대한안과학회지 2016 년제 57 권제 9 호 J Korean Ophthalmol Soc 2016;57(9):1451-1459 ISSN 0378-6471 (Print) ISSN 2092-9374 (Online) http://dx.doi.org/10.3341/jkos.2016.57.9.1451 Original Article 시력과낙상 : 국민건강영양조사 2008-2012 Visual Acuity and Falls in South Korea: Korean National Health and Nutrition Examination Survey 2008-2012 강민재 1 임형택 2 김성수 1 대한안과학회역학조사위원회 Min Jae Kang, MD 1, Tyler Hyungtaek Rim, MD, MBA 2, Sung Soo Kim, MD, PhD 1 ; The Epidemiologic Survey Committee in the Korean Ophthalmological Society 연세대학교의과대학안과학교실 1, 국민건강보험일산병원안과 2 Department of Ophthalmology, Yonsei University College of Medicine 1, Seoul, Korea Department of Ophthalmology, National Health Insurance Service Ilsan Hospital 2, Goyang, Korea Purpose: To assess the influence of visual acuity (VA) and ocular condition on falls. Methods: We analyzed 28,899 Korean adults using cross-sectional data from the Korean National Health and Nutrition Examination Survey (2008-2012). Associations between best corrected VA based on better or worse seeing eye and ocular condition and falls were identified using multivariable logistic regression. We included sociodemographic factors and comorbidities including hypertension, diabetes, arthritis, acute myocardial infarction/angina, and stroke as independent variables. VA was divided into 1.0, 0.8, 0.5-0.63, and <0.5. Results: Among 28,899 subjects, falls occurred in 511. In multivariable logistic regression analysis, low VA based on the better seeing eye was significantly associated with falls (VA 1.0 as a reference group; adjusted odds ratio [aor] = 1.31, 95% confidence interval [CI], 1.00-1.72 in VA of 0.8; aor = 1.86, 95% CI, 1.07-3.24 in VA of 0.5-0.63; and aor = 1.21, 95% CI, 0.58-2.54 in VA of <0.5; p = 0.025 for trend). There was no association between VA based on the worse seeing eye and falls. Early age-related macular degeneration was associated with falls in univariable analysis (OR = 2.24) and age- and sex-adjusted analysis (aor = 1.52), but not in multivariable analysis. In terms of age subgroups, subjects with VA of 0.5-0.63 were more likely to have experienced falls compared with subjects with VA of 1.0 (aor = 5.83, 95% CI, 1.58-21.54) among subjects 50 years of age or younger. An increasing trend of falls with decreasing VA among subjects between 50 and 70 years of age was observed (p = 0.033 for trend). However, no such association was observed in elderly subjects 70 years of age. Conclusions: VA should be considered for preventing falls because lower VA is associated with increased risk of falls. J Korean Ophthalmol Soc 2016;57(9):1451-1459 Keywords: Falls, Korean National Health and Nutrition Examination Survey (KNHANES), Low vision, Visual acuity Received: 2016. 5. 4. Revised: 2016. 6. 22. Accepted: 2016. 8. 11. Address reprint requests to Tyler Hyungtaek Rim, MD, MBA Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, #100 Ilsan-ro Ilsandong-gu Goyang 10444, Korea Tel: 82-31-900-0094, Fax: 82-31-900-0049 E-mail: awaitingyourfeedback@gmail.com * This work was supported by a National Health Insurance Service Ilsan Hospital grant (NHIMC 2016-20-015). 낙상은전세계적으로예상치못한사고와조기사망과연관된주요원인이다. 1 2010년에 50세이상에서교통사고다음으로빈도가흔한사고로조사되었고, 전세계적인고령화와더불어예방가능한중요한원인으로낙상은중요한공중보건학적인주제로고려되고있다. 2 시력은다양한부분에서건강행태와관련이있는데, 3 낮은시력은삶의질중에서도활동적인제약과, 일상생활과관련한삶의질과관련있다. 4 시력과낙상과의관계는 Beaver Dam Eye c2016 The Korean Ophthalmological Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 1451
- 대한안과학회지 2016 년제 57 권제 9 호 - Study, Blue Mountains Eye Study를포함하여서양에서수행된많은선험적인연구들이있으며, 낮은시력은낙상의위험을대응비 1.1부터 2.6배까지증가시킬수있음을보고하였다. 5-16 우리나라의저시력자는 40대이상에서 4.1% 로다른나라와비교하여다소높은것을고려할때, 17 저시력혹은저시력을유발하는안질환들과낙상과의관계를밝히는것이필요하다. 본연구에서는 19세이상의한국성인에서 2008년부터 2012년국민건강영양조사자료를토대로시력, 안질환과낙상과의관계를분석하였다. 대상과방법 대상본연구는이미공개된 2008년부터 2012년국민건강영양조사자료를이용하여분석하였다. 국민건강영양조사는국민건강증진법제16조에의거하여국민의건강과영양에관한기초통계를산출하기위한목적으로시행된법종조사이다. 이는질병관리본부연구윤리심의위원회승인하에, 제1기 (1998) 부터제3기 (2005) 까지 3년주기로실시되고있으며, 제4기 (2007-2009) 부터는연중조사체계로개편하여조사를실시하고있다. 현재는제6기조사를진행하고있다. 국민건강영양조사는조사부문별로건강설문조사, 영양조사, 검진조사로구분할수있는데, 본연구는시력검사를완료한 19세이상성인 28,899명을대상으로분석하였다. 방법모든변수는국민건강영양조사에서제시한방법대로정의되고분석되었다. 결과변수는건강설문조사중 손상 ( 사고및중독 ) 에서 최근 1년동안병의원이나응급실등에서치료를받아야했던사고나중독이발생한적이있습니까? 질문을사용하였다. 기전에관련한 이사고또는중독은어떻게발생했습니까? 를사용하여, 대답중 2번항목인 추락 / 미끄러짐 을낙상으로정의하였다. 손상횟수가 1회가넘어가는경우를낙상으로정의하였다. 독립변수들은안과관련변수, 사회인구통계학적및건강행태변수, 및동반질환으로구분하였다. 시력은최대교정시력을기준으로시력이좋은눈과시력이나쁜눈을기준으로각각분석하였다. 시력구간은빈도수를고려하려임으로나누었는데, 63.3% 가시력 1.0으로조사되었기에시력 1.0인군을기준군으로하였고, 31.0% 에해당하는 0.8인군과, 4.25% 에해당하는 0.5부터 0.63군과나머지 0.5 미만군, 총 4군으로분류하였다. 시력의가장하위그룹은 Baltimore Eye Survey나, Barbados Eye Study 등에서사용된미국의저시력기준인 0.5 미만을저시력으로정의하는것을적용하였 다. 18-22 황반변성은안검사결과중 나이관련황반변성 early, late, dry, wet 유병여부 를기준으로하였다. 당뇨망막증의경우 당뇨망막증유사소견 으로정의하였다. 사회인구통계학적및건강행태요인으로나이, 성별, 소득수준, 거주지, 동거인유무, 음주습관, 흡연, 신체활동, 스트레스, 수면시간, 비만이포함되었고, 동반질환은고혈압, 당뇨, 관절염, 심근경색혹은협심증, 뇌졸중의의사진단과거력을사용하였다. 사회인구통계학적인요인중나이는 19-29세 /30-39세/40-49세/50-59세/60-69세/70-79세/80세이상으로분류하였고, 소득수준은대상자선정전, 전체대상자를기초로한 5분위수를다시 3등분하여, 하위 5분위수, 중간 2-4 분위수, 상위 5분위수로분류하였다. 거주지는 16개시도로분류하였고, 음주행태는 alcohol use disorder identification test (AUDIT) 점수를사용하였으며, 기존의연구에서비정상군에대한기준인 12점이상을이상음주행태로정의하였다. 23 통계조사대상에대한기술통계분석결과를제시하였다. 기술통계에서낮은시력과초기황반변성이낙상과관련있어, 시력과초기황반변성을보고자하는독립변수로정의하고낙상을결과변수로분석하였다. 단변량분석을통해최대교정시력기준시력이좋은눈의시력과시력이나쁜눈의시력및초기황반변성과낙상과의관련성을보았고, 나이와성별이보정된모형 (Model 1) 을사용하여관련성을보았으며, 마지막으로기술통계에서카이검정시유의수준이 0.1 미만인변수를포함하여모형 (Model 2) 을만들고이에기반하여관련성을보였다. 최종모형 (Model 2) 에는각각의시력혹은초기황반변성유무와, 나이, 성별, 소득, 거주지, 동거인유무, 음주습관, 스트레스, 수면시간, 비만, 고혈압, 관절염, 심근경색혹은협심증, 뇌졸중이변수로포함되었다. 인구구조가보정된낙상을구하기위해질병관리본부지침에따라사후보정가중치를고려하여 Stata 통계패키지의 svy procedure 를이용한산출을시행하였다. 관련성분석은로지스틱회귀분석을사용하였고대응비와 95% 신뢰구간, p-value과함께제시하였다. 유의수준은 p<0.05로정하였으며, 모든분석은 Stata 14.0/MP software (Stata Corp, College Station, TX, USA) 를이용하여수행하였다. 결과 조사자의특성을 Table 1에제시하였다. 좌측열은낙상경험이없는 28,408명의특성이며, 우측열은낙상을경험 1452
- 강민재외 : 시력과낙상 - Table 1. Characteristics of participants (n = 28,899) Variables Fall down Not happened (n = 28,408) Happened (n = 511) p-value Ocular condition BCVA (better seeing eye) <0.001 1 17,703 (62.3) 255 (49.9) 0.8 8,850 (31.2) 191 (37.4) 0.5-0.63 1,361 (4.8) 52 (10.2) <0.5 495 (1.7) 13 (2.5) BCVA (worse seeing eye) <0.001 1 11,701 (41.2) 166 (32.5) 0.8 13,125 (46.2) 241 (47.2) 0.5-0.63 2,027 (7.1) 66 (12.9) <0.5 1,556 (5.5) 38 (7.4) Early AMD 1,250 (4.8) 41 (9.1) <0.001 Late AMD 122 (0.5) 3 (0.7) 0.536 Dry AMD 27 (0.1) 1 (0.2) 0.439 Wet AMD 97 (0.4) 2 (0.4) 0.797 DMR 379 (17.4) 9 (13.9) 0.451 Sociodemographic and behavioral factors Age group <0.001 19-29 3,582 (12.6) 39 (7.6) 30-39 5,357 (18.9) 57 (11.2) 40-49 5,296 (18.6) 64 (12.5) 50-59 5,197 (18.3) 94 (18.4) 60-69 4,747 (16.7) 112 (21.9) 70-79 3,476 (12.2) 117 (22.9) over 80 754 (2.7) 28 (5.5) Female 16,263 (57.3) 324 (63.4) 0.005 Income <0.001 Lowest quintile 5,908 (21.1) 146 (28.9) 2nd 4th quintiles 15,837 (56.5) 267 (52.9) Highest quintile 6,268 (22.4) 92 (18.2) Living in rural area 6,467 (22.8) 135 (26.4) 0.051 Living without spouse 3,675 (13.0) 110 (21.5) <0.001 Abnormal alcohol user 9,538 (33.6) 191 (37.4) 0.071 Lifetime smoker 10,781 (38.7) 180 (35.4) 0.134 Physical activity 1,123 (4.0) 15 (3.0) 0.219 Perceptional stress 0.025 None 4,408 (15.8) 87 (17.1) Moderate 22,148 (79.5) 385 (75.8) Severe 1,309 (4.7) 36 (7.1) Sleep duration <0.001 <5 hours 1,267 (4.6) 44 (8.7) 5-9 hours 24,344 (87.5) 416 (82.4) 9 hours 2,214 (8.0) 45 (8.9) Obesity 0.029 Low weight (<18.5) 1,335 (4.7) 16 (3.2) Normal (18.5 25) 17,967 (63.8) 307 (60.6) Overweight ( 25) 8,878 (31.5) 184 (36.3) Comorbidities Hypertension 6,059 (21.3) 161 (31.5) <0.001 Diabetes mellitus 2,226 (7.8) 65 (12.7) <0.001 Arthritis 3,632 (12.8) 121 (23.7) <0.001 Angina or MI 674 (2.4) 20 (3.9) 0.024 Stroke 532 (1.9) 20 (3.9) 0.001 Values are presented as n (%) unless otherwise indicated. p-value was calculated based on t-test for age and other p-values were calculated based on chi test. BCVA = best corrected visual acuity; AMD = age-related macular degeneration; DMR = diabetic retinopathy; MI = myocardial infarction. 1453
- 대한안과학회지 2016 년제 57 권제 9 호 - Table 2. Odds ratios (OR) of visual acuity and early age-related macular degeneration for fall down using simple and multivariable logistic regression analyses with complex sampling Ocular condition Unadjusted Model 1 Model 2 p-value p-value OR (95% CI) Adjusted OR (95% CI) Adjusted OR (95% CI) p-value BCVA (better seeing eye) 1.0 1 (reference) 1 (reference) 1 (reference) 0.8 1.62 (1.27-2.06) <0.01 1.31 (1.01-1.72) 0.045 1.31 (1.00-1.72) 0.052 0.5-0.63 3.08 (2.07-4.59) <0.01 1.94 (1.15-3.30) 0.014 1.86 (1.07-3.24) 0.028 <0.5 2.27 (1.13-4.57) 0.022 1.50 (0.70-3.20) 0.300 1.21 (0.58-2.54) 0.610 p < 0.001 for trend p = 0.010 for trend p = 0.025 for trend BCVA (worse seeing eye) 1.0 1 (reference) 1 (reference) 1 (reference) 0.8 1.21 (0.94-1.56) 0.137 0.98 (0.75-1.28) 0.861 0.97 (0.74-1.27) 0.825 0.5-0.63 2.41 (1.65-3.53) <0.01 1.36 (0.84-2.21) 0.211 1.26 (0.76-2.10) 0.373 <0.5 1.64 (1.06-2.54) 0.026 0.93 (0.55-1.56) 0.773 0.87 (0.52-1.47) 0.611 p < 0.001 for trend p = 0.813 for trend p = 0.977 for trend Early AMD No 1 (reference) 1 (reference) 1 (reference) Yes 2.24 (1.52-3.30) <0.01 1.52 (1.01-2.30) 0.045 1.37 (0.90-2.09) 0.136 Model 1 include each outcome variable, age, and sex; Model 2 include each outcome variable, age, sex, income, residential area, spouse, alcohol use, stress, sleep duration, obesity, hypotension, arthritis, angina or myocardial infarction, and stroke. CI = confidence interval; BCVA = best corrected visual acuity; AMD = age-related macular degeneration. 한 511명의특성이다. 최대교정시력기준, 시력이좋은눈의시력과, 시력이나쁜눈의시력이낮을수록, 초기황반변성이있는경우낙상이더많은것으로조사되었다 (p<0.001). 말기, 습성황반변성및당뇨망막증유사소견이있는경우에낙상을경험한수가 10명미만으로적어분석시충분한검증력을갖기어려웠다. 낙상을경험한사람들의평균나이는 56.9세로낙상경험이없는 49.9세보다높았고, 연령별분포를제시하였다. 여성에서낙상이더많았으며, 소득수준이낮을수록낙상이더많은것을알수있다. 지방거주자, 동거인이없는경우, 이상음주습관을갖는경우낙상을더경험하는것으로조사되었다. 낙상과스트레스는경향성보다는스트레스가없는경우와심한경우에낙상이좀더많은것으로조사되었다. 수면시간이적은경우낙상이더많았으며, 비만인경우낙상이더많았다. 동반질환은동반질환이있는경우가낙상을더경험하는것으로조사되었다. Table 2는안과변수중분포의차이가있었던시력 ( 최대교정시력기준시력이좋은눈과나쁜눈의시력 ) 과초기황반변성을독립변수로하고, 단변량및다변량로지스틱회귀분석결과를제시하였다. 단변량분석에서는시력이좋은눈기준혹은시력이나쁜눈기준에상관없이시력이낮을수록낙상이더많은것으로분석되었다 (p<0.01 for trend). 연령과성별을보정한다변량모형 (Model 1) 및 Table 1에서유의한차이를보인변수를모두고려한모형 (Model 2) 모두에서좋은눈의시력기준시력이낮을수록낙상의경향이높을것으로조사되었다. 하지만시력이나 쁜눈의시력은다변량분석결과낙상과관련이없는것으로조사되었다. 초기황반변성이있는경우단변량분석에서낙상이많았으며, 나이와성별을보정하여도유의한차이를보였다 (Model 1). 하지만최종모델에서는유의한차이는아니었다. Supplementary Table 1을통해시력이좋은눈의시력과다른변수를포함한 Model 2의다변량결과를제시하였다. Table 3에서연령군별 (50세미만 14,395명, 50에서 70세미만 10,150명, 70세이상 4,375명 ) 다변량최종모형인 Model 2를이용하여대응비를산출하였다. 시력이좋은눈의시력을기준으로, 50세미만에서는 0.5 미만의시력군에서낙상은관찰되지않아분석에서제외되었고, 시력이 1.0 인군을기준으로 0.8인군은대응비 1.30으로낙상이더많았고, 시력이 0.5-0.63 사이의군은대응비 5.83으로유의하게낙상이더많았다. 50세에서 69세까지는시력이 1인군을기준으로시력이 0.5-0.63인군에서대응비 2.44로더높은낙상을경험하였고전체적으로시력이낮을수록낙상률이높은경향성을확인하였다 (p=0.033 for trend). 70세이상군에서는시력과낙상은특별한관련성을보이지않았다. 시력이나쁜눈의시력을기준으로보면, 50세미만군에서시력이정상인군에비해, 시력이 0.5-0.63인경우대응비 3.53으로낙상의위험이증가하였다. 다른시력구간및다른연령에서는특별한경향성을보이지못했다. 모든연령에서초기황반변성이있는경우낙상을더경험하는것으로조사되었으나 ( 대응비 2.12 [50세미만군 ], 1.28 [50에서 70세미만군 ], 1.32 [70세이상군 ]), 황반변성자체 1454
- 강민재외 : 시력과낙상 - Table 3. Subgroup analysis of visual acuity and early age-related macular degeneration (AMD) for fall down using multivariable logistic regression analyses (Model 2) with complex sampling according to age groups Ocular condition Age <50 years (n = 14,395) Age 50 and <70 years (n = 10,150) Age 70 years (n = 4,375) OR (95% CI) p-value OR (95% CI) p-value OR (95% CI) p-value BCVA (better seeing eye) 1.0 1 (reference) 1 (reference) 1 (reference) 0.8 1.30 (0.85-1.99) 0.229 1.25 (0.86-1.83) 0.242 1.14 (0.64-2.05) 0.656 0.5-0.63 5.83 (1.58-21.54) <0.01 2.44 (1.05-5.66) 0.037 0.97 (0.52-1.78) 0.910 <0.5 No observation 1.81 (0.58-5.62) 0.303 0.85 (0.29-2.49) 0.765 p = 0.068 for trend p = 0.033 for trend p = 0.614 for trend BCVA (worse seeing eye) 1.0 1 (reference) 1 (reference) 1 (reference) 0.8 0.95 (0.65-1.38) 0.775 0.95 (0.63-1.44) 0.818 0.68 (0.31-1.46) 0.317 0.5-0.63 3.53 (1.30-9.61) 0.014 1.40 (0.74-2.65) 0.298 0.48 (0.22-1.05) 0.065 <0.5 0.52 (0.07-3.88) 0.527 0.88 (0.30-2.60) 0.824 0.53 (0.22-1.25) 0.148 p = 0.605 for trend p = 0.828 for trend p = 0.114 for trend Early AMD No 1 (reference) 1 (reference) 1 (reference) Yes 2.12 (0.46-9.88) 0.336 1.28 (0.67-2.47) 0.456 1.32 (0.75-2.32) 0.344 Model 2 include each outcome variable, age, sex, income, residential area, spouse, alcohol use, stress, sleep duration, obesity, hypotension, arthritis, angina or myocardial infarction, and stroke. OR = odds ratio; CI = confidence interval; BCVA = best corrected visual acuity. 가수가적고, 이를나이군으로나누었기에신뢰구간이넓어지면서충분한검증력을갖지못했다. 고찰 본연구는국민건강영양조사자료를토대로최대교정시력이좋은눈의시력이 1.0인군에비해시력이낮을수록낙상의위험이증가하는경향을확인하였다. 하지만시력이나쁜눈의시력정도는낙상과관련이없었다. 지금까지보고에서낮은시력은낙상과관련이있는것으로일관되게조사되었다. 5-16 기존의연구에서시력구간별로낙상위험을평가했을경우시력이정상인군에비해시력이낮아질수록낙상위험이높아지나, 가장시력이나쁜군은낙상위험이높긴하지만, 중등도의시력손상군보다그위험이다소낮아지는경향을보인바있다. 24 우리의연구에서도시력이 1.0인군에비해 0.8 시력군에서대응비 1.31로상승하고, 0.5-0.63인군에서대응비 1.86으로더상승하지만, 시력이무광각에서 0.4인군은대응비 1.21로다소감소하는데, 이는기존의결과와일치한다. 시력이아주낮은군에서는활동능력이감소하고더욱조심하여낙상의위험이다소감소할수있음을의미한다. 6 낙상은균형감각기, 시력, 심도 (depth perception), 대비도 (contrast sensitivity), 시야가복합적으로관여하는것으로알려져있다. 25 시력이좋은눈의시력과양안시력 (binocular acuity) 과높은상관관계를보여준기존의연구에서, 시력이좋은눈의시력과양안시력이글을읽는속도와기능적 시력점수 (functional vision score) 의좋은예측요인이었으며, 스스로보고하는시력장애 (self-reported vision disability) 와도높은상관관계임을알려주었다. 26 본연구에서시력이좋은눈과시력이나쁜눈의시력을기준으로평가해보았을때낙상과좋은눈의시력이상관을보인것은, 잘보이는눈의시력이양안시와상관이있는것을반영하는결과로해석된다. 본연구는최대교정시력기준좋은눈의시력자체도낙상의주요예측인자임을보였다. 낙상위험에노출되어있는병원입원이나, 낙상에의해치명적인손실이있을수있는건설현장등에서시력은낙상예방을위해고려할사항이다. 나이군으로나누었을때비교적젊은나이군에서는시력이 0.5에서 0.63 사이에있는군이시력 1.0인군에비해대응비 5.83으로낙상위험이높게관찰되었다. 이연령층에서안과이용이상대적으로적은것을고려할때, 27 이는활동량이많은젊은대상에서저시력에대한검진과, 낮은시력과낙상에대한경각심이필요하다. 50세에서 70세사이에서는시력이낮을경우낙상의위험이더올라가는것을확인할수있었다 (Table 3). 본연구에서 70세이상의고령에서는시력과낙상의뚜렷한관련성을찾을수없었는데, 기존의고령에서의연구에서낙상은시력뿐아니라, 하지마비, 뇌졸중, 파킨슨병등이관련요인으로보고된바있다. 8 고령에서의낙상은시력보다도다른요인도복합적으로작용하는것으로보인다. 황반변성이있는경우자세유지가어렵거나, 28 활동성이떨어지고걷는것에장애를줄수있다는선험적인보고가 1455
- 대한안과학회지 2016 년제 57 권제 9 호 - 있다. 29 황반변성은낙상과연관된것으로알려진시야손상이나, 시야감도에도영향을주는것으로알려져있다. 30 선험적인연구에서, 다양한단계의황반변성환자중 76% 에서낙상경험이있는것으로보고하였고, 더불어충돌이나, 자상등의가정에서의사고도높은것으로보고하였다. 12 본연구에서는다른종류의심한황반변성의경우적은숫자로충분한검증력을갖고분석을못하였고, 초기황반변성의경우총낙상을경험한 511명중 41 (9.1%) 에서초기황반변성을갖고있고 (Table 1) 이는단변량분석에서는대응비 2.24로관련성을보였다. 나이와성별을보정하여도대응비 1.52로유의한연관성을보였다 (Table 2). 하지만다른변수들을모두포함한다변량분석에서는크기효과는 1.37로양의상관관계를보였으나, 유의한결과는아니었다. 비록충분한검정력을갖지는못하지만초기황반변성이낙상의위험요인일가능성이있다. 본연구의주요제한점으로는낙상이어떻게일어났는지조사되지않았다는점으로, 예컨대야외활동중에혹은동절기에낙상이일어나는등의경로는조사되지못했다. 이에시력이구체적으로어떤상황에서낙상에영향을미친것인지알기어려운면이있다. 단면연구로인과관계를보일수없고조사자가직접일정장소로나와서조사를받아야하기때문에, 낙상을경험하더라도낙상이후몸이어느정도회복한사람들만참여가가능한선택치우침을갖는제한점이있으며, 질문지로인한조사는회상치우침이있을수있고, 습성황반변성등안과질환들의경우낮은유병률로충분한검증력을갖지못한부분이있다. 심도나대비감도검사등을이용한자세한검사는검진상어려워, 좀더하위군분석이어려운면이있다. 하지만시력검사에동원된참여자의수는충분히크며, 한국인을대상으로낙상을안과적인문제로접근한대규모연구로의미가있다. 최대교정시력기준나쁜눈의시력은낙상과무관하였으나, 좋은눈의시력은시력은낙상의유의한예측인자였다. 좋은눈의시력이 1.0인정상군에비해시력이낮을때낙상의위험이높았으며, 이러한낙상의위험은 70세미만군에서의미있게높았으나, 70세이상의고령군에서는의미가없었다. 낙상과시력의관련성은보건당국에서공중보건학적낙상예방정책을세울때고려해야할요소이다. REFERENCES 1) Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2197-223. 2) Stewart Williams J, Kowal P, Hestekin H, et al. Prevalence, risk factors and disability associated with fall-related injury in older adults in low- and middle-incomecountries: results from the WHO Study on global AGEing and adult health (SAGE). BMC Med 2015;13:147. 3) Rim TH, Lee CS, Lee SC, et al. Influence of visual acuity on suicidal ideation, suicide attempts and depression in South Korea. Br J Ophthalmol 2015;99:1112-9. 4) Rim THT, Lee DM, Chung EJ. Visual acuity and quality of life: KNHANES IV. J Korean Ophthalmol Soc 2013;54:46-52. 5) Jack CI, Smith T, Neoh C, et al. Prevalence of low vision in elderly patients admitted to an acute geriatric unit in Liverpool: elderly people who fall are more likely to have low vision. Gerontology 1995;41:280-5. 6) Klein BE, Klein R, Lee KE, Cruickshanks KJ. Performance-based and self-assessed measures of visual function as related to history of falls, hip fractures, and measured gait time. The Beaver Dam Eye Study. Ophthalmology 1998;105:160-4. 7) Koski K, Luukinen H, Laippala P, Kivelä SL. Risk factors for major injurious falls among the home-dwelling elderly by functional abilities. A prospective population-based study. Gerontology 1998; 44:232-8. 8) Grisso JA, Kelsey JL, Strom BL, et al. Risk factors for falls as a cause of hip fracture in women. The Northeast Hip Fracture Study Group. N Engl J Med 1991;324:1326-31. 9) Brundle C, Waterman HA, Ballinger C, et al. The causes of falls: views of older people with visual impairment. Health Expect 2015;18:2021-31. 10) Hong T, Mitchell P, Burlutsky G, et al. Visual impairment and the incidence of falls and fractures among older people: longitudinal findings from the Blue Mountains Eye Study. Invest Ophthalmol Vis Sci 2014;55:7589-93. 11) Reed-Jones RJ, Solis GR, Lawson KA, et al. Vision and falls: a multidisciplinary review of the contributions of visual impairment to falls among older adults. Maturitas 2013;75:22-8. 12) Wood JM, Lacherez P, Black AA, et al. Risk of falls, injurious falls, and other injuries resulting from visual impairment among older adults with age-related macular degeneration. Invest Ophthalmol Vis Sci 2011;52:5088-92. 13) La Grow SJ, Robertson MC, Campbell AJ, et al. Reducing hazard related falls in people 75 years and older with significant visual impairment: how did a successful program work? Inj Prev 2006; 12:296-301. 14) de Boer MR, Pluijm SM, Lips P, et al. Different aspects of visual impairment as risk factors for falls and fractures in older men and women. J Bone Miner Res 2004;19:1539-47. 15) Ivers RQ, Cumming RG, Mitchell P, Attebo K. Visual impairment and falls in older adults: the Blue Mountains Eye Study. J Am Geriatr Soc 1998;46:58-64. 16) Kwan MM, Lin SI, Close JC, Lord SR. Depressive symptoms in addition to visual impairment, reduced strength and poor balance predict falls in older Taiwanese people. Age Ageing 2012;41: 606-12. 17) Rim TH, Nam JS, Choi M, et al. Prevalence and risk factors of visual impairment and blindness in Korea: the Fourth Korea National Health and Nutrition Examination Survey in 2008-2010. Acta Ophthalmol 2014;92:e317-25. 18) Tielsch JM, Sommer A, Witt K, et al. Blindness and visual impairment in an American urban population. The Baltimore Eye Survey. Arch Ophthalmol 1990;108:286-90. 1456
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- 강민재외 : 시력과낙상 - = 국문초록 = 시력과낙상 : 국민건강영양조사 2008-2012 목적 : 시력및안질환과낙상과의관계를밝히고자하였다. 대상과방법 : 2008 년부터 2012 년까지국민건강영양조사를완료한 19 세이상성인 28,899 명을대상으로양안중최대교정시력이좋은눈혹은최대교정시력이나쁜눈의시력과동반안질환이낙상에미치는영향을다변량회귀분석을이용하여분석하였다. 고려한독립변수로는사회인구통계학적인요인, 동반질환 ( 고혈압, 당뇨, 관절염, 심근경색혹은협심증, 뇌졸중 ) 을고려하였다. 시력은 1.0, 0.8, 0.5-0.63, <0.5 로 4 단계로분류하였다. 결과 : 낙상경험이있는대상자는 28,899 명중총 511 명이었다. 다변량분석에서시력이좋은눈의낮은시력과낙상은관련이있었는데, 좋은눈의시력이 1 인군을기준으로 0.8 인군대응비 1.31 (95% 신뢰구간 1.00-1.72), 0.5-0.63 인군대응비 1.86 (95% 신뢰구간 1.07-3.24), <0.5 군대응비 1.21 (95% 신뢰구간 0.58-2.54) 로낙상의위험을높였다 (p=0.025 for trend). 시력이나쁜눈의시력정도는낙상과관련이없었다. 초기황반변성은단변량분석 ( 대응비 2.24) 및나이성별을보정한분석 ( 대응비 1.52) 에서낙상의위험을높였으나, 다변량분석에서는유의한결과는아니었다. 연령별로하위분석을하였을때, 50 세미만의비교적젊은군에서는시력이 1.0 인정상군에비해시력이 0.5-0.63 인군의낙상위험이, 대응비 5.83 (95% 신뢰구간 1.58-21.54) 으로높았으며, 50 세이상 70 세미만군에서시력이낮을수록낙상이많은경향성 (p=0.033 for trend) 을확인하였으나, 70 세이상의고령에서는시력과낙상은무관하였다. 결론 : 시력은낙상의유의한예측인자로, 낙상예방을위해고려해야할요인이다. < 대한안과학회지 2016;57(9):1451-1459> 1459