결 론

대사증후군은 그 개념에 입각하여 전인적인 예방관리가 필요한 집단이다. 따 라서 대사증후군이지만 관련 특정 질병 진단을 받지 않은 군의 의료이용과 건 강행태를 보다 심층적으로 분석하고자 하였으며 그 결과는 다음과 같다.

첫째, 본 연구대상자는 MS-0 9,075명, MS-1 2,027명, MS-2 1,802명, MS-3 275명으로 중증도가 높아질수록 사회경제적 상태 변수와 의료 필요를 나타내는 변수들에서 확연한 빈도의 차이가 나타났다. 즉, 중증도가 높아질수록 고소득계 층의 비율은 줄어들었고 의료필요가 높아졌다.

둘째, 네 그룹(MS-0, MS-1, MS-2, MS-3)안에서 소득수준에 따른 의료비용 의 차이는 MS-1에서 유의한 차이가 나타났으며 이는 중증도가 낮은 집단에서 소득수준에 따른 질적 의료이용의 차이가 많이 나타났다는 것을 의미한다. 건 강행태 측면에서는 중증도와 무관하게 고소득계층에서 전반적인 건강관리가 상 대적으로 잘 이루어졌다.

셋째, 대사증후군 관련 질병유무와 소득수준의 상호작용 효과를 분석한 결과, 외래비용에서 통계학적으로 유의한 결과가 나타나 중증도가 낮은 그룹에서 소 득계층에 따른 외래비용 불형평성이 다른 그룹에 비하여 통계학적으로 유의하 게 컸다.

이상의 결과에서 질병이 없는 대사증후군 집단의 저소득계층에 대한 의료이 용 및 건강행태 권장 정책을 통하여 대사증후군의 발생을 억제하고 관련 질병 으로의 전이를 막아야 할 것이다.

참고문헌

권순만, 양봉민, 이태진, 오주환, 이수형: 보건의료이용의 형평성. 보건경제연구.

Vol.9, No.2, pp.13-24, 2003

이용재: 한국사회의 소득불평등과 국민 의료이용. 집문당, 2012

윤현중: 유산소 및 유연성 운동이 고령자의 건강관련 체력과 대사증후군 위험 인자 및 혈관염증지표에 미치는 영향. 경상대학교 박사학위 논문, 2012

전병환: 근력운동의 대사증후군 예방효과. 한국 운동 재활 학회지 2012-11, pp.51-60, 2012

전영숙: 손상환자의 사회경제적 상태에 따른 의료 이용의 형평성. 서울대학교 석사학위 논문, 2011

질병관리본부: 제 4기 국민건강영양조사 원시자료 이용지침서. 보건복지부, 2008

최병호, 노연홍, 윤병식, 신형웅, 김명희, 김창엽: 국민의료의 형평성분석과 정책 과제. 한국보건사회연구원 연구보고서 2004-09, 2004

한국건강증진재단, 경희대학교: 건강관리서비스운영 및 관련 인력 양성을 위한 표준모형 개발. 보건복지부, 2011

허갑범: 대사증후군. 진기획, 2009

Alexander CM, Landsman PB, Teutsch SM, Haffner SM: NCEP-defined metabolic syndrome, diabetes, and prevalence of coronary heart disease among NHANES III participants age 50 years and older. Diabetes 52

Azevedo A, Bettencourt P, Almeida PB, Santos AC, Abreu-Lima C, Hense HW, Barros H: Increasing number of components of the metabolic syndrome and cardiac structural and functional abnormalities–cross-sectional study of the general population. BMC cardiovascular disorders 7: 17, 2007

Baron RM, Kenny DA: 1986. The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of personality and social psychology 51: 1173, 1986

Bennett, Jill A: Focus on research methods-mediator and moderator variables in nursing research: conceptual and statistical differences. Research in nursing and health 23: 415, 2000

Boudreau D, Malone D, Raebel M, Fishman P, Nichols G, Feldstein A, Boscoe A, Ben-Joseph R, Magid D, Okamoto L: Health care utilization and costs by metabolic syndrome risk factors. Metabolic Syndrome and Related Disorders 7: 305-314, 2009

Chen J, Muntner P, Hamm LL, Jones DW, Batuman V, Fonseca V, Whelton PK, He J: The metabolic syndrome and chronic kidney disease in US adults.

Annals of internal medicine 140: 167-174, 2004

Culyer AJ, van Doorlsaer E, Wagstaff A: Access utilisation and equity: A further comment. Journal of health economics 11-2: 207-210, 1992

Curtis LH, Hammill BG, Bethel MA, Anstrom KJ, Gottdiener JS, Schulman KA: Costs of the Metabolic Syndrome in Elderly Individuals Findings from the Cardiovascular Health Study. Diabetes Care 30: 2553-2558, 2007

Eckel RH, Grundy SM, Zimmet PZ: The metabolic syndrome. The Lancet 365: 1415-1428, 2005

Fu T, Wen T, Yeh P, Chang H: Costs of metabolic syndrome‐related

diseases induced by obesity in Taiwan. Obesity Reviews 9: 68-73, 2008

Hunt KJ, Williams K, Hazuda HP, Stern MP, Haffner SM: The metabolic syndrome and the impact of diabetes on coronary heart disease mortality in women and men: the San Antonio Heart Study. Annals of epidemiology 17:

870-877, 2007

Liu Z, Grundy S, Wang W, Sidney C, Wu Z, Zeng Z, Wang W, Zhao D, Hill C: Ten-year risk of cardiovascular incidence related to diabetes, prediabetes, and the metabolic syndrome. American heart journal 153:

552-558, 2007

Kaplan GA, Keil JE: Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation 88: 1973-1998, 1993

Kurella M, Lo JC, Chertow GM: Metabolic syndrome and the risk for chronic kidney disease among nondiabetic adults. Journal of the American Society of Nephrology 16: 2134-2140, 2005

Lee JS, Koeske GF, Sales E: Social support buffering of acculturative stress: A study of mental health symptoms among Korean international students. International Journal of Intercultural Relations 28: 399-414, 2004

Lim S, Shin H, Song JH, Kwak SH, Kang SM, Yoon JW, Choi SH, Cho SI, Park KS, Lee HK: Increasing Prevalence of Metabolic Syndrome in Korea The Korean National Health and Nutrition Examination Survey for 1998–

2007. Diabetes Care 34: 1323-1328, 2011

Meigs JB, Wilson PW, Nathan DM, D’Agostino RB, Williams K, Haffner SM: Prevalence and characteristics of the metabolic syndrome in the San Antonio Heart and Framingham Offspring Studies. Diabetes 52: 2160-2167,

Noh S, Kaspar V: Perceived discrimination and depression: Moderating effects of coping, acculturation, and ethnic support. American Journal of Public Health 93: 232-238, 2003

Park MJ, Yun KE, Lee GE, Cho HJ, Park HS: A cross-sectional study of socioeconomic status and the metabolic syndrome in Korean adults. Annals of epidemiology 17: 320-326, 2007

Park YW, Zhu S, Palaniappan L, Heshka S, Carnethon MR, Heymsfield SB:

The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey(1988-1994). Archives of internal medicine 163: 427, 2003

Ritz E, Koleganova N, Piecha G: Is there an obesity–metabolic syndrome related glomerulopathy? Current opinion in nephrology and hypertension 20:

44-49, 2011

Rutter MK, Meigs JB, Sullivan LM, D’Agostino RB, Wilson PW: C-reactive protein, the metabolic syndrome, and prediction of cardiovascular events in the Framingham Offspring Study. Circulation 110: 380-385, 2004

Sanisoglu SY, Oktenli C, Hasimi A, Yokusoglu M, Ugurlu M: Prevalence of metabolic syndrome-related disorders in a large adult population in Turkey.

BMC public health 6: 92, 2006

Solymoss BC, Bourassa MG, Campeau L, Sniderman A, Marcil M, Lespérance J, Lévesque S, Varga S: Effect of increasing metabolic syndrome score on atherosclerotic risk profile and coronary artery disease angiographic severity. The American journal of cardiology 93: 159-164, 2004

Tong W, Lai H, Yang C, Ren S, Dai S, Lai S: Age, gender and metabolic syndrome-related coronary heart disease in US adults. International journal of cardiology 104: 288-291, 2005

Sambamoorthi U, McAlpine D: Racial, ethnic, socioeconomic, and access disparities in the use of preventive services among women. Preventive medicine 37: 475-484, 2003

Vogelzangs N, Beekman AT, Kritchevsky SB, Newman AB, Pahor M, Yaffe K, Rubin SM, Harris TB, Satterfield S, Simonsick EM: Psychosocial risk factors and the metabolic syndrome in elderly persons: findings from the Health, Aging and Body Composition study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 62: 563-569, 2007

Lorant V, Boland B, Humblet P, Deliege D: Equity in prevention and health care. J Epidemiol Health 56: 510-516, 2002

Wagstaff A, van Doorslaer E: Equity in the finance and delivery of health care: concepts and definitions. Journal of Health economics, Oxford university press, 1993

Wamala SP, Lynch J, Horsten M, Mittleman MA, Schenck-Gustafsson K, Orth-Gomer K: Education and the metabolic syndrome in women. Diabetes Care 22: 1999-2003, 1999

Wilson PW, D’Agostino RB, Parise H, Sullivan L, Meigs JB: Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation 112: 3066-3072, 2005

Abstract

-The association between socio-economic status and healthcare utilization and health behavior by the

progressive stage of metabolic syndrome.

Min-Ho Cho

Department of Medical Sciences The Graduate School, Ajou University (Supervised by Professor Ki-Hong Chun)

The prevalence of metabolic syndrome, required high level of preventive care, has been rapidly increased in Korea. Therefore, the importance of comprehensive assessing the health utilization in the group of metabolic syndrome has been also emphasized in the aspects of effective resources distribution in community. The objectives of this research are to classify the metabolic syndrome into several groups based on the severities of clinical symptoms (MS-0, MS-1, MS-2, MS-3). In addition, the differences in health care utilization, cost and health behaviors by socio-economic statusis also investigated in each group.

We analyzed a total of 15,617 adult subject (ages ≥20) who participated in the Korean National Health and Nutrition Examination Survey Ⅳ (2007,2008,2009). We distinguished metabolic syndrome groups according to

progressive stage of metabolic syndrome. Socioeconomic status was measured by income level that ranges from 1(lowest) to 4(highest). We conducted ANOVA to investigate the difference of cost, utilization and health behavior (exercise score & eating low salt food) by income level in two groups, and used univariate general linear model(GLM) to assess whether interaction between income and having MS-related disease has an effects on dependent variables.

There was no significant difference of average outpatient cost by income level in other groups, but differences in subject with MS-1 significantly existed, especially between highest income group(￦31,992) and the other groups(1Q: ￦6,438 2Q: ￦4,720 3Q: ￦8,578). In health behavior, There were significant differences of exercise score and eating low-salt food by income level in all group except for MS-3. Interaction term between income level which means whether they are highest income group or not and having MS-related diseases was significantly effective on outpatient cost(P<0.01).

In conclusion, various differences were found in health care utilization as well as cost and health behaviors according to their socio-economic status especially in the patients with mild symptoms(MS-1). Low and middle income patients take relatively low level of medical care services in the group of metabolic syndrome with mild symptoms(MS-1) who need intensive preventive care, and high income group tends to have appropriate health behavior relatively.

Keyword : Metabolic syndrome, Metabolic syndrome-related disease,