ORIGINAL ARTICLE ISSN(Online) 22879129 Child Health Nurs Res, Vol.21,.1, January 2015: 2027 http://dx.doi.org/10.4094/chnr.2015.21.1.20 부모의특성을포함한아동기천식과아토피피부염의영향요인 : 제 5 기 2 차년도 (2011 년 ) 국민건강영양조사자료를중심으로 이윤정 1, 김지수 2 1 경인여자대학교간호과, 2 가천대학교간호학과 Factors Affecting Asthma and Atopic Dermatitis in Korean Children: A Populationbased Crosssectional Survey Yunjeong Yi 1, Jisoo Kim 2 1 Department of Nursing, Kyungin Women s University, Incheon; 2 Department of Nursing, Gachon University, Incheon, Korea Purpose: The purpose of this study was to investigate factors affecting childhood asthma and atopic dermatitis. Methods: For this study, data for 1,170 children (111 years) from the Fifth Korean National Health and Nutrition Examination Survey (KNHANES V2, 2011) were analyzed. First correlation matrices were computed to test the normality of every data set and then to be in accordance with the real demographic composition, data were added weight before being analyzed. Results: The child with asthma of a three generation family (OR=3.91, 95% CI [1.33, 11.45], p =.013) compared with a two generation family showed higher asthma development, and maternal asthma (OR=9.71, 95% CI [2.66, 35.40], p =.001) showed higher asthma development in child. The only factor affecting atopic dermatitis was parental perceptions of child health: poor (OR=3.40, 95% CI [1.29, 8.98], p =.014). Conclusion: These results suggest that childhood asthma and atopic dermatitis are both affected by parental perceptions of child health. Accordingly, management and support programs for children who have asthma and/or atopic dermatitis and their families should be comprehensive and also give attention to any other health problems because health perception represents quality of life. Key words: Child, Asthma, 연구의필요성 서론 알레르기질환이수십년간전세계적으로꾸준히증가하면서알레 Corresponding author Jisoo Kim Department of Nursing, Gachon University, 191 Hambakmoero, Yeonsugu, Incheon 406799, Korea TEL +82328204206 FAX +82328204201 EMAIL kimjisoo@gachon.ac.kr * 이논문은 2014 년도가천대학교교내연구비지원에의한결과임 (GCU2014M010). * This study was supported by the Gachon University research fund of 2014 (GCU 2014M010). Key words 아동, 천식, 아토피피부염 Received 29 July 2014 Received in revised form 15 September 2014 Accepted 17 September 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution n Commercial License (http://creativecommons.org/licenses/bync/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 르기질환을이해하고체계적으로관리하여대책을마련하고자하는사회적관심이높아지고있다. 대부분알레르기질환은영유아기에시작하여성인기까지지속되는경우가많고소아기발병률도성인보다높은경향을보인다 (Asher et al., 2006; Lee, Shin, & Oh, 2008). 한국에서도최근알레르기질환이증가하고있는데특히천식과아토피는대표적인소아기의알레르기질환으로알려져있다. 국민건강보험공단의보도자료에의하면천식환자의 43.2% 가 12세이하의아동이며 (National Health Insurance Corporation [NHIC], 2013), 아토피피부염의경우는 9세이하가환자의절반을차지하는것으로나타나 (NHIC, 2014) 어느다른연령대보다소아기의천식과아토피피부염에관한연구가더욱요구되고있다. 연구에따르면천식으로인한사회경제적비용이연간 2조원을넘고아토피피부염의경우도환자한명당한달평균 27만원의치료비 20 Copyright 2015 Korean Academy of Child Health Nursing
http://dx.doi.org/10.4094/chnr.2015.21.1.20 로인해가정경제에도큰부담을초래하고있는것으로나타났다 (Kim et al., 2011; Kim, Kim, & Park, 2008). 또한천식, 아토피피부염과같은알레르기질환은환자와부모의삶의질에도영향을주는것으로보고되고있어질병자체로의문제뿐만아니라가족의삶에도영향을미치고있음을알수있다 (Cho et al., 2012). 증상이심해질경우활동제한이따르고결석이잦아지며심리적 정서적장애와사회적기능에제한을주기도하기때문에사회성을배워나가기시작하는아동에게천식, 아토피피부염은적절한예방과관리가반드시필요하다 (Cho et al., 2012; Kim et al., 2008). 천식과아토피피부염같은알레르기질환의원인은아직명확하게밝혀져있지않지만유전적요인과환경적요인이합쳐져서생기는면연학적질환이자만성질환인것으로알려져있다. 특히부모와유전적특성이영향을주고있다는연구결과들이오래전부터끊임없이발표되면서알레르기질환의유전적영향은분명해지고있다 (Galli et al., 2007). 또한최근에는황사, 매연, 공해와같은대기환경과도관련이있는것으로보고되고있으며 (Park et al., 2013) 다양한유형의스트레스 (Carroll, Balkrishnan, Feldman, Fleischer, & Manuel, 2005), 거주환경 (Gehring et al., 2008; Lee, Kwon, et al., 2012; Strachan, 2000), 부모의흡연 (Wilson & Weis, 2011), 가족의사회경제적인수준 (Almqvist, Pershagen, & Wickman, 2005), 출생력 (Laubereau et al., 2004), 모유수유여부 (Gdalevich, Mimouni, & Mimouni, 2001; Gdalevich, Mimouni, David, & Mimouni, 2001) 등의다양한환경적요인들이천식, 아토피피부염과관련이있는것으로보고되면서유전과환경적요인모두가알레르기질환의발생에분명히관여하고있음을시사하고있다. 이렇듯소아천식과아토피피부염같은알레르기질환은다양한요인들이긴밀한연관성을가지며복합적으로관여하고있으므로질환의예방을위해서는위험요인을파악하는지속적인연구를통해효율적인관리를도모해야한다. 또한소아의아토피피부염이천식으로이행 (allergic march) 된다는연구결과가보고되면서 (Galli et al., 2007; Illi et al., 2004) 두질환간의연관성이제기되고있으므로, 두질환의위험요인을동시에파악하여비교하는연구가이두알레르기질환의이해를돕고예방관리를위해서필요한것으로보인다. 지금까지천식과아토피피부염의위험요인을분석한국내의선행연구들은일개지역을대상으로하거나편의추출된대상자를분석함으로써연구결과의편향 (bias) 을배제할수없을뿐아니라연구결과의일반화에제한점을가지고있다 (Lee & Hwang, 2008; Lee & Kim, 2008; Lee, Lee, et al., 2012; Lee et al., 2011; Nam, Youn, & Kim, 2005). 또한진료기록을분석한경우에는대상자의일반적변수와부모의특성을함께포함하지못해소아천식과아토피피부염의위험요인에대한유전적 환경적변수를포괄적으로분석하지못하고있다 (Ahn et al., 2005; Kim, Lee, & Park, 2013). 이에본연구에서는전국적대단위조사 로진행된국민건강영양조사를이용하여유전적및환경적요인을포괄하도록대상자와부모의변수를모두포함시켜아동기천식과아토피피부염의영향요인을분석하고자한다. 우리나라아동기천식과아토피피부염의유전적 환경적영향요인을종합적으로분석한본연구결과가소아기대표적알레르기질환인천식과아토피피부염의영향요인에대한기초자료의확립에기여함으로써소아기알레르기질환의예방관리를위한토대를마련하고자한다. 연구목적본연구의목적은아동기천식과아토피피부염에영향을미치는요인을확인하기위함이며, 구체적인연구목적은다음과같다. 1) 아동의일반적특성과일반적특성에따른천식및아토피피부염발생을파악한다. 2) 부모의특성에따른자녀의천식및아토피피부염발생을파악한다. 3) 천식및아토피피부염발생에영향을미치는요인을확인한다. 연구방법 연구자료및대상본연구는보건복지부, 질병관리본부가공동으로수행한 2011년국민건강영양조사제5기 2차년도 (KNHANES V2) 자료를이용한 2차분석이다. 국민건강영양조사는질병관리본부연구윤리심의위원회의승인을받았으며 ( 승인번호 : 200702CON04P, 200804EXP01C, 200901CON032C, 20102CON21C, 201102CON06C), 저자들은해당기관에공식적으로자료요청을하고승인을받았다 ( 자료승인일2013 년 9월 11일 ). 제5기 (20102012) 국민건강영양조사는매년약 3,840가구, 만 1세이상가구원전체를조사대상으로 1월부터 12월까지실시된다. 표본추출은순환표본설계방법을활용하여제5기 3개년도표본이전국을대표하는독립적인확률표본이되고각연도별로유사특성을갖는표본이뽑히도록설계되었다. 먼저표본조사구를추출하고시도별로 1차층화를, 일반지역 26개층, 아파트지역 24개층으로 2차층화를실시하였다. 추출된표본조사구내에서는계통추출법으로조사대상가구를추출하였다. 조사내용중본분석에서사용한건강설문조사는대부분면접방법으로실시되었으며건강행태영역은자기기입식으로조사되었다. 제5기 2차년도전체건강설문조사대상자는 10,589명이며참여자는 8,055명으로참여율은 76.1% 였다. 본연구는 12세미만아동 1,170명을대상으로분석하였다. www.chnr.or.kr 이윤정, 김지수 21
Child Health Nurs Res, Vol.21,.1, January 2015: 2027 변수의선정및측정아동의천식및아토피피부염발생에영향을미치는요인을파악하기위하여연구에포함된주요변수에대한정의는다음과같다. 일반적특성성별, 연령 (13 세, 46세, 711세 ), 주거유형 ( 아파트, 일반주택 ), 세대구성 (2세대, 3세대이상 ), 가족수, 가구소득 ( 하, 중하, 중상, 상 ), 국민기초생활수급권자여부, 주관적건강상태 ( 좋음, 보통, 나쁨 ), 인플루엔자예 았음 에대해체크한경우를천식 ( 혹은아토피피부염 ) 경험이있는것으로정의하였다. 부모의천식 ( 혹은아토피피부염 ) 은 지금까지천식 ( 혹은아토피피부염 ) 을앓은적있음 에체크한경우를천식 ( 혹은아토피피부염 ) 경험이있는것으로정의하였다. 아동에게는목적질병의정확한정의를위하여의사진단여부로판단하였고부모의경우에는관련요인으로파악하여의사진단이없더라도본인이앓은적있다는경험여부로판단하였다. 방접종여부, 신종플루예방접종여부를분석하였다. 이중연령은만 연령에대한응답을영유아 (13 세 ), 학령전기 (46 세 ), 학령기 (711 세 ) 로 구분하였고, 주관적건강상태는 매우좋음 부터 매우나쁨 까지 5 점 척도를 3 개의분류로재구분하여분석하였다. 자료분석방법 자료는 SPSS WIN 21.0 을이용하였고, 자료분석시복합표본 (complex samples) 분석을사용하였으며각단위별가중치를적용하였다. 대상자의일반적인특성과부모특성은실수와백분율, 평균과표준편 부모관련특성 부모각각의천식및아토피피부염유병여부, 평생흡연여부 ( 평생 100 개비이상흡연경험 ), 현재흡연여부를분석하였다. 차등의기술통계로분석하였고, 아동의천식과아토피피부염에영향 을주는일반적특성, 부모특성의영향요인을파악하기위하여 chisquare test and ttest 분석을하였으며단변량분석에서통계적으로유 천식및아토피피부염발생 아동에게는 천식 ( 혹은아토피피부염 ) 이라고의사에게진단을받 의성을나타낸변수로다중로지스틱회귀분석 (multiple logistic regression) 을통해각영향인자에대한 Odds Ratio (OR) 와 95% 신뢰구간을 구하였다. Table 1. Asthma and Atopic Dermatitis according to the General Characteristics of Children (N = 1,170) Asthma Variables (n = 1,102) (n = 68) Total (n = 1,170) chisquare or t (p) (n = 1,025) (n = 145) Total (n = 1,170) chisquare or t (p) Gender Age (year) (M±SD) Type of house Family composition Male Female Infant (13) Preschool (46) School age (711) General housing Apartment 2 generations 3 generations 563 (92.3) 539 (93.9) 5.91 ± 3.21 324 (96.6) 283 (89.3) 495 (93.1) 378 (91.7) 724 (95.0) 883 (94.5) 218 (88.5) 43 (7.7) 25 (6.1) 6.42 ± 2.63 7 (3.4) 30 (10.7) 31 (6.9) 27 (8.3) 41 (5.0) 49 (5.5) 19 (11.5) 606 (100.0) 564 (100.0) 5.93 ± 3.18 331 (100.0) 313 (100.0) 526 (100.0) 405 (100.0) 765 (100.0) 932 (100.0) 237 (100.0) 1.19 (.376) 524 (88.0) 501 (86.6) 0.76 (.447) 12.60 (.052) 5.82 ± 3.19 303 (91.2) 274 (86.9) 448 (85.4) 4.70 (.056) 359 (87.5) 666 (86.9) 11.80 (.040) 818 (87.9) 206 (85.3) 82 (12.0) 63 (13.4) 6.71 ± 2.97 28 (8.8) 39 (13.1) 78 (14.6) 46 (12.5) 99 (13.1) 114 (12.1) 31 (14.7) 606 (100.0) 564 (100.0) 5.92 ± 3.18 331 (100.0) 313 (100.0) 526 (100.0) 405 (100.0) 765 (100.0) 932 (100.0) 237 (100.0) 0.54 (.554) 2.05 (.041) 6.19 (.125) 0.09 (.799) 1.27 (.446) Number in family (M±SD) 4.32±3.01 4.33±0.79 4.32±2.92 0.64 (.524) 4.31±3.10 4.32±1.08 4.30±2.92 0.27 (.787) Income (%) < 25 25 < 50 50 < 75 75 87 (91.0) 358 (91.2) 396 (95.6) 254 (93.7) 7 (9.0) 30 (8.8) 13 (4.4) 17 (6.3) 94 (100.0) 388 (100.0) 409 (100.0) 271 (100.0) 7.01 (.336) 86 (90.9) 346 (87.5) 353 (87.0) 233 (85.3) 8 (9.1) 42 (12.5) 56 (13.0) 38 (14.7) 94 (100.0) 388 (100.0) 409 (100.0) 271 (100.0) 2.43 (.713) National basic livelihood supply Subjective health status (by parent) Influenza vaccination Swine flu vaccination *Excluding nonresponse. Good Average Poor 1,087 (93.6) 14 (73.8) 842 (96.1) 228 (86.7) 32 (71.7) 735 (92.8) 365 (93.5) 681 (92.4) 419 (94.0) 65 (6.4) 3 (26.2) 31 (3.9) 26 (13.3) 11 (28.3) 44 (7.2) 24 (6.5) 43 (7.6) 25 (6.0) 1,152 (100.0) 17 (100.0) 873 (100.0) 254 (100.0) 43 (100.0) 779 (100.0) 389 (100.0) 724 (100.0) 444 (100.0) 18.03 (.005) 1,010 (87.6) 14 (73.8) 61.80 ( <.001) 781 (89.1) 213 (84.4) 31 (69.6) 0.17 (.751) 690 (87.4) 333 (87.0) 1.06 (.410) 646 (87.7) 378 (87.2) 142 (12.4) 3 (26.2) 92 (10.9) 41 (15.6) 12 (30.4) 89 (12.6) 56 (13.0) 78 (12.3) 66 (12.8) 1,152 (100.0) 17 (100.0) 873 (100.0) 254 (100.0) 43 (100.0) 779 (100.0) 389 (100.0) 724 (100.0) 444 (100.0) 5.13 (.130) 17.59 (.009) 0.04 (.886) 0.08 (.838) 22 아동기천식과아토피피부염의영향요인 www.chnr.or.kr
http://dx.doi.org/10.4094/chnr.2015.21.1.20 Table 2. Asthma and Atopic Dermatitis according to the Parents Characteristics (N = 1,170) Asthma Variables (n = 1,102) (n = 68) Total (n = 1,170) chisquare or t (p) (n = 1,025) (n = 145) Total (n = 1,170) chisquare or t (p) Father Asthma 364 (93.1) 10 (93.3) 21 (6.9) 1 (6.7) 385 (100.0) 11 (100.0) 0.06 (.962) 858 (87.8) 5 (78.0) 117 (12.2) 1 (22.0) 975 (100.0) 6 (100.0) 0.96 (.508) Lifetime smoking 64 (94.6) 311 (92.8) 3 (5.4) 19 (7.2) 67 (100.0) 330 (100.0) 0.30 (.733) 58 (79.3) 290 (88.1) 9 (20.7) 40 (11.9) 67 (100.0) 330 (100.0) 3.92 (.164) Present smoking 175 (91.6) 199 (94.5) 11 (8.4) 11 (5.5) 186 (100.0) 210 (100.0) 1.29 (.411) 168 (88.6) 179 (84.4) 18 (11.4) 31 (15.6) 186 (100.0) 210 (100.0) 1.50 (.332) Mother Asthma 479 (93.1) 10 (52.6) 30 (6.9) 4 (47.4) 509 (100.0) 14 (100.0) 41.21 ( <.001) 1,003 (87.2) 2 (64.4) 142 (12.8) 1 (35.6) 1,145 (100.0) 3 (100.0) 1.44 (.277) Lifetime smoking 431 (91.7) 58 (91.2) 27 (8.3) 7 (8.8) 458 (100.0) 65 (100.0) 0.02 (.898) 404 (87.3) 56 (83.9) 54 (12.7) 9 (16.1) 458 (100.0) 65 (100.0) 0.61 (.571) Present smoking 467 (91.6) 22 (91.5) 31 (8.4) 3 (8.5) 498 (100.0) 25 (100.0) 0.01 (.979) 438 (86.7) 22 (89.2) 60 (13.3) 3 (10.8) 498 (100.0) 25 (100.0) 0.14 (.761) *Excluding nonresponse. Table 3. Affecting Factors of Childhood Asthma (N = 1,170) Table 4. Affecting Factors of Childhood Atopic Dermatitis Variables (ref.) Categories Asthma OR (95% CI) p Variables (ref.) Categories OR (95% CI) p Family composition (2 generations) 3 generation 3.91 (1.33, 11.45).013 National basic livelihood supply (no) 3.07 (0.53, 17.75).209 Age (infant) Preschool School age 1.46 (0.79, 2.72) 1.68 (0.96, 2.91).227.067 Subjective health status (good) Average Bad 3.74 (1.51, 9.29) 11.14 (2.29, 54.13).005.003 Subjective health status (good) Average Bad 1.45 (0.89, 2.35) 3.40 (1.29, 8.98).131.014 Mother's asthma (no) 9.71 (2.66, 35.40).001 연구결과 의한차이를나타낸독립변수를투입하여천식및아토피피부염발생 에영향을미치는요인을다중회귀분석 (multiple logistic regression) 으 대상자의일반적특성대상자는전체 1,170명으로천식이있는아동은 68명 (5.8%), 아토피피부염이있는아동은 145명 (12.4%) 이었다. 일반적특성에따른천식발생의차이분석에서는세대구성 (p =.040), 국민기초생활수급권자여부 (p =.005), 주관적건강상태 (p <.001) 에따라유의한차이가있었다. 일반적특성에따른아토피피부염발생의차이분석에서는연령 (p =.041), 주관적건강상태 (p =.009) 에따라유의한차이가있었다 (Table 1). 로분석한결과, 아동의천식발생에영향을미치는요인은세대구성, 국민기초생활수급권자여부, 주관적건강상태, 어머니의천식여부로나타났다. 즉 2세대가족에비해 3세대가족의아동은천식발생위험이 3.91배 (95% CI [1.33, 11.45], p =.013) 높았고, 주관적건강상태가 좋음 에비해 보통 인경우에 3.74배 (95% CI [1.51, 9.29], p =.005), 나쁨 인경우에 11.14배 (95% CI [2.29, 54.13] p =.003) 높았다. 또한어머니가천식경험이있는가정의아동은천식발생위험이 9.71배 (95% CI [2.66, 35.40], p =.001) 높았다 (Table 3). 한편아토피피부염의경우는주관적 부모관련특성부모관련특성에따른천식발생차이분석에서는어머니의천식유병여부에서만차이를보였고 (p <.001), 부모관련특성중에아동의아토피피부염발생에차이를보인항목은없었다 (Table 2). 건강상태가 좋음 에비해 나쁨 인경우의발생위험이 3.40 배 (95% CI [1.29, 8.98], p =.014) 높았다 (Table 4). 논의 천식및아토피피부염에영향을미치는요인 일반적특성및부모관련특성의단변량분석에서통계적으로유 본연구는대규모무작위표본추출로시행한 2011 년제 5 기 2 차국민 건강영양조사를이용하여아동의천식과아토피피부염에영향을미 www.chnr.or.kr 이윤정, 김지수 23
Child Health Nurs Res, Vol.21,.1, January 2015: 2027 치는영향요인을탐색해보고자시도되었다. 연구결과, 2세대로구성된가구에비해 3세대로구성된가구의아동이천식발생위험이높아세대구성이천식발생에영향을주는요인인것으로나타났다. 가족구성을변수로포함하여천식발생에영향을미치는지를살펴본선행연구 (Lee & Kim, 2008) 에서는핵가족, 대가족같은세대구성은영향요인이아닌것으로나타나본연구결과와차이가있었다. 하지만가족구성원의수가 4인이하의경우에천식발생위험이높다는연구 (Lee, Lee, et al., 2012) 도보고된바있어가족구성과천식간의연관성에대해서는연구마다상이한결과를나타내고있다. 선행연구 (Lee & Kim, 2008; Lee, Lee, et al., 2012) 가일개지역을모집단으로하여표본을추출한결과이고본연구는전국민을모집단으로하여무작위추출한연구결과라는차이가있으나세대구성을변수로포함하여분석한연구결과가소수이므로소아천식발생의영향요인에대한추후연구에서는본연구에서확인된세대구성을변수에포함하여천식의위험요인을분석하는것이바람직할것으로사료된다. 더구나본연구결과가가족수가적고집이깨끗할수록천식과같은면역질환의발생이높다 (Stachan, 2000) 는위생가설 (hygiene hypothesis) 과는다소상반되므로천식아동을위한유용한자료를마련하기위해서는천식발생위험요인과가족구성간의관계를재확인하는반복연구가필요할것이다. 사회경제수준과천식발생간에도상반된결과들이보고되고있다. 본연구에서는가족의사회경제적수준으로볼수있는기초생활수급여부는천식발생의위험요인이아닌것으로나타나 Almqvist 등 (2005) 이천식과가족의경제상태가관련이없다고보고한연구결과와일치하지만 Lee와 Kim (2008) 의연구에서는월평균소득 100만원미만의경우가 100300만원대의경우보다천식발생위험도가낮은것으로나타나연구마다사회경제적수준과아동천식의발생위험이불일치하는것을알수있다. 이러한결과들은사회경제적수준을구분하는절대적인기준이없고소득수준의간격과기준이연구마다다르기때문에차이가나타날수있을것으로추측되지만소득수준보다는환경이나유전적인요인이더큰영향요인이될수있기때문인것으로생각한다. 하지만명확한분석을위해서는추후공개되는제5 기 3차국민건강영양조사를활용한반복연구를제언하며 13차자료를통합한빅데이터를분석한연구도필요할것으로보인다. 한편주관적건강상태가좋음에비해보통이거나나쁘다고인식하는경우가천식발생위험이높은것으로나타난본연구결과는부모가인식하는영유아의주관적건강수준이높을수록천식발생이낮은것으로보고한 Kim 등 (2013) 의연구결과와일치한다. 주관적건강인식은건강관련삶의질과상관관계가있는것으로알려져있다 (Juniper, 2001). 따라서천식으로인한활동제한과잦은병원방문등이신체적, 사회적기능에제한을주고이로인해아동의삶의질이저하되기때문에부모의입장에서는자녀의주관적건강상태를부정적으 로인식하고있고이것이상호교환적으로천식에영향을미치는요인으로나타나보인다. 천식같은알레르기질환은지속적인관리가필요한만성질환이므로삶의질을유지하고개선시키는것이치료의목적이지만 (Juniper, 2001) 간호학에서천식아동의삶의질에관한연구는매우미흡하다. 따라서앞으로천식아동을위한간호중재는삶의질에대한사정과평가를포함할필요가있으며이를근거로아동삶의질향상을위한간호중재의개발이필요하다. 아동천식과관련된부모의특성에서는어머니가천식이있는경우에소아천식의발생위험이높은것으로나타났다. 천식은유전적소인과관련있는것으로알려져있는데특히아버지보다는어머니의천식이더강력한위험요인인것으로알려져있어본연구결과와도일치한다 (Lee, Lee, et al., 2012). 하지만아동의아토피피부염과천식에대한위험요인중에서도알레르기의가족력이다른요인들에비해위험도가가장높다는선행연구들 (Cole, Ownby, Havstad, & Peterson, 2004; Nam et al., 2005) 과는달리본연구에서아토피피부염과부모의병력은관련이없는것으로나타났다. 본연구가아동기알레르기질환의영향요인을포괄적으로분석하기위해부모변수를포함하면서국민건강영양조사의부모측면에대한많은결측치가배제된것이연구결과에영향을미쳤을것으로추측하므로향후연구에서는이러한제한점을극복하기위해제5기국민건강영양조사 13차를통합하여분석하는것이필요하겠다. 또한 1995년부터 2010년까지아동과청소년의유병률을조사한국내연구 (Ahn et al., 2011) 에따르면천식보다는아토피피부염이크게증가한것을확인할수있고, 도시보다농촌지역아동의아토피피부염유병률이높게나타난 Lee와 Kwon 등 (2012) 의연구를통해아토피피부염의위험요인으로환경적영향의중요성을추측할수있다. 따라서추후연구에서는국민건강영양조사와함께환경오염에관한자료를병합하여분석한다면아토피피부염발생의유전적, 환경적요인을좀더명확하게규명할수있을것으로사료된다. 본연구결과, 아동의천식과아토피피부염발생의공통적인관련요인은주관적건강상태로나타났는데이것은자녀의천식과아토피피부염이부모에게건강하지않은상태로인식되기때문에역방향으로영향을미친결과라고생각할수있다. 특히아토피피부염아동은가려움증과피부병변으로인한불편감으로신체적발달뿐아니라또래관계의형성이어렵고사회성과대인관계에영향을받아전반적인삶의질이저하될수있다 (Cho et al., 2011). 하지만천식과마찬가지로간호학에서아토피피부염아동의삶의질에관한연구는찾아보기어렵다. 천식과아토피피부염은장기간동안관리가필요한만성질환이고치료가어렵기때문에아동과가족이질병을겪으면서발생할수있는삶의질저하와같은문제는간호학에서연구하고중재방안을마련하는것이바람직할것으로사료된다. 소아기대표적인알레르기질 24 아동기천식과아토피피부염의영향요인 www.chnr.or.kr
http://dx.doi.org/10.4094/chnr.2015.21.1.20 환인천식과아토피피부염의공통적인영향요인이주관적건강상태이고이것은삶의질과관련이있음을고려할때, 본연구결과가앞으로알레르기질환아동의삶의질에관한간호학연구의기초자료로활용되기를기대한다. 천식과아토피피부염같은알레르기질환은원인이복잡하고많은요인들이관여하고있기때문에연구방법이나연구기관마다결과들이조금씩다르게나타나고있지만질환을예방하고관리하기위해서는발생에영향을주는위험요소들을지속적으로규명하여위험요인을줄일수있도록중재하는것이필수적이다. 이에본연구결과는선행연구와함께천식, 아토피피부염의위험요인을규명할수있는자료구축에도움이될수있을것으로보이며천식, 아토피피부염아동과가족을위한간호중재방향을제시할수있는자료를마련한점에의미를두고자한다. 결론 본연구는아동기천식과아토피피부염에영향을미치는요인을국민건강영양조사로분석함으로써국내천식과아토피피부염환아의간호중재를위한기초자료로활용하는데기여하고자시도되었다. 본연구를통해아동천식에는 3세대가족구성, 주관적건강상태에대한인식이보통이하인경우, 그리고어머니의천식이영향요인으로확인되었고아토피피부염은주관적건강상태에대한인식이영향요인으로확인되었다. 아동기주요문제가되고있는천식과아토피피부염모두부모로부터인식되는주관적건강상태와관련이있는것으로나타났는데주관적건강인식이삶의질을반영하는결과인만큼아동의천식과아토피피부염은질병으로써의치료뿐만아니라가족과아동을모두포함하는포괄적인건강증진에초점을두는중재방안이필요하다. 대단위조사자료로아동특성과부모특성을모두포함하여분석함으로써연구결과를일반화할수있다는점에본연구의의미를두고자한다. 또한본연구결과가제5기국민건강영양조사의 2차자료를활용하여대상자수에제한이있으므로향후공개되는 3차자료와 1, 2차자료를통합 분석하여연구결과를확장할것을제안한다. Conflict of Interest potential conflict of interest relevant to this article was reported. Acknowledgements This study was supported by the Gachon University research fund of 2014 (GCU2014M010). 요약 목적본연구는국민건강영양조사자료를이용하여아동천식과아토피피부염에영향을미치는요인을규명하기위한서술적조사연구이다. 방법본연구는보건복지부, 질병관리본부가공동으로수행한 2011년국민건강영양조사제5기 2차년도 (KNHANES V2) 자료를이용한 2차분석으로 12세미만아동 1,170명을대상으로 SPSS를이용한복합표본분석을하였으며각단위별가중치를적용하였다. 결과본연구를통해아동천식에는 3세대가족구성, 주관적건강상태에대한인식이보통이하인경우, 그리고어머니의천식이영향요인으로확인되었고아토피피부염은주관적건강상태에대한인식이영향요인으로확인되었다. 결론아동기주요문제가되고있는천식과아토피피부염모두부모로부터인식되는주관적건강상태와관련이있는것으로나타났는데주관적건강인식이삶의질을반영하는결과인만큼아동의천식과아토피피부염은질병으로써의치료뿐만아니라가족과아동을모두포함하는포괄적인건강증진에초점을두는중재방안이필요하다. 본연구를토대로천식과아토피피부염아동과가족의삶의질향상을위한간호중재방안을마련하는연구의계기가마련되기를기대한다. References Ahn, K., Kim, J., Kwon, H. J., Chae, Y., Hahm, M. I., Lee, K. J., et al. (2011). The prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in Korean children: Nationwide crosssectional survey using complex sampling design. Journal of Korean Medical Association, 54(7), 769778. http://dx.doi.org/10.5124/jkma.2011.54.7.769 Ahn, S. H., Seo, W. H., Kim, S. J., Hwang, S. J., Park, H. Y., Han, Y. S., et al. (2005). Risk factors of moderate to severe atopic dermatitis in the first 6 months of life. Pediatric Allergy and Respiratory Disease, 15(3), 242 249. Almqvist, C., Pershagen, G., & Wickman, M. (2005). Low socioeconomic status as a risk factor for asthma, rhinitis and sensitization at 4 years in a birth cohort. Clinical & Experimental Allergy, 35(5), 612618. http:// www.chnr.or.kr 이윤정, 김지수 25
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