroke 34: 47-52, 2003. https://doi.org/10.1161/01.STR.0000052974.79428.0C
  8. Chou SH, Tung YC, Lin YS, et al.: Major adverse cardiovascular events in treated periodontitis: a population-based follow-up study from Taiwan. PLoS One 10: e0130807, 2015. https://doi.org/10.1371/journal.pone.0130807
  9. Woodward M, Oliphant J, Lowe G, Tunstall-Pedoe H: Contribution of contemporaneous risk factors to social inequality in coronary heart disease and all causes mortality. Prev Med 36: 561-568, 2003. https://doi.org/10.1016/S0091-7435(03)00010-0
  10. Im JS, Choi DK, Yim J, et al.: Socioeconomic differentials in stroke and cardiovascular disease mortality in Korea. Korean J Health Educ Promot 23: 109-119, 2006.
  11. Zhou G, Liu X, Xu G, Liu X, Zhang R, Zhu W: The effect of socioeconomic status on three-year mortality after first-ever ischemic stroke in Nanjing, China. BMC Public Health 6: 227, 2006. https://doi.org/10.1186/1471-2458-6-227
  12. Jung-Choi K, Khang YH, Cho HJ: Changes in contribution of causes of death to socioeconomic mortality inequalities in Korean adults. J Prev Med Public Health 44: 249-259, 2011. https://doi.org/10.3961/jpmph.2011.44.6.249
  13. Singh GK: Area deprivation and widening inequalities in US mortality, 1969-1998. Am J Public Health 93: 1137-1143, 2003. https://doi.org/10.2105/AJPH.93.7.1137
  14. Jung SW, Cho YT: Neighborhood characteristics and individual health under Korean context. J Prev Med Public Health 38: 259-266, 2005.
  15. World Health Organization: Health 2020: A European policy framework and strategy for the 21st century. WHO Regional Office for Europe, Copenhagen, pp.1-26, 2012.
  16. House JS: Understanding social factors and inequalities in health: 20th century progress and 21st century prospects. J Health Soc Behav 43: 125-142, 2002. https://doi.org/10.2307/3090192
  17. Wallace D: Kevin Fitzpatrick and Mark LaGory (2011): Unhealthy cities: poverty, race, and place in America. New York: Routledge. Int J Urban Reg Res 38: 1923-1925, 2014. https://doi.org/10.1111/1468-2427.12191_3
  18. National Health Insurance Service Big Data: Sample DB fourth-quarter educational materials. National Health Insurance Service, Wonju, pp.105-169, 2015.
  19. Shin H, Lee S, Chu JM: Development of composite deprivation index for Korea: the correlation with standardized mortality ratio. J Prev Med Public Health 42: 392-402, 2009. https://doi.org/10.3961/jpmph.2009.42.6.392
  20. Kim HS, Kim MK, Shin HS: Expenditure in ambulatory dental care and factors related to its spending. Health Policy Manag 22: 207-224, 2012. https://doi.org/10.4332/KJHPA.2012.22.2.207
  21. Chai GM: Advanced statistics by using SPSS and AMOS. Yangseowon, Paju, pp.71-160, 2014.
  22. Sim JH, Ahn DC, Son MA: Difference of area-based deprivation and education on cerebrovascular mortality in Korea. Health Policy Manag 22: 163-182, 2012. https://doi.org/10.4332/KJHPA.2012.22.2.163
  23. Shin HS, Kim DJ: The evolution of health and utilization inequalities over time. In-depth analyses of the third national health and nutrition examination survey: the health interview and health behavior survey part. Korea Centers for Disease Control and Prevention, Seoul, pp.405-438, 2007.
  24. Shi L, Lebrun LA, Tsai J: Access to medical care, dental care, and prescription drugs: the roles of race/ethnicity, health insurance, and income. South Med J 103: 509-516, 2010. https://doi.org/10.1097/SMJ.0b013e3181d9c2d8
  25. Lu JF, Leung GM, Kwon S, Tin KY, Van Doorslaer E, O'Donnell O: Horizontal equity in health care utilization evidence from three high-income Asian economies. Soc Sci Med 64: 199-212, 2007. https://doi.org/10.1016/j.socscimed.2006.08.033
  26. Shin HW, Shin JW, Song JC, Kong YH, Yu CH, Shin JK: A study on the feasibility and supporting method of supporting the operation cost of the low income elderly. Korea Institute for Health and Affairs, Sejong, 2014.

Cited by

  1. 한국 노인의 심혈관질환과 치주질환의 관련성 연구 : 독거노인과 가족동거노인을 중심으로 vol.10, pp.12, 2019, https://doi.org/10.15207/jkcs.2019.10.12.135