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성인 당뇨병 환자의 소득수준에 따른 혈당, 당화혈색소, 혈압, 및 혈중지질 지표의 변화 추이 : 국민건강영양조사 1998~2014 분석 결과

Trends in metabolic risk factors among patients with diabetes mellitus according to income levels: the Korea National Health and Nutrition Examination Surveys 1998~2014

  • 조수경 (영남대학교 식품영양학과) ;
  • 박경 (영남대학교 식품영양학과)
  • Cho, Sukyung (Department of Food and Nutrition, Yeungnam University) ;
  • Park, Kyong (Department of Food and Nutrition, Yeungnam University)
  • 투고 : 2018.11.13
  • 심사 : 2019.01.22
  • 발행 : 2019.04.30

초록

본 연구는 당뇨병 환자들의 소득수준에 따라 대사위험지표 관리수준을 비교하고, 최근 관리 추이를 관찰하여 궁극적으로 당뇨병 환자들의 합병증 예방 관련 전략을 마련할 수 있는 기초자료를 마련하기 위하여 1998 ~ 2014년 국민건강영양조사 자료를 분석하였다. 국민건강영양조사에 참여한 조사대상자 중 당뇨병 환자이면서 본인의 질환을 인지하고 있는 대상자들을 추출하였고, 가구소득정보를 이용하여 세 그룹으로 분류하여 분석하였다. 당뇨병 환자들의 기본정보, 생활습관정보, 영양소 섭취 정보, 혈액지표 등은 건강설문조사, 영양조사, 검진조사를 통해 수집되었다. 자료 분석은 변수 특성에 따라 카이검정, 일원분산분석 등을 실시하였고, 다중선형회귀분석을 이용하여 혈압 및 혈액지표의 보정평균을 산출하였다. 당뇨환자들의 공복혈당, HbA1c 및 혈중지질 농도의 평균은 소득수준에 따라 유의적인 차이를 보이지 않았다. 조사기간인 1998년부터 2014년간의 16년 동안 대사위험지표 변화 추이를 살펴본 결과, 모든 그룹에서 혈압의 유의미한 감소 추세를 보였다 (p < 0.001). 소득이 가장 높은 그룹에서는 공복혈당 (p = 0.004), 총 콜레스테롤 (p < 0.001), LDL-콜레스테롤 농도 (p = 0.01)가 유의하게 감소하는 추이를 보였고, HDL-콜레스테롤 농도 (p < 0.001)는 유의하게 증가하는 추이를 보였다. 저소득층에서는 공복혈당 (p = 0.02), 총 콜레스테롤 (p < 0.001), 중성지방 농도 (p = 0.003)가 시간 경과에 따라 유의적으로 감소하는 경향을 보였다. 그러나 중간소득층에서는 혈압을 제외한 모든 대사 위험 인자에 유의적인 변화 추이가 발견되지 않았다. 결론적으로 당뇨병 환자의 소득수준에 따른 대사 위험 인자의 관리수준에는 차이가 없었다. 최근 16년의 관찰 기간 동안 소득이 가장 높은 그룹과 가장 낮은 그룹은 대사 위험 인자의 유의미한 개선 추이를 보였으나, 중간소득 그룹은 변화가 관찰되지 않았다. 본 연구는 당뇨병 환자들의 지표 관리에 대한 전략 마련과 효과적인 보건대책을 위한 기초자료로서 중요한 의미가 있다고 사료된다.

Purpose: Management of the metabolic risk factors in diabetes patients is essential for preventing or delaying diabetic complications. This study compared the levels of the metabolic risk factors in diabetes patients according to the income levels, and examined the secular trends in recent decades. Methods: The data from the Korea National Health and Nutrition Examination Survey 1998 ~ 2014 were used. The diabetes patients were divided into three groups based on their household income levels. General information was obtained through self-administered questionnaires, and the blood biomarkers and blood pressure data were obtained from a health examination. Multivariable linear regression models were used to compare the metabolic biomarker levels according to the household income levels, adjusting for potential confounding factors. Results: The fasting blood glucose, hemoglobin A1c, and blood lipid (total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride) levels were similar in the three groups. During the survey period of 16 years, the blood pressure showed a significant decreasing trend with time in all groups (p < 0.001). In contrast, the fasting blood glucose (p = 0.004), total cholesterol (p < 0.001), and LDL-cholesterol levels (p = 0.007) decreased significantly, and the HDL-cholesterol level (p < 0.001) increased significantly in the highest-income groups. In the lowest-income group, the fasting blood glucose (p = 0.02), total cholesterol (p < 0.001), and triglyceride (p = 0.003) levels showed a significant decreasing trend over time. On the other hand, the middle-income group showed no significant change in any of the metabolic risk factors except for blood pressure. Conclusion: The level of management of metabolic risk factors according to the income level of Korean diabetes patients was similar. On the other hand, the highest- and lowest-income groups showed positive trends of management of these factors during 16 years of observation, whereas the middle-income group did not show any improvement.

키워드

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피인용 문헌

  1. The Associated Factors of Medical Treatment in Diabetic Patients vol.46, pp.3, 2019, https://doi.org/10.21032/jhis.2021.46.3.302