2017년 국민건강영양조사 자료를 이용한 성별에 따른 초고령 노인의 건강특성과 의료이용

Abstract

본 연구의 목적은 만 80세 이상 초고령 노인의 일반적 특성, 건강특성, 의료이용을 성별에 따라 분석하고 차이를 규명하는 것이다. 이를 위해 한국인을 대표할 수 있는 국민건강영양조사 제 7기 2차년도(2017년)자료를 바탕으로 가중치를 고려하여 복합표본 분석방법으로 분석하였다. 연구결과는 다음과 같다.

첫째, 대상자의 일반적 특성은 만 80세 이상 초고령 노인304명 중 남자는 120명(38.0%), 여자는 184 명(62.0%)이었으며, 교육수준은 최종학력이 초등학교 졸업 이하인 경우가 72.7%, 별거, 이혼, 사별로 배우자와 동거하지 않는 경우는 56.5% 였다. 소득수준은 ‘중’인 경우가 46.1%로 높았으며, 72.5%의 대상자가 경제활동이 없는 것으로 나타났으며, 국민건강보험 가입자 중 건강보험 가입은 91.1%로 가장 높았으며, 민간보험 가입은 8.4%로 낮았다. 둘째, 대상자의 성별에 따른 일반적 특성에서 유의한 차이를 보인 항목은 교육수준, 배우자와 동거, 경제활동 여부였다. 일반적 특성에서 여자는 남자에 비해 초등학교 졸업 이하(χ2 =76.515, p<.001), 배우자가 없는 경우(χ2 =105.388, p<.001), 경제활동을 하지 않는 경우(χ2 =4.553, p= .008)가 더 높은 것으로 나타났다. 셋째, 대상자의 건강특성 중 신체적 건강특성의 차이에서 여자는 남자에 비해 동반질환이 더 많은 것으로 나타났으며, 여자노인에서 동반질환은 고혈압 74.0%, 안과질환 62.1%, 관절염 42.6%, 골다공증 36.2%, 이상고지혈증 27.8%, 당뇨병 20.8% 순이었다. 넷째, 대상자의 건강특성 중 정신적 건강특성에서 통계학적으로 유의한 차이를 보인 항목은 평소 스트레스 인지정도(χ2 =11.111, p= .006)로 여자가 남자보다 스트레스를 더 많이 인지하는 것으로 확인되었다. 다섯째, 대상자의 건강특성 중 건강행위 특성에서 여자가 남자보다 활동제한(χ2 =8.277, p= .007)과 체질량지수(χ2 =10.328, p<.001)가 높았으며, 구강검진(χ2 =13.888, p<.001), 규칙적으로 걷기(χ2 = 5.576, p= .016)와 근력운동(χ2 =32.974, p<.001)은 낮았다. 여섯째, 의료이용에 대한 성별 비교에서 통계학적으로 유의한 차이를 보인 항목은 2주간 외래이용(χ2=3.516 p= .013), 필요 의료서비스 미 충족(χ2 =9.281, p= .001)이었다. 여자는 50.7%, 남자는 39.0%로 여자가 외래이용을 더 많이 한 것으로 나타났다. 남자는4.0%, 여자는15.8% 로 여자노인에서 필요 의료서비스 미 충족이 높게 나타났다.

본 연구의 결과 초고령 노인은 교육 수준은 낮고 독거 중이고, 소득 수준이 중간이며, 대부분 경제활동이 없는 것으로 나타났다. 건강특성을 보면, 남자에 비해 여자가 동반질환을 더 많이 가지고 있었고, 스트레스를 더 많이 인지하는 것으로 나타났다. 건강행위 특성에서는 남자에 비해 여자가 활동제한이 많았으며, 구강검진과, 운동실천율은 낮은 것으로 나타났다. 마지막으로 의료이용에 있어 여자가 남자에 비해 외래이용을 더 많이 하는 것으로 나타났으며, 필요 의료서비스 미 충족은 높았다. 이에 초고령 여자노인의 활동 증진을 위한 맞춤형 건강증진 프로그램 개발이 요구되며, 필요 의료서비스 미 충족 영역을 확인하여 의료서비스 제공을 확대하는 정책 마련이 필요하다. |The purpose of this study is to analyze the general characteris-tics, health characteristics, and use of medical care of the oldest-old males and females aged over 80 according to gender and investi-gate the differences. For this, the 7th session and the 2nd year of the 2017 Korea National Health and Nutrition Examination Survey data, which shows the health and nutrition status of Koreans, was analyzed by considering the weight and using a complex sample analysis method.

First, as for the general characteristics of the research subjects, the survey was conducted with 304 seniors including 120 males (38.0%) and 184 females (62.0%). 72.7% of them answered that their highest education was elementary school or lower, and 56.5% of the elderly did not live with a spouse due to separation, divorce, or death. The majority of them (46.1%) had “medium” levels of income and 72.5% had been engaged in no economic activity. In addition, the majority of the senior people (91.1%) had been subscribing the national health insurance service, while only 8.4% of them had had private insurance. Second, as a result of comparing the general characteristics, health characteristics, and use of medical care of the research sub-jects according to gender, the education level, spousal cohabitation, economic activity, accompanying diseases, self-perception of usual stress level, dental exams, activity restriction, exercising, use of outpatient medical care for 2 weeks, and non-satisfaction of re-quired medical services showed statistically significant differences. When it came to the general characteristics, more female received their highest level of education at elementary school or lower (χ2 =76.515, p<.001), did not have a spouse (χ2 =105.388, p<.001), and were not engaged in economic activity (χ2 =4.553, p= .008) compared to their counterparts. Third, in terms of the characteristics of physical health, the fe-male had more accompanying diseases than male in order of hyperten-sion (74.0%), Ophthalmic diseases (62.1%), arthritis (42.6%), osteo-porosis (36.2%), Dyslipidemia (27.8%), and diabetes (20.8%). Fourth, with regard to the characteristics of psychological health, self-perception of usual stress level (χ2 =11.111, p= .006) re-vealed a statistically significant difference, revealing that the female perceived more stress than male. In subjective health condi-tions, 36.1% of the female and 26.7% of the male answered that they were “not healthy.” For depression and experience of depressed mood, no significant difference was found as per gender, but the fe-male generally showed worse psychological health conditions than their counterparts. On the other hand, compulsion for suicide was answered by more male (11.0%) than the female (7.7%). Fifth, regarding the characteristics of health behavior, the fe-male showed higher activity restriction (χ2 =8.277, p= .007) and body mass index (χ2 =10.328, p<.001) than the male, while dental exams (χ2 =13.888, p<.001), taking a walk regularly (χ2 = 5.576, p= .016), and muscle exercising (χ2 =32.974, p<.001) were lower in the female. Sixth, as a result of comparing the use of medical care according to gender, statistically significant differences were found in the use of outpatient medical care for 2 weeks (χ2=3.516 p= .013) and non-satisfaction of required medical services (χ2 =9.281, p= .001). It was also found that more females (50.7%) had used outpatient med-ical care than males (39.0%). Non-satisfaction of required medical services was also higher in the female (15.8%) than the male (4.0%).

Based on these results, the elderly are low in education, living alone, have a moderate income level, and most are inactive. In terms of health characteristics, female had more comorbidities and male perceived stress more than male. In terms of health behavior, female had more activity restrictions than male, and the oral examination rate and exercise practice rate were lower. Lastly, in terms of med-ical use, female outpatient use and unsatisfactory medical service were higher than male. Therefore, it is necessary to develop customized health promotion programs to promote activities for the oldest old female, and to prepare policies to expand the provision of medical services by identifying areas that do not meet required medical services.