The association between socio-economic status and healthcare utilization and health behavior by the progressive stage of metabolic syndrome

Abstract

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.

본 연구는 효과적인 대사증후군 관리를 위해 대사증후군을 관련 질환 진행 단계에 따라 분류하고 각 단계별 건강행태 실천과 의료이용이 소득수준에 따라 차이가 있는지를 보고자 하였다. 제 4기 국민건강영양조사 자료(2007년-2009년)를 이용하여 암을 진단 받지 않은 20세 이상의 국민건강보험 가입자를 대상으로 하였고 대사증후군을 진행 단계별로 분류하였다. 대사증후군의 진행단계가 높아질수록 낮은 교육수준과 소득수준의 분포가 많아졌으며, 의료비용은 관련 질병의 진단을 받지 않은 대사증후군 집단에서 소 득계층에 따른 차이가 통계학적으로 유의하였다. 건강행태는 통계학적으로 유의하지는 않았지만 진행단계와 관계없이 고소득계층에서 더 좋은 건강행태를 보였다. 관련 질병 유무와 소득수준 간 상호작용 효과는 의료비용에서 통계학적으로 유의하게 나타났고 관련 질병 없는 저소득계층의 경우 대사증후군 집단은 고소득계층에 비하여 의료비용을 적게 사용하였다. 그러므로 대사증후군 저소득층 집단에 대한 예방사업의 필요성이 크고 의료 이용의 접근성을 높여 대사증후군이 관련 질병으로 이행하는 것을 예방하는 정책이 시급하다.