Therapeutic Science for Rehabilitation (재활치료과학)

Korean Society of Neurological Occupational Therapy (대한신경계작업치료학회)
권호 표지
DOI QR코드

DOI QR Code

Association Between Lifestyle and Medical Expenses of Older Adults With Mental Illness: Using Korea Older Adults' Cohort Database

노인 코호트 DB를 이용한 정신과 질환 동반 노인의 생활 습관과 의료비 지출 크기의 연관성 분석 연구

  • Jeong, Jiin (Dept. of Occupational Therapy, Graduate School, Yonsei University) ;
  • Bae, Suyeong (Dept. of Occupational Therapy, Graduate School, Yonsei University) ;
  • Yoo, Eun-Young (Dept. of Occupational Therapy, College of Software and Digital Healthcare Convergence, Yonsei University) ;
  • Hong, Ickpyo (Dept. of Occupational Therapy, College of Software and Digital Healthcare Convergence, Yonsei University)
  • 정지인 (연세대학교 일반대학원 작업치료학과 ) ;
  • 배수영 (연세대학교 일반대학원 작업치료학과 ) ;
  • 유은영 (연세대학교 소프트웨어디지털헬스케어융합대학 작업치료학과) ;
  • 홍익표 (연세대학교 소프트웨어디지털헬스케어융합대학 작업치료학과)
  • Received : 2022.06.28
  • Accepted : 2022.08.01
  • Published : 2023.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : This study aimed to analyze the association between lifestyle and medical expenses of older adults with mental illness using claims data. Methods : We conducted secondary data analysis using the older adult cohort database provided by the Korea National Health Insurance Service. The lifestyle and medical expense variables were extracted from the cohort database. We used a generalized linear model to examine the association between lifestyle and medical expenses. Results : In total, 32,853 records were extracted. The results showed that smokers had medical expenses (estimate = -218,255, p = .037). As the number of days of walking increased, medical expenses significantly decreased (estimate = -58,843, p < .0001). Furthermore, as the number of days of drinking decreased, medical expenses increased (estimate = 692,289, p < .0001). Conclusion : This study analyzed the estimates of medical expenses according to lifestyle among older adults with mental illness. Smoking and exercise were negatively associated with medical expenses. These results suggest the importance of a healthy lifestyle for older adults with mental illness. In addition, this study can be used as clinical evidence for lifestyle management programs to improve physical and mental health.

목적 : 본 연구에서는 빅데이터를 통해 정신과 질환을 가진 노인의 생활 습관 행태와 의료비 지출 크기 간의 연관성을 분석하여 생활 습관의 긍정적 영향 및 중요성을 제시하고 이에 관련한 중재의 근거를 제언하고자 하였다. 연구방법 : 건강보험공단에서 제공하는 노인 코호트 데이터베이스(Database; DB)의 2014, 2015년 자료를 활용하여 이차데이터 분석을 시행하였다. 연구 목적에 따라 전체 변수 중 생활 습관 행태와 연간 의료비 지출 크기를 추출하였다. 각각의 생활 습관 행태와 연간 의료비 지출 크기 사이의 연관성은 일반선형모형(Generalized linear model)을 사용하여 분석하였다. 결과 : 선정기준에 따라 추출된 총 32,853명의 데이터가 분석에 사용되었다. 12,617명(38.40%)의 남성과 20,236명(61.60%)의 여성으로 구성되어 있었다. 생활 습관과 의료비의 연관성을 분석한 결과, 비흡연자의 경우 흡연자보다 의료비 지출이 유의하게 낮았으며(estimate = -218,255원, p = .037), 일주일 중 30분 이상 걷는 일수가 증가할수록 의료비 지출이 유의하게 감소하였다(estimate = -58,843원, p < .0001). 반면, 일주일 중 술을 마시는 일수가 감소할수록 의료비 지출이 증가하는 양상이 나타나는 결과가 도출되었다(estimate = 692,289원, p < .0001). 결론 : 본 연구는 정신과 질환을 가지고 있는 노인에게 있어 생활 습관의 행태에 따른 의료비의 변화를 분석하였다. 흡연과 운동은 의료비 지출과 음의 연관성을 나타냈으며 걷기 운동을 많이 할수록, 흡연을 하지 않을수록 의료비 지출이 감소함을 알 수 있었다. 이러한 결과는 정신과 질환을 가지고 있는 노인에게 있어 건강한 생활 습관의 중요성을 시사한다. 본 연구가 정신과 질환을 가진 노인의 신체적, 정신적 건강 증진을 위한 생활 습관 관리 프로그램의 임상적 근거로써 활용될 수 있기를 기대한다.

Keywords

Acknowledgement

본 연구는 교육부 및 한국연구재단의 4단계 BK21 사업의 지원을 받았음 (교육연구팀명: 빅데이터를 기반으로 한 지역사회 노인의 인지건강과 사회통합을 위한 교육연구팀)

References

  1. Anthony, W. A. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychological Rehabilitation Journal, 16(4), 521-538. https://doi.org/10.1037/h0095655
  2. Barnett, A., Zhang, C., Johnston, J., & Cerin, E. (2018). Relationships between the neighborhood environment and depression in older adults: A systematic review and meta-analysis. International Psychogeriatrics, 30 (8), 1153-1176. https://doi.org/10.1017/S104161021700271X
  3. Choi, S. E. (2016). Health expenditure of smokers and the effect of smoking. Korean Journal of Public Finance, 9(2), 1-21.
  4. Chu, J. E., Lee, H. J., Yoon, C. H., Cho, H. I., Hwang, J. Y., & Park, Y. J. (2014). Relationships between depressed mood and life style patterns in Koreans aged 40 years. Journal of the Korean Society of Food Science & Nutrition, 43(5), 772-783. https://doi.org/10.3746/jkfn.2014.43.5.772
  5. Go, S. J. (2015). The effect and policy implication of elderly fitness programs. Health & Welfare Policy Forum, 225, 28-37. https://doi.org/10.23062/2015.07.4
  6. Ha, G. Y. (2016). The association between health behaviors and medical expenditures (Unpublished doctoral dissertation). Ewha Womans University.
  7. Heise, B. (2010). Healthcare system use by risky alcohol drinkers: A secondary data analysis. Journal of the American Academy of Nurse Practitioners, 22(5), 256-263. https://doi.org/10.1111/j.1745-7599.2010.00500.x
  8. Her, W. B., Jung, E. J., Choi, S. Y., & Chun, J. S. (2013). Influencing factors on drinking among schizophrenia patients in community care: Focusing on daytime rehabilitation facilities in Seoul and Gyeonggi areas. Health & Social Welfare Review, 33(3), 104-129. https://doi.org/10.15709/hswr.2013.33.3.104
  9. Hwang, S. Y. (2007). The perception of recovery: Perspective from people with mental illness. Mental Health & Social Work, 27, 28-63.
  10. Izumi, Y., Tsuji, I., Ohkubo, T., Kuwahara, A., Nishino, Y., & Hisamichi, S. (2001). Impact of smoking habit on medical care use and its costs: A prospective observation of national health insurance beneficiaries in Japan. International Journal of Epidemiology, 30(3), 616-621. https://doi.org/10.1093/ije/30.3.616
  11. Jeong, S. G., & So, A. Y. (2017). Quality of sleep and depression for patients in psychiatric hospitals. Journal of Korean Academy of Psychiatric Mental Health Nursing, 26(4), 374-381. https://doi.org/10.12934/jkpmhn.2017.26.4.374
  12. Jolley, D., Kosky, N., & Holloway, F. (2004). Older people with long-standing mental illness: The graduates. Advances in Psychiatric Treatment, 10(1), 27-34. https://doi.org/10.1192/apt.10.1.27
  13. Ju, S. H. (2010). A study on the effects ADL and depression on the elderly living alone's ideation of suicide. Family & Culture, 22(2), 31-53. https://doi.org/10.21478/family.22.2.201006.002
  14. Kim, D. B., Yoo, B. S., & Min, J. S. (2011). Analysis of factors affecting health inequalities among Korean elderly. Korean Journal of Social Welfare Studies, 42(3), 267-290. https://doi.org/10.16999/kasws.2011.42.3.267
  15. Kim, I. S., & Lee, J. W. (2019). Effects of acceptance commitment therapy based recovery enhancement program on psychological flexibility, recovery attitude, and quality of life for inpatients with mental illness. Journal of Korean Academy of Psychiatric & Mental Health Nursing, 28(1), 79-90. https://doi.org/10.12934/jkpmhn.2019.28.1.79
  16. Kim, K. H. (2016). Comobidity adjustment in health insurance claim database. Health Policy & Management, 26(1), 71-78. http://dx.doi.org/10.4332/KJHPA.2016.26.1.71
  17. Kim, N., & Jung, M. S. (2017). The influence of elderly social activity and depression on elderly well being. Journal of the Korea Contents Association, 17(3), 496-506. https://doi.org/10.5392/JKCA.2017.17.03.496
  18. Kim, S. W. (2018). Psychosocial intervention for patients with schizophrenia. Journal of Korean Neuropsychiatric Association, 57(3), 235-243. https://doi.org/10.4306/jknpa.2018.57.3.235
  19. Kim, H. L., Yoon, S. H., Lee, J. W., & Ha, J. H. (2018). The effects of an acceptance-commitment therapy based stress management program on hospitalization stress, self-efficacy and psychological well-being of inpatients with schizophrenia. Journal of Korean Academy of Nursing, 48(4), 443-453. https://doi.org/10.4040/jkan.2018.48.4.432
  20. Korea Institute for Health and Social Affairs. (2018). 2017 National survey of older Koreans (Policy Report 2018-01). Ministry of Health and Welfare. https://www.kihasa.re.kr/api/external/viewer/doc.html?fn=14222:2018102911242242388.pdf&rs=/api/external/viewer/upload/kihasaold/report/201810
  21. Korea Institute for Health and Social Affairs. (2022). Current smoking rate trend. https://kosis.kr/statHtml/statHtml.do?orgId=331&tblId=DT_33109_D020&conn_path=I2
  22. Kwak, Y. B., Kim, J. Y., & Lee, M. H. (2018). Effects of self-efficacy, health attitudes, and healthy lifestyle on recovery of people with mental disorders in the community. Journal of Korean Academy of Psychiatric & Mental Health Nursing, 27(4), 303-312. https://doi.org/10.12934/jkpmhn.2018.27.4.303
  23. Lee, E. R., Kang, J. H., & Jung, J. P. (2013). Factors influencing the depression of aged people. Journal of the Korea Contents Association, 13(7), 290-300. https://doi.org/10.5392/JKCA.2013.13.07.290
  24. Lee, J. H., & Lee, E. S. (2019). Smoking-cessation interventions for hospitalized patients with mental disorder: Systematic review and meta-analysis. Korean Journal of Stress Research, 27(4), 298-303. https://doi.org/ 10.17547/kjsr.2019.27.4.298
  25. Lee, S. W. (2012). A study of factors on the poverty of households with mentally disabled members. Korea Welfare Panel Study Conference, 5, 61-72.
  26. Lee, S. Y., & Moon, Y. P. (2018). A study of the financial projection of health expenditures of the aged of national health insurance -focused on the healthy ageing of EU-. Journal of Critical Social Welfare, 58, 53-93. https://doi.org/10.47042/ACSW.2018.02.58.53
  27. Ministry of Health and Welfare, & Korea Health Promotion Institution. (2020). Health plan 2030, 2021~2030. https://www.khealth.or.kr/board/view?pageNum=1&rowCnt=8&no1=34&linkId=1002152&menuId=MENU00829&schType=0&schText=&searchType=&boardStyle=Gallery&categoryId=&continent=&country=&contents1=
  28. National Health Insurance Service. (2021a). Long term care insurance statistical yearbook. https://www.nhis.or.kr/nhis/together/wbhaec07200m01.do?mode=view&articleNo=10810012&article.offset=0&articleLimit=10
  29. National Health Insurance Service. (2021b). Medical cost status of older adults aged 65 or older by disease subcategory (2017). https://kosis.kr/statHtml/statHtml.do?orgId=350&tblId=DT_35001_A667412&conn_path=I2
  30. National Health Insurance Service. (2021c). Medical cost status of older adults aged 65 or older by disease subcategory (2019~2021). https://kosis.kr/statHtml/statHtml.do?orgId=350&tblId=DT_35001_A090111&conn_path=I2
  31. National Health Insurance Service. (2022). Medical cost status of older adults aged 65 or older by disease subcategory [Data Set]. https://www.data.go.kr/data/15011868/fileData.do#/tab-layer-file
  32. Park, C. U., Kim, N. E., Liu, F. Y., & Yoon, M. J. (2020). A study of social isolation and its socio-demographic characteristics in Korea. Journal of Social Research, 21(2), 41-73. https://doi.org/10.22862/kjsr.2020.21.2.002
  33. Park, J. H., & Lee, S. H. (2020). The relationship between social participation and self-rated health in persons with psychiatric disabilities: Is the health behavior mediation model useful. Korean Journal of Health Education & Promotion, 37(2), 69-83. https://doi.org/10.14367/kjhep.2020.37.2.69
  34. Park, S. Y., & Lee, C. K. (2016). The socioeconomic factors of older generations' depression. The Journal of Korean Public Policy, 18(1), 3-27.
  35. Rho, B., & Mo, S. H. (2007). The effect of levels and dimensions of social support on geriatric depression. Journal of the Korean Gerontological Society, 27(1), 53-69.
  36. Sohn, J. H., Ahn, S. H., Cho, S. J., Seo, H. Y., Kim, K. N., Ryu, J. M., & Park, J. M. (2019). Living alone, social isolation and depressive disorder among community-dwelling older adults in an urban community in Korea. Journal of Korean Geriatric Psychiatry, 23(2), 58-64. https://doi.org/10.47825/jkgp.2019.23.2.58
  37. Statistics Korea. (2020). Statistics on the aged 2020. http://kostat.go.kr/portal/eng/pressReleases/11/1/index.board?bmode=read&bSeq=&aSeq=388599&pageNo=1&rowNum=10&navCount=10&currPg=&searchInfo=&sTarget=title&sTxt=
  38. Stubbs, B., Vancampfort, D., Hallgren, M., Firth, J., Veronese, N., Solmi, M., Brand, S., Cordes, J., Malchow, B., Gerber, M., Schmitt, A., Correll, C. U., Hert, M. D., Guaghran, F., Schneider, F., Kinnafick, F., Falkai, P., Moller, H. J., & Kahl, K. G. (2018). EPA guidance on physical activity as a treatment for severe mental illness: A meta-review of the evidence and position statement from the European Psychiatric Association (EPA), supported by the International Organization of Physical Therapists in Mental Health (IOPTMH). European Psychiatry, 54, 124-144. https://doi.org/10.1016/j.eurpsy.2018.07.004
  39. Thapa, D. K., Visentin, D. C., Kornhaber, R., & Cleary, M. (2020). Prevalence and factors associated with depression, anxiety, and stress symptoms among older adults: A cross sectional population based study. Nursing & Health Sciences, 22(4), 1139-1152. https://doi.org/10.1111/nhs.12783
  40. The National Mental Health and Welfare Commission. (2019). The health of people with mental illnesses. http://www.nmhc.or.kr/.
  41. Tsai, A. C., Chi, S. H., & Wang, J. Y. (2013). Cross-sectional and longitudinal associations of lifestyle factors with depressive symptoms in ≥ 53-year old Taiwanese results of an 8-year cohort study. Preventive Medicine, 57(2), 92-97. https://doi.org/10.1016/j.ypmed.2013.04.021
  42. Whitley, R., & Drake, R. E. (2010). Recovery: A dimensional approach. Psychiatric Services, 61(12), 1248-1250. https://doi.org/10.1176/ps.2010.61.12.1248
  43. Yoon, M. S., & Jeong, H. S. (2012). Life experiences of older people with mental disorder. Journal of Rehabilitation Research, 16(1), 59-85.
  44. Yoon, M. S., & Park, H. J. (2011). Life experience of persons with physical disability and problem drinking as coexisting disabilities. Journal of Rehabilitation Research, 15(1), 149-178.
  45. Yu, J., Kwon, S. H., Ho, C. M. B., Lee, K., Kim, N., Pyo, C. S., & Park, S. J. (2020). Stroke disease prediction based on deep learning using the elderly cohort DB. Journal of Digital Contents Society, 21(6), 1191-1199. http://dx.doi.org/10.9728/dcs.2020.21.6.1191
  46. Zarkin, G. A., Bray, J. W., Babor, T. F., & Higgins-Biddle, J. C. (2004). Alcohol drinking patterns and health care utilization in a managed care organization. Health Services Research, 39(3), 553-570. https://doi.org/10.1111/j.1475-6773.2004.00244.x