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1 pissn: eissn: (2): , March ORIGINAL ARTICLE 성인아토피피부염의사회경제적관계에관한연구 김범준 1, 정진아 2, 이주석 3 1 중앙대학교의과대학피부과학교실, 2 동아대학교의과대학소아과학교실, 3 성균관대학교의과대학삼성창원병원소아청소년과 Association between social economic status and atopic dermatitis in Korean adult: an analysis of the Fifth Korea National Health and Nutrition Examination Survey ( ) Beom Joon Kim 1, Jin-A Jung 2, Ju Suk Lee 3 1 Department of Dermatology, Chung-Ang University College of Medicine, Seoul; 2 Department of Pediatrics, Dong-A University School of Medicine, Busan; 3 Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea Purpose: Atopic dermatitis is one of the most common allergic diseases, and its prevalence has been increasing in recent decades. Social economic status is a well-known risk factor for allergic disease. This study was performed to investigate the relationship between social economic status and atopic dermatitis in Korean adults. Methods: Data were acquired from 18,066 men and women aged older than 19 years who participated in the Fifth Korea National Health and Nutrition Examination Surveys (KNHANES), which was conducted from 2010 to The presence of atopic dermatitis was based on self-reported physician diagnosis of atopic dermatitis in the Health Interview Surveys. Results: The prevalence of atopic dermatitis was 2.3%, which decreased with age. In univariate analysis, adults with atopic dermatitis were younger, well-educated, had higher monthly family income, had more household members, and lived in the urban area (P< 0.05), whereas sex, residential type, or smoking status was not associated with the presence of atopic dermatitis. The prevalence of hypertension, diabetes mellitus, and obesity were lower in atopic dermatitis subjects, while asthma was higher (P< 0.05). Binary logistic regression analysis showed that younger age and the presence of asthma were associated with higher prevalence of atopic dermatitis (P< 0.01). Conclusion: The results of this study suggest that younger age and the prevalence of asthma may be important risk factors for the prevalence of atopic dermatitis in Korean adults. These results warrant future studies to explore mechanisms underlying the association between social economic status and atopic dermatitis. ( 2015;3: ) Keywords: Atopic dermatitis, Education, Economics, Income 서론아토피피부염은가려움증을동반하는만성알레르기염증질환으로주로소아에서호발한다. 소아에서는 10% 20%, 성인에서는 2% 10% 의유병률을보이며최근다른알레르기질환과함께국내외적으로증가추세를보인다. 1-4) 대한소아알레르기호흡기학회의조사결과에의하면초등학생에서의아토피피부염진단이 1995년 13.7% 에서 2005년 29.2% 로증가한다고보고하였으나아직국내에 서성인아토피피부염환자를대상으로실시한전국조사와유병률변화에대한연구는없다. 성인아토피피부염의유병률은나라마다다르게나타나는데일본성인을대상으로한연구에서는 2.9% 로보고하였으며 5) 미국성인을대상으로한연구에서는 3.2% 로보고하였다. 6) 한국성인을대상으로조사한아토피피부염연구에서유병률은 7.1% 로보고하였으나 7) 서울, 경기거주지역거주자를대상으로실시한연구이므로전국민을대표하는데한계점이있다. 아토피피부염과관련된환경적, 사회경제학적요인에대한기존의 Correspondence to: Ju Suk Lee Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158 Paryong-ro, Masanhoewon-gu, Changwon , Korea Tel: , Fax: , ljs @lycos.co.kr Received: July 21, 2014 Revised: October 2, 2014 Accepted: October 4, The Korean Academy of Pediatric Allergy and Respiratory Disease The Korean Academy of Asthma, Allergy and Clinical Immunology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (

2 김범준외 성인아토피피부염의사회경제적관계에관한연구 연구는대부분소아를대상으로실시되었으며부모의교육수준이높을수록소아에서아토피피부염의발생이높다고알려져있다. 8) 성인에서도아토피피부염은질환악화시결근과같은사회경제학적문제를발생한다고보고하고있으나 9,10) 아직소아에비해연구가부족하며국내성인아토피피부염과사회경제학적요인에대한연구는아직없다. 이에본저자들은 5차국민건강영양조사 (Korea National Health and Nutrition Examination Survey) 자료를이용하여성인아토피피부염의국내유병률과성인아토피피부염의사회경제학적특성에대해알아보고자인구기반설문조사자료를이용하여후향적단면연구를실시하였다. 대상및방법 1. 연구대상본연구는 5차국민건강영양조사의자료를이용하여실시하였다. 국민건강영양조사는국민의건강및영양상태를파악하여보건정책과사업이효과적으로전달되고있는지를평가하기위해 1998년부터질병관리본부에서실시하고있다. 국민건강영양조사는매년 192개지역의 20가구를확률표본으로추출하여만 1세이상가구원약 1만명을조사하며대상자의생애주기별특성에따라소아 (1 11 세 ), 청소년 (12 18 세 ), 성인 (19세이상 ) 으로나누어, 각기특성에맞는조사항목을적용한다. 국민건강영양조사는검진조사, 건강설문조사, 영양조사세부분으로구성되어있으며세부적인조사내용과방법은질병관리본부연구윤리심의위원회 (Institutional Review Board) 의승인을받아수행되고있다. 검진조사는비만, 고혈압, 당뇨병, 이상지혈증등의내용을조사하며건강설문조사는흡연, 음주, 신체활동, 이환, 의료이용등의내용을조사하고영양조사는식품및영양소섭취현황, 식생활등을조사한다. 5차국민건강영양조사는 2010년부터 2012년까지 3년동안의조사이며총 25,534명이참여하였다. 본연구는 25,534명중 19세이상의성인을대상으로실시하였으며 18세이하 5,935명을제외하였다. 19,599명중에서아토피피부염, 천식의유무를응답하지않은 1,533 명은연구에서제외하여 18,066명을대상으로연구를실시하였다. 전체대상자의분포는 2010년 6,272명, 2011년 6,068명, 2012년 5,726명이었다. 2. 연구방법본연구는 5차국민건강영양조사를이용하여실시한인구기반후향적설문조사연구이며국민건강영양조사자료는국민건강영양조사홈페이지 ( 에서제공받았다. 연구에사용되었던각변수의정의는체질량지수의경우 <23, 23 25, >25 kg/m 2 을기준으로세군으로나누었고이는정상, 과체중, 비만을의미한다. 흡연의경우는흡연을한번도하지않 Table 1. Demographic characteristics of subjects (n= 18,066) Characteristic No. (%) Sex Male 7,632 (42.2) Female 10,434 (57.8) Age (yr) ,359 (13.1) ,448 (19.1) ,156 (17.5) ,434 (19.0) ,082 (17.1) > 70 2,587 (14.3) Education, n= 17,860 < Middle school 4,606 (25.8) Middle school 1,948 (10.9) High school 5,939 (33.3) > High school 5,367 (30.0) Monthly family income (quartile), n= 17, ,538 (19.8) 2 4,597 (25.7) 3 4,841 (27.1) 4 4,880 (27.3) No. of household members 1 1,368 (7.6) 2 4,741 (26.2) 3 4,461 (24.7) 4 5,040 (27.9) 5 2,456 (13.6) Residential type Apartment 8,361 (46.3) House 9,705 (53.7) Residence area Urban 14,315 (79.2) Rural 3,751 (20.8) Smoking status Current 3,673 (20.3) Ex-smoker 3,632 (20.1) None 10,761 (59.6) Hypertension Yes 4,117 (22.8) No 13,949 (77.2) Diabetes mellitus Yes 1,506 (8.3) No 16,560 (91.7) Body mass index (kg/m 2 ), n= 17,961 < 23 8,074 (45.0) ,187 (23.3) > 25 5,700 (31.7) 았던군, 이전에흡연을하였지만현재금연을한군, 현재도흡연을하고있는군으로나누었으며금연군은금연시행후흡연을한번 129

3 Kim BJ, et al. Association between social economic status and atopic dermatitis in Korean Table 2. Atopic dermatitis prevalence among adults in Korea, The Fifth Korea National Health and Nutrition Examination Survey ( ) Region Total subjects Atopic dermatitis, n (%) Seoul 3, (3.3) Busan 1, (1.7) Daegu (1.2) Incheon 1, (2.4) Gwangju (1.7) Daejeon (2.3) Ulsan (2.5) Gyeunggi 3, (2.6) Gangwon (3.3) Chungbuk (1.9) Chungnam (1.3) Jeonbuk (1.4) Jeonnam (0.8) Gyeungbuk 1, (1.7) Gyeungnam 1, (2.0) Jeju (0.5) 도하지않은군으로정의하였고간헐적흡연이있었던군은흡연군 으로분류하였다. 거주지역은도시와농촌으로나누었으며시, 동 은도시로읍, 면은농촌으로분류하였다. 1 달가족수입은 5 차국민 영양조사에서분류한 4 분위수를이용하였고교육수준은중학교 졸업미만, 중학교졸업, 고등학교졸업, 대학졸업이상으로나누었 다. 천식, 아토피피부염, 당뇨, 고혈압의유무는평생의사에의해진 단받은적이있는경우로한정하였다. 3. 통계분석 자료분석은 PASW Statistics ver (SPSS Inc., Chicago, IL, USA) 프로그램을사용하였고 2 군에서빈도비교는 chi-square 를 사용하였고아토피피부염과사회경제학적요인과의연관성을알 아보기위해 logistic regression analysis 를사용하였으며 P 값이 0.05 미만인경우를통계적으로의미있다고판단하였다. 1. 연구대상자들의특징 결과 총 18,066 명의연구대상자들중아토피피부염으로진단된경우 는 409 명 (2.3%) 이었다. 교육수준은고졸이상인경우 (63.3%) 가많 았으며한달소득 4 분위수중 1 분위수인경우 (19.8%) 가연구대상 자중빈도가낮았고가족구성원의수는 1 인가정인경우 (7.6%) 와 5 인이상인경우 (13.6%) 가빈도가낮았다. 거주지역은도시거주자 의빈도 (79.2%) 가높았으며대상자들의현재흡연율은 20.3% 였고 고혈압의빈도는 22.8% 였다. 당뇨병의빈도는 8.3% 였고체질량지 수 25 kg/m 2 이상의비만을나타내는경우는 31.7% 였다 (Table 1). Table 3. Demographic characteristics according to the presence of atopic dermatitis (n= 18,066) Characteristic Atopic dermatitis Nonatopic dermatitis P-value Sex 0.25 Male 161 (39.4) 7,471 (42.3) Female 248 (60.6) 10,186 (57.7) Age (yr) < (43.5) 2,181 (12.4) (20.8) 3,363 (19.0) (10.0) 3,115 (17.6) (10.8) 3,390 (19.2) (9.3) 3,044 (17.2) > (5.6) 2,564 (14.5) Education, n= 17,860 < 0.01 < Middle school 43 (10.5) 4,563 (26.1) Middle school 24 (5.9) 1,924 (11.0) High school 186 (45.6) 5,753 (33.0) > High school 155 (38.0) 5,212 (29.9) Monthly family income (quartile), n= 17, (11.7) 3,491 (20.0) (25.8) 4,493 (25.7) (31.3) 4,715 (27.0) (31.3) 4,754 (27.2) 2. 아토피피부염환자의사회경제학적특성 < 0.01 No. of household members < (7.6) 1,337 (7.6) 2 64 (15.6) 4,677 (26.5) (27.4) 4,349 (24.6) (34.7) 4,898 (27.7) 5 60 (14.7) 2,396 (13.6) Residential type 0.29 Apartment 8,161 (46.2) 200 (48.9) House 9,496 (53.8) 209 (51.1) Residence area < 0.01 Urban 346 (84.6) 13,969 (79.1) Rural 63 (15.4) 3,688 (20.9) Smoking status 0.36 Current 93 (22.7) 3,580 (20.3) Ex-smoker 74 (18.1) 3,558 (20.1) None 242 (59.2) 10,519 (59.6) Values are presented as number (%). 국민건강영양조사에서아토피피부염의유무는 2005 년부터조 사하였으며 2009 년부터성인아토피피부염의유병률은 2.2% 2.3% 로조사되고있다. 본연구에서아토피피부염의전체유병률은 2.3% 였으나각지역별로 0.5% 3.3% 의유병률을보였다 (Table 2). 본연구대상자들에서아토피피부염으로진단된경우에연령이 어린경우가많았으며연령이증가할수록아토피피부염의빈도는 감소하였다. 고등학교졸업이상의학력을가진경우와소득수준 130

4 김범준외 성인아토피피부염의사회경제적관계에관한연구 Table 4. Comorbidity conditions in atopic dermatitis subjects (n= 18,066) Characteristic Atopic dermatitis Nonatopic dermatitis P-value Hypertension < 0.01 Yes 45 (11.0) 4,072 (23.1) No 364 (89.0) 13,585 (76.9) Diabetes mellitus < 0.01 Yes 16 (3.9) 1,490 (8.4) No 393 (96.1) 16,167 (91.6) Body mass index (kg/m 2 ), n= 17,961 < (53.1) 7,859 (44.8) (18.8) 4,111 (23.4) > (28.1) 5,586 (31.8) 이높은경우에아토피피부염의빈도가높았고 4 인가족인경우에 아토피피부염의빈도가높았다. 거주형태에따른차이는없었으나 도심에거주하는경우에아토피피부염의빈도가높았으며흡연유 무에따른차이는없었다 (Table 3). 아토피피부염이있는경우에고 혈압, 당뇨, 비만의빈도는낮았으나천식의동반빈도는높았다 (Table 4). 다변량분석후아토피피부염이동반된경우에유의하게연령이 어렸고천식의동반빈도가높았다. 나이가증가할수록아토피피부 염의빈도는감소하는경향을보였으며교육수준, 가족수, 한달 가구수입, 거주지역, 고혈압, 당뇨병, 비만에있어서는유의한차이 를보이지않았다 (Table 5). 고찰 < 0.01 Asthma < 0.01 Yes 27 (6.6) 560 (3.2) No 382 (93.4) 17,097 (96.8) Values are presented as number (%). 성인아토피피부염의유병률은조사마다많은차이를보이고있 는데 10,762 명을대상으로한한일본연구에서는 3% 의유병률을 보고하였고 5) 2,123 명의성인을대상으로한다른일본연구에서는 6.9% 로보고하였다. 11) 본연구에서는이전연구에서보고된 7.1% 의 아토피피부염유병률과는 7) 달리아토피피부염의유병률은 2.3% 로 조사되어차이를보이고있다. 이러한차이가발생한이유로는연 구대상자의차이때문으로추론되는데이전연구의경우에는서 울, 경기지역거주자중병원을내원한참여자를대상으로하였고 7) 본연구의경우에는전국민을대상으로실시한국민건강영양조사 참여자를대상으로하였다. 국민건강영양조사에서아토피피부염 의유무는 3 차조사인 2005 년부터실시되었는데아토피피부염의 유병률은조사연도에따라 7.1% 에서 2.2% 로큰차이를보이지만 2009 년부터는 2.2% 2.3% 의비교적균일한유병률을보이고있다. 이러한차이는조사초기의조사방법의표준화에문제가있었을 Table 5. Adjusted odd ratio (OR) and their 95% confidence interval (CI) for the prevalence of atopic dermatitis Characteristic Adjusted OR 95% CI P-value Age < < > 70 Reference Education 0.11 < Middle school Reference Middle school High school > High school No. of household members Reference Monthly family income (quartile) 1 Reference 것으로추정되나향후유병률의변화에대한지속적관찰이필요 하리라생각된다 Residential type Urban Asthma Yes < 0.01 Hypertension Yes Diabetes mellitus Yes Body mass index (kg/m 2 ) 0.72 < 23 Reference > 본연구대상자들에서아토피피부염으로진단된경우에연령이 어린경우가많았으며연령이증가할수록아토피피부염의빈도는 감소하였다. 이러한나이에따른아토피피부염의유병률변화는다 른보고에서도동일한결과가관찰되었다. 5,7,12) 일반적으로성인아 토피피부염의유병률은여성의빈도가높은것으로알려져있으나 6,12) 본연구에서는성별간유병률의차이는없었다. 성별간성인아 토피피부염의유병률차이가있다고보고했던연구들은 6,12) 코커서 131

5 Kim BJ, et al. Association between social economic status and atopic dermatitis in Korean 스인종을기반을한연구이며일본성인을대상으로한연구에서도성별간차이가없다고보고하고있어 5) 이러한차이가인종간의차이에의한가능성을배제할수없으리라생각된다. 본연구에서고등학교졸업이상의학력을가진경우와소득수준이높은경우에아토피피부염의빈도가높은경향을보였고이는다른연구와동일한결과이나 6) 가족구성인수에따른아토피피부염의빈도는이전연구와다른결과를보였다. 6,13) 이전연구에서는가족구성원수가작은경우에아토피피부염의빈도가높았으나 6,13) 본연구에서는가족구성원수가많은경우에아토피피부염의빈도가높은경향을보였고이러한차이가서구와다른문화적, 인종적차이에의한특성때문에발생할가능성이있으나이를확인하기위해서는추가연구가필요하다. 이전보고들에서도심에거주하는경우에아토피피부염의유병률이높다고보고하고있고 14,15) 본연구에서도도심에거주하는경우에아토피피부염의빈도가높은경향을보였다. 그러나이전보고들은소아를대상으로하였으며성인에있어서거주지역차이에대한보고는거의보고되고있지않다. 흡연과알레르기질환과의연관성에대해많은연구가이루어졌으며임신시담배연기에대한노출은출생아에서천식의빈도를높이는것으로알려져있으나 16) 아토피피부염과의연관성은아직확실하지않다. 17,18) 흡연에대한노출이 IgE를증가시키고 19) 흡연이성인아토피피부염과연관이있다는있다는보고가있어 12,20) 흡연과성인아토피피부염사이에연관관계가있으리라추정될수있지만이는서구인을대상으로한연구이며본연구에서는흡연과아토피피부염사이에연관성은없었고일본인을대상으로한연구에서도흡연과아토피피부염사이에유의한연관성은없었다. 18) 본연구에서아토피피부염이있는경우에천식동반빈도가유의하게높았으며다른이전보고에서도비슷한결과를보고하였다. 6) 이전연구에서는성인습진이있는경우천식의빈도뿐아니라천식의중등도와연관이있다고하였고 6) 아토피피부염이천식발생요인으로보고하였다. 21) 비만은천식발생의위험인자로널리알려져있으나 22-24) 성인아토피피부염과비만과관련된보고는거의없다. 젊은성인여성에서아토피피부염의빈도와체질량지수사이에유의한양의상관관계를가진다고알려져있으나 25) 본연구에서는유의성을관찰할수없었다. 이론적으로는아토피피부염이있는환자의경우에말초혈관조절이상을보이는경향을보이므로 26) 고혈압가능성이있으리라추론할수있으나본연구결과에서는아토피피부염과고혈압사이에유의한상관관계가없었으며이전연구에서도유의한관계는없었다. 27) 본연구에서는당뇨병과아토피피부염의유의성을관찰할수없었으나이전소아를대상으로한연구에서는인슐린의존성당뇨 병이있는경우에아토피피부염의발생이감소한다고보고하였 다. 28) 이전보고에서인슐린의존성당뇨병은 Th1 면역질환이므로 Th2 면역질환인아토피피부염을억제한다고추론하였으나 28) 현재 에는 Th1, Th2 면역질환모두가조절 T 세포기능장애에의해발생 한다알려져있다. 29,30) 본연구의단점은첫째, 후향적단면연구로아토피피부염과사회 경제학적요인사이의인과관계를밝히기어렵고둘째, 대상자선 정에서선택삐뚤림이발생할수있으며셋째, 연구참여자의기억에 의하므로회상삐뚤림이발생할수있다. 또한아토피피부염의진단 이아토피피부염의정확한진단기준없이의사의주관에의해이 루어질수있어이또한본연구의단점으로생각된다. 그럼에도불 구하고본연구의장점은전국민을대상으로한인구기반연구이 며검사에있어서동일한방법으로표준화가시행되었다. 또한각 지역별성인아토피피부염의유병률의차이와아토피피부염의사 회경제학적특성에대한첫보고에의의가있다. 소아에서아토피피부염에대해서는국내외적으로많은연구가 이루어지고있으나국내에서성인아토피피부염에대한연구는소 아에비해부족하며성인아토피피부염의사회경제학적특성에대 한연구는아직보고되지않고있다. 본논문에서연령과천식만이 유의한성인아토피피부염위험인자로보고되고있는데이러한결 과가인종, 사회적특성에기반한것인지또는연구상의오류에의 한것인지에대해서는향후다른추가연구가필요하리라생각된다. 본논문내용을기반으로할때저자들은성인아토피피부염이있 는경우에천식의동반유무를확인하는과정이필요하리라생각 된다. REFERENCES 1. Williams H, Flohr C. How epidemiology has challenged 3 prevailing concepts about atopic dermatitis. J Allergy Clin Immunol 2006;118: Hong SJ, Lee MS, Sohn MH, Shim JY, Han YS, Park KS, et al. Self-reported prevalence and risk factors of asthma among Korean adolescents: 5-year follow-up study, Clin Exp Allergy 2004;34: Lee SI, Shin MH, Lee HB, Lee JS, Son BK, Koh YY, et al. Prevalences of symptoms of asthma and other allergic diseases in korean children: a nationwide questionnaire survey. J Korean Med Sci 2001;16: Williams H, Stewart A, von Mutius E, Cookson W, Anderson HR; International Study of Asthma and Allergies in Childhood (ISAAC) Phase One and Three Study Groups. Is eczema really on the increase worldwide? J Allergy Clin Immunol 2008;121: e Muto T, Hsieh SD, Sakurai Y, Yoshinaga H, Suto H, Okumura K, et al. Prevalence of atopic dermatitis in Japanese adults. Br J Dermatol 2003; 148: Silverberg JI, Hanifin JM. Adult eczema prevalence and associations with asthma and other health and demographic factors: a US population-based study. J Allergy Clin Immunol 2013;132: Kim MJ, Kang TW, Cho EA, Kim HS, Min JA, Park H, et al. Prevalence of atopic dermatitis among Korean adults visiting health service center of 132

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한국성인에서초기황반변성질환과 연관된위험요인연구

한국성인에서초기황반변성질환과 연관된위험요인연구 한국성인에서초기황반변성질환과 연관된위험요인연구 - - i - - i - - ii - - iii - - iv - χ - v - - vi - - 1 - - 2 - - 3 - - 4 - 그림 1. 연구대상자선정도표 - 5 - - 6 - - 7 - - 8 - 그림 2. 연구의틀 χ - 9 - - 10 - - 11 -