J Dent Hyg Sci Vol. 16, No. 1, 2016, pp.101-109 http://dx.doi.org/10.17135/jdhs.2016.16.1.101 RESEARCH ARTICLE 고혈압환자의구강건강관리행태와주관적치주건강수준의상관관계연구 안은숙 1,2 ㆍ김민영 1 1 원광대학교치과대학인문사회치의학교실, 2 경복대학교치위생과 Relationship between Oral Health Care Behaviors and Perceived Periodontal Disease on Hypertension Patients Eunsuk An 1,2 and Min-Young Kim 1 1 Department of Social and Humanity in Dentistry, Dental College, Wonkwang University School of Dentistry, Iksan 54538, 2 Department of Dental Hygiene, Kyungbok University, Pocheon 11138, Korea The purpose of this study was to examine the impact of the oral health behaviors and lifestyle of hypertension patients on their perceived periodontal diseases. The data of the 2013 community health survey were used, and the data of 55,632 patients who suffered from hypertension and who were at the ages of 19 and over was analyzed. The analying methods used in this study were chi-square test and multiple logistic regression analysis. Gender, age, marital status, education, economic activity, income level and subscription to private medical insurance were identified as the factors to affect the perceived periodontal disease of the hypertension patients, and lifestyle and oral health behaviors were found to have exerted a significant influence on perceived periodontal disease. As this study found that not only the socioeconomic characteristics of the hypertension patients but their oral health care and lifestyle were all correlated with perceived periodontal disease, how to promote the oral health of those who are susceptible to periodontal diseases should carefully be considered. Key Words: Health related life style, Hypertension, Oral health behavior, Perception periodontal diseases 서론 고혈압 (hypertension) 은뇌졸증 (stroke) 과심혈관계질환 (cardiovascular disease) 의주요한원인중하나이다 1). 세계보건기구 (World Health Organizaion) 에따르면고혈압은성인의 30% 에서발현되고있으며, 서태평양과동남아시아의경우남성에서는 5 47%, 여성은 7 38% 의유병률을기록하는것으로보고되었다 2). 2012년국민건강영양보고서 3) 에따르면 30세이상한국성인의고혈압유병률은 31.5% 를기록하는것으로나타났다. 기존의연구를통해구강질환 (oral health disorder) 과고혈압간에양의상관관계 가있는것으로밝혀져있다 4-6). 다양한구강질환중치주질환은성인에서빈번하게발생하는만성감염성질환으로, 치료하지않을경우치아기반조직이퇴축되고결국치아손실로까지이어진다 7). 치주질환의경우초기병소에따른자각증상이크게나타나지않으며, 불편감을주지도않기때문에질병이일정정도진행되기전까지대부분의경우방치된다. 심각한상황에이르게되면경조직인치조골의파괴로까지이어져치료를받는다고해도소실된치조골을이전의상태도회복시켜줄수있는방법이아직개발되어있지않다 7-9). 치주질환치료는치주조직을원상태로회복시키는것이아니라치주질환으로인한추가적손상을정지시키 Received: December 31, 2015, Revised: January 18, 2016, Accepted: January 19, 2016 ISSN 1598-4478 (Print) / ISSN 2233-7679 (Online) Correspondence to: Min-Young Kim Department of Social and Humanity in Dentistry, Dental College, Wonkwang University School of Dentistry, 460 Iksan-daero, Iksan 54538, Korea Tel: +82-63-850-6995, Fax: +82-63-850-6934, E-mail: 6514114@hanmail.net Copyright 2016 by the Korean Society of Dental Hygiene Science This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
J Dent Hyg Sci Vol. 16, No. 1, 2016 는역할을하기때문에, 질병의조기치료와적절한예방관리가필수적이다. 치주질환, 치은출혈및치아손실은고혈압과관련성을가진다고보고된다. 이는치주질환과치아상실은좋지않은섭식습관으로이어지고, 이러한상태의환자는정제된탄수화물음식 (soft carbohydrate foods) 섭취를선호하게되며과일섭취에제한을받게되어혈압 (blood pressure) 에영향을미치는것을말한다 6-8). 치주질환으로인한섭식장애와혈압사이에는동시적 (simultaneously) 관계가있기때문에적절한이해와관리가필요할것으로생각된다. 치주질환과관련된연구들을통해치주질환을야기하는위험요인으로세균요인뿐만아니라인구학적요인과사회경제적요인, 구강건강관리행태, 라이프스타일 (life style) 등이관련성을보이는것으로나타났다 10-12). Choi와 Lee 13) 의연구에서는칫솔질방법, 흡연, 섭식습관등이치주질환진단에영향을미치는것으로나타났다. 치주건강의불평등을확인한연구에따르면주관적구강건강인식이낮은경우와구강건강행태가좋지않은경우치주건강상태가좋지않은것으로보고되었다 14). Kim 등 15) 은청소년을대상으로한연구에서구강건강행태는물론흡연, 음주, 섭식습관등이구강질환경험에영향을미치는것을확인했다. Darnaud 등 16) 의연구에서는흡연습관및구강건강상태와혈압과의관련성을확인했으며, Rivas-Tumanya 등 17) 은보건의료인들을대상으로한코호트조사에서흡연습관과구강건강상태에따른고혈압발생률의상대위험도를확인했다. 또한일본에서는전향적코호트연구를통해섭식습관, 신체상태, 음주및흡연습관과구강건강행태에따른치주질환과고혈압유병률에상관성을밝혀냈다 18). 결국, 앞서언급한위험요인들은인체면역반응에작용하여낮은수준의면역작용에영향을받는고혈압과치주질환을야기한다. 이에이번연구에서는건강한사람에비해치주질환에취약한고혈압환자를대상으로하여구강건강관리행태와라이프스타일이주관적치주건강수준에미치는영향을살펴보고, 이러한결과를바탕으로치주질환취약집단구강건강증진을위한대안마련과프로그램개발에기초자료를제공하고자한다. 연구대상및방법 1. 연구대상연구자료는질병관리본부연구윤리심의위원회로부터심의및승인받은 2013년지역사회건강조사원시자료 (2013-06EXP-01-3C) 를이용하였다. 지역사회건강조사는행정자치부의주민등록인구자료와국토교통부의주택유형 자료를협조받아표본추출틀을작성하고이를기반으로표본가구를추출하는전국표본조사이다. 지역보건의료계획을수립및평가하고, 비교가능한지역건강통계를생산하고자 2008년부터매년전국보건소에서실시하고있다. 조사대상은만 19세이상성인으로 2013년에는총 228,781명이조사되었다. 2013년 8월 16일에서 2013년 10월 31일까지약 3개월의조사기간동안훈련된조사원이표본으로선정된가구에직접방문하여 1:1 면접조사를진행하였다. 이번연구는고혈압환자의구강관리행태와고혈압환자가인식하는주관적치주건강수준의상관관계를알아보기위하여고혈압환자로진단된 55,632명을최종분석대상으로하였으며, 모든변수의질문에 응답거부 와 모름 에해당하는건수는제외하고분석하였다. 2. 연구도구이번연구에서는주관적치주건강수준을종속변수로사용하였다. 치주조직의건강은어느정도라고생각하는가? 라는변수의질문에이가흔들린다, 잇몸이자주붓는다, 치석이많다, 잇몸에서피가난다, 정상이다라는 5문항의답변을 치조골파괴 와 정상 으로이분화된변수로구분하여분석하였다. 17개광역시도로분류된지역을 광역시 와 도 로구분하였고, 연령은고혈압환자를대상으로하였기때문에고혈압유병률이급격히상승하는 40세를기준으로 19) 분류하였다. 결혼상태는미혼, 기혼-동거, 기혼-비동거, 이혼및사별로나누어분석하였다. 가구총소득을가구원수의제곱근으로나눈가구균등화소득을포함하였다. 구강건강상태에따른고혈압발생률을확인하기위해치주질환을야기하는위험요인인음주, 흡연등의라이프스타일변수를포함하였다 (Table 1). 3. 분석방법연구자료는 STATA ver. 11.0 (StataCorp, College Station, TX, USA) 을이용하여분석하였다. 연구대상자의일반적특성과라이프스타일에따른구강건강행태의차이를확인하기위해카이제곱검정 (chi-square test) 을시행하였고, 고혈압환자의주관적치주건강수준에영향을미치는요인을파악하기위해다중로지스틱회귀분석 (multiple logistic regression analysis) 을실시하였다. 결과 1. 일반적특성에따른구강건강행태의차이고혈압환자의일반적특성에따른구강건강행태의차이 102
안은숙ㆍ김민영 : 고혈압환자의구강건강관리행태와주관적치주건강수준 Table 1. Variables of Analysis Variable Dependent variables Periodontal health level Independent variables Region Gender Age Marital status Education level Income quartile Economic activity Private medical insurance Smoking status Alcohol drinking status Toothbrushing after lunch Use of proxabrush and dental floss Oral examination experience Scaling experience Description Normal gingival=1, periodontal disease=2 City=1, province=2 Male=1, female=2 39 years=1, 40 49 years=2, 50 59 years=3, 60 69 years=4, 70 years=5 Unmarried=1, cohabitation with marrige=2, separation after marrige=3, divorced/bereavement=4 Primary school=1, middle school=2, high school=3 Low=1, low-middle=2, high-middle=3, high=4 Activity=1, non-activity=2 Membership=1, nonmember=2 Non-smoking=1, current smoking=2, past smoking=3 Non-drinking=1, current drinking=2, past drinking=3 Yes=1, no=2 Yes=1, no=2 Yes=1, no=2 Yes=1, no=2 를조사하였다 (Table 2). 성별에따른점심식사후칫솔질여부 (p>0.05) 만제외하고통계적으로유의한관계가나타났다. 지역으로구분하여살펴본결과 시 에서는점심식사후칫솔질을하는사람이 53.2% 로더많았지만, 도 에서는점심식사후칫솔질을안하는사람이 55.2% 로더높게나타났다. 연령에서는 59세까지는점심식사후칫솔질을하는사람이더많았으나, 60세이후부터는점심식사후칫솔질을안하는사람이더높게나타났다. 교육수준에따라초등학교졸업이하에서는점심식사후칫솔질을안하는사람이 61.5% 로높게나타났으나, 학력이증가할수록칫솔질을하는사람의비율이점점높아지는것으로조사되었다. 또한학력이증가할수록, 연령이낮아질수록치실및치간칫솔사용, 구강검진경험, 치석제거경험을하는사람의비율이점점증가하는것으로나타났다. 2. 라이프스타일에따른구강건강행태의차이고혈압환자의흡연과음주등라이프스타일에따른구강건강행태의차이를살펴보았다 (Table 3). 라이프스타일에따른구강건강행태는통계적으로유의한차이가있는것으로나타났다 (p<0.05). 비흡연자가점심식사후칫솔질을하는비율이 47.4% 로현재흡연자 44.7%, 과거흡연자 46.9% 에비해높게나타났다. 치실및치간칫솔사용은과거흡연자가 16.6% 로비흡연자 15.0%, 현재흡연자 14.0% 보다높은비율로조사되었다. 구강검진의경험과치석제거의경험은과거흡연자가각각 24.7%, 24.0% 로비흡연자와 현재흡연자에비해구강검진과치석제거를경험한비율이좀더높은것으로나타났다. 3. 주관적치주건강수준에영향을미치는요인주관적치주건강수준을종속변수로하여고혈압환자의주관적치주건강수준에영향을미치는요인을살펴본다중로지스틱회귀분석결과는 Table 4와같다. 남자에비해여자가 1.247배높게 치주질환이있다 고치주건강을인식하는결과를보였다. 연령에서는 39세미만에비해연령이증가할수록치주가 건강하다 라고인식하는것으로확인되었다. 미혼에비해기혼-동거에서, 초등학교졸업이하에비해학력이높아질수록치주가 건강하다 라고인식하는수준이높게나타났다. 경제활동을하는사람에비해하지않는사람이 1.060배높게 치주질환이있다 라고치주건강수준을인식하는경향으로확인되었다. 민간의료보험가입여부에따라서는민간의료보험에비가입자가가입자에비해 1.156배 치주질환이있다 고높게인식하는것으로나타났다. 소득수준이낮은집단에비해높아질수록치주가 건강하다 라고인식하는주관적치주건강이확인되었다. 주관적치주건강수준에영향을미치는라이프스타일에서흡연여부에따라살펴본결과, 비흡연자보다현재흡연자가 1.275 배, 과거흡연자가 1.104배높게 치주질환이있다 라고인식하는것으로분석되었다. 음주를하지않는사람에비해현재음주를하는사람이 1.080배, 과거음주를했던사람이 1.191배 치주질환이있다 라고응답하여더높은주관적 103
J Dent Hyg Sci Vol. 16, No. 1, 2016 Table 2. Oral Health Behavior according to General Characteristics Variable Toothbrushing after lunch Use of proxabrush and dental floss Oral examination experience Scaling experience Yes No p-value Yes No p-value Yes No p-value Yes No p-value Area City 7,325 (53.2) 6,455 (46.8) <0.001 3,012 (21.6) 10,913 (78.4) <0.001 4,296 (30.8) 9,634 (69.2) <0.001 3,907 (28.1) 10,023 (71.9) <0.001 Province 18,528 (44.8) 22,822 (55.2) 5,461 (13.1) 36,165 (86.9) 7,484 (18.0) 34,181 (82.0) 7,651 (18.4) 33,994 (81.6) Gender Male 11,145 (46.7) 12,717 (53.3) 0.438 3,944 (16.4) 20,102 (83.6) <0.001 6,286 (2.1) 17,766 (73.9) <0.001 6,044 (25.1) 18,066 (74.9) <0.001 Female 14,708 (47.0) 16,560 (53.0) 4,529 (14.4) 26,976 (85.6) 5,494 (17.4) 26,049 (82.6) 5,514 (17.5) 26,011 (82.5) Age (y) 39 911 (66.5) 460 (33.5) <0.001 378 (27.0) 1,023 (73.0) <0.001 500 (36.0) 901 (64.0) <0.001 445 (32.0) 955 (68.0) <0.001 40 49 2,458 (60.4) 1,614 (39.6) 1,151 (28.0) 2,954 (72.0) 1,449 (35.0) 2,656 (65.0) 1,444 (35.0) 2,660 (65.0) 50 59 6,178 (55.5) 4,961 (44.5) 2,818 (25.1) 8,420 (74.9) 3,431 (31.0) 7,803 (69.0) 3,786 (34.0) 7,450 (66.0) 60 69 7,149 (47.1) 8,041 (52.9) 2,608 (17.0) 12,708 (83.0) 3,543 (23.0) 11,779 (77.0) 3,744 (24.0) 11,578 (76.0) 70 9,157 (39.2) 14,201 (60.8) 1,518 (6.5) 21,973 (93.5) 2,857 (12.1) 20,676 (87.9) 2,139 (9.1) 21,374 (90.9) Marital status Unmarried 704 (57.9) 512 (42.1) <0.001 238 (19.2) 1,001 (80.8) <0.001 298 (24.0) 942 (76.0) <0.001 295 (23.8) 943 (76.1) <0.001 Cohabitation with marrige Separation after marrige Divorced/ bereavement Education level Primary school or lower Middle school or lower 18,278 (48.5) 19,442 (51.5) 6,856 (18.1) 31,117 (81.9) 9,248 (24.3) 28,736 (75.7) 9,315 (25.0) 28,662 (75.0) 595 (50.4) 585 (49.6) 213 (17.8) 984 (82.2) 285 (23.8) 913 (76.2) 291 (24.3) 908 (75.7) 6,268 (41.8) 8,728 (58.2) 1,165 (7.7) 13,959 (92.3) 1,947 (12.9) 13,208 (87.1) 1,652 (11.0) 13,491 (89.0) 10,666 (38.5) 17,037 (61.5) <0.001 1,682 (6.0) 26,194 (94.0) <0.001 3,342 (12.0) 24,579 (88.0) <0.001 2,837 (10.2) 25,067 (89.8) <0.001 10,630 (52.1) 9,752 (47.9) 4,256 (20.7) 16,312 (79.3) 5,413 (26.3) 15,156 (73.7) 5,697 (27.7) 14,870 (72.3) High school 4,525 (64.9) 2,451 (35.1) 2,515 (35.7) 4,512 (64.3) 3,007 (42.8) 4,027 (57.2) 3,008 (42.8) 4,025 (57.2) Economic activity Activity 13,240 (48.0) 14,323 (52.0) <0.001 4,718 (17.0) 23,011 (83.0) <0.001 6,923 (25.0) 20,810 (75.0) <0.001 6,974 (25.2) 20,757 (74.8) <0.001 Non-activity 12,613 (45.8) 14,953 (54.2) 3,755 (13.5) 24,066 (86.5) 4,854 (17.4) 23,004 (82.6) 4,584 (16.5) 23,259 (83.5) Income quartile Low 6,042 (42.5) 8,183 (57.5) <0.001 1,399 (9.8) 12,940 (92.2) <0.001 2,202 (15.0) 12,158 (85.0) <0.001 1,930 (13.0) 12,416 (87.0) <0.001 Low-middle 5,796 (46.5) 6,676 (53.5) 1,723 (13.7) 10,864 (86.3) 2,486 (19.7) 10,115 (80.3) 2,342 (19.0) 10,252 (81.0) High-middle 6,845 (51.5) 6,448 (48.5) 2,727 (20.4) 10,653 (79.6) 3,425 (26.0) 9,963 (74.0) 3,487 (26.0) 9,900 (74.0) High 6,845 (47.5) 6,448 (52.5) 2,329 (17.6) 10,937 (82.4) 3,292 (25.0) 9,975 (75.0) 3,392 (26.0) 9,874 (74.0) Private medical insurance Membership 14,082 (54.1) 11,963 (45.9) <0.001 6,045 (23.0) 20,220 (77.0) <0.001 7,727 (29.4) 18,535 (70.6) <0.001 8,127 (30.9) 18,136 (69.1) <0.001 Nonmember 11,714 (40.5) 17,224 (59.5) 2,409 (8.3) 26,730 (91.7) 4,038 (13.8) 25,148 (86.2) 3,406 (11.7) 25,758 (88.3) Values are presented as number (%). Using chi-square test. 104
안은숙ㆍ김민영 : 고혈압환자의구강건강관리행태와주관적치주건강수준 Table 3. Oral Health Behavior according to Lifestyle Toothbrushing after lunch Use of proxabrush and dental floss Oral examination experience Scaling experience Yes No p-value Yes No p-value Yes No p-value Yes No p-value Variable Smoking status Non-smoking 16,389 (47.4) 18,180 (52.6) <0.001 5,237 (15.0) 29,574 (85.0) <0.001 6,712 (19.3) 28,140 (80.7) <0.001 6,700 (19.2) 28,134 (80.8) <0.001 Current smoking 3,536 (44.7) 4,373 (55.3) 1,117 (14.0) 6,874 (86.0) 1,912 (23.9) 6,078 (76.1) 1,802 (22.5) 6,190 (77.5) Past smoking 5,928 (46.9) 6,720 (53.1) 2,119 (16.6) 10,626 (83.4) 3,155 (24.7) 9,594 (75.3) 3,056 (24.0) 9,690 (76.0) Alcohol drinking status Non-drinking 7,085 (43.5) 9,219 (56.5) <0.001 1,694 (10.3) 14,709 (89.7) <0.001 2,467 (15.0) 13,961 (85.0) <0.001 2,381 (14.5) 14,034 (85.5) <0.001 Current drinking 14,204 (49.5) 14,516 (50.5) 5,463 (18.9) 23,487 (81.1) 7,534 (26.0) 21,427 (74.0) 7,469 (25.8) 21,485 (74.2) Past drinking 4,563 (45.2) 5,536 (54.8) 1,316 (12.9) 8,875 (87.1) 1,778 (17.4) 8,421 (82.6) 1,707 (16.7) 8,492 (83.3) Values are presented as number (%). Using chi-square test. 인식이나타났다. 고혈압환자의구강건강관리행태와주관적치주건강수준의상관관계를분석한결과, 점심식사후칫솔질을하는고혈압환자에비해칫솔질을하지않는고혈압환자가 1.087배높게 치주질환이있다 라고인식했으며, 치석제거경험이있는고혈압환자에비해치석제거경험이없는고혈압환자가 1.197배 치주질환이있다 라고치주건강을인식하는경향이더높게나타났다. 고찰 성인에게서높은유병률을보이는고혈압과치주질환은상관성이있는질환으로알려져있다 4,5,13). 치주질환으로인한섭식습관과고혈압은동시적관계를갖는것으로보고되기때문에두질환사이의관계및관련요인을파악하여치주질환취약집단의구강건강증진을위한프로그램개발이필요할것으로생각된다. 이에이번연구에서는지역사회건강조사자료를이용하여치주질환취약집단인고혈압이환자를대상으로주관적으로인식하는치주질환건강에영향을미치는요인에대한실증분석을실시하였다. 본인이 치주질환이있다 라고인지하는정도에거주지역은통계적으로영향을미치지않는것으로나타났다. 일반적으로보건의료에있어지역의의미는한정된의료자원을효율적으로사용함을통해의료서비스를제공하는단위로서지역사회의건강수준에영향을미치는것으로나타난다 20). 그러나이는의료서비스의이용이나객관적건강수준과관련된것으로 Park과 Lee 14) 의연구에서와같이이번연구의결과도본인이인지하는구강건강수준에는거주지역이영향을미치지않는다는것을의미한다. 연령에따라서는 39세이하집단에비해연령이증가할수록본인의치주상태를건강하다고인식하는것으로나타났다. 치주질환은성인기에호발하는치과질환으로서연령이증가할수록유병률이증가하는정비례관계를보인다 6,13,14). 그러나이번연구에서는이와는상반된결과를나타내는데, 연구대상을고혈압에이환된집단으로한정했기때문에나타난결과로보여진다. 고혈압에이환된경우치주질환에취약한집단으로분류되는데, 비단치주질환에만국한된것이아니라기타만성질환에도취약한특성을갖는다. 또한연령의증가에따라서기타만성질환에이환될확률이증가하기때문에 21-23) 다른질환에비해생명에위협을덜느끼는치주질환에대한인식정도가낮을수있을것으로생각된다. 이에계속되는연구에서는고혈압뿐만아니라기타만성질환을고려함을통해연령에따른효과를확인해보기위한노력이 105
J Dent Hyg Sci Vol. 16, No. 1, 2016 Table 4. Factors on Perceived Periodontal Health Status Variable OR z p>z 95% CI Area City 1 Province 0.959 1.890 0.059 0.918 1.002 Gender Male 1 Female 1.247 6.890 0.000 1.171 1.328 Age (y) 39 1 40 49 0.872 1.920 0.055 0.759 1.003 50 59 0.717 4.850 0.000 0.626 0.820 60 69 0.616 6.920 0.000 0.537 0.707 70 0.580 7.530 0.000 0.503 0.668 Marital status Unmarried 1 Cohabitation with marrige 0.808 3.120 0.002 0.707 0.924 Separation after marrige 0.921 0.890 0.372 0.769 1.103 Divorced/bereavement 1.006 0.080 0.933 0.874 1.158 Education level Primary school or lower 1 Middle school or lower 0.815 8.390 0.000 0.776 0.855 High school 0.675 10.150 0.000 0.625 0.728 Economic activity Activity 1 Non-activity 1.060 2.680 0.007 1.016 1.106 Income quartile Low 1 Low-middle 0.893 4.310 0.000 0.849 0.940 High-middle 0.820 7.310 0.000 0.778 0.865 High 0.839 6.420 0.000 0.795 0.885 Private medical insurance Membership 1 Nonmember 1.156 6.120 0.000 1.103 1.210 Smoking status Non-smoking 1 Current smoking 1.275 6.970 0.000 1.191 1.365 Past smoking 1.104 3.020 0.003 1.035 1.177 Alcohol drinking status Non-drinking 1 Current drinking 1.080 3.180 0.001 1.030 1.133 Past drinking 1.191 6.210 0.000 1.127 1.258 Toothbrushing after lunch Yes 1 No 1.087 4.380 0.000 1.047 1.129 Use of proxabrush and dental floss Yes 1 No 1.026 0.880 0.378 0.969 1.086 Oral examination experience Yes 1 No 1.053 2.060 0.040 1.002 1.106 Scaling experience Yes 1 No 1.197 6.800 0.000 1.136 1.261 OR: odds ratio, CI: confidence interval. Using multiple logistic regression. 106
안은숙ㆍ김민영 : 고혈압환자의구강건강관리행태와주관적치주건강수준 계속되어야할것이다. 결혼상태에따라서는기혼이비해미혼에서치주건강수준을나쁘게인식하는것으로나타났다. 또한미혼에비해이혼 / 사별의경우치주건강수준을안좋게인식하는경향을보였다. 결혼상태에따른치주건강수준은기혼이미혼보다더건강한경향을보인다. 이와같은결과는배우자의관심이나돌봄이건강한행동을하는데영향을주고결혼상태에기인한여러사회경제적특성에도영향을받기때문일것으로예측된다 24,25). 사회경제적수준을나타내는교육수준과소득수준에따라서는교육수준이낮은것에비해높은경우, 소득수준이높은경우주관적치주건강수준을 건강하다 라고인식하는것으로나타났다. 이러한연구결과는기존의연구에서나타난결과를지지하는것으로 13,14,24,25), 개인의사회경제적수준에따라구강건강의중요성과인식정도에서차이를보이고, 구강건강증진을위한예방서비스수혜및구강건강행태에서도차이를보인다. 또한개인의사회경제적수준은치과의료서비스의접근성에영향을미치기때문에 22,23,25-27), 접근성의불평등정도에따라개인의구강건강수준에서격차가나타날것이며, 이는결국개인이인지하는구강건강수준에영향을미칠것으로생각된다. 구강건강과관련된흡연, 음주등의라이프스타일과구강건강행태도주관적치주건강수준에영향을미치는요인으로나타났다. 먼저흡연경험은비흡연자에비해현재흡연자, 흡연경험자의경우본인의치주건강수준을나쁘게인식하는것으로나타났다. 음주경험도흡연경험과유사한결과를보인다. 기존의연구들 17,28-32) 에서치주질환을판단하는여러지수를이용하여흡연과치주질환관계를분석함을통해흡연자가치주질환을더많이보유하고있다고하였고, 흡연은치주염의유력한위험지표이고잠재적인위험요소가될수있다고주장하였다. 음주습관과치주질환사이의관계를확인한연구에서는이번연구결과와유사하게음주경험에따라치주질환발생확률이높아지는경향을보이는것으로나타났다 15,18,32). 구강건강행태도치주건강인식에유의한영향을미치는것으로나타났는데, 점심식사후칫솔질습관구강검진경험, 스케일링경험등이있는경우경험이없는경우에비해주관적치주건강수준을상대적으로좋게인식하는것으로나타났으며기존의연구결과들 15,16,20) 을지지했다. 이번연구는고혈압과치주질환사이의관련성을전제로하여, 고혈압이환자를치주질환취약집단으로간주하고주관적치주건강수준에영향을미치는요인들을다각적으로파악하고자하였다는데의의를둘수있다. 치주질환취약집단인고혈압환자에주관적치주상태에영향을미치는요 인은비취약집단과유사한경향을보인다. 면역증상의저하로인하여야기될수있는고혈압과치주질환의관계를보다더정확하게파악하기위한노력이계속되어야할것으로생각된다. 이번연구는 2013년도한해년도자료를바탕으로한단면적연구이기때문에치주질환에영향을미치는요인들의인과관계를제시할수없다는한계점이있다. 이에향후계속되는연구에서는이번연구를통해확인된여러요인들을통제하고종단적연구및환자-대조군 (case-control) 연구를통해인과성을규명하는연구가진행되길기대한다. 요약 이번연구는 2013년도지역사회건강조사원시자료를이용하여만 19세이상성인을대상으로하였다. 치주질환에취약한고혈압환자를대상으로구강건강관리행태와라이프스타일에주관적치주건강수준에미치는영향을분석하고자하였다. 고혈압환자의연령이증가할수록본인의치주상태를건강하다고인식하고, 기혼에비해미혼에서치주건강수준을나쁘게인식하는것으로조사되었다. 구강건강과관련된라이프스타일과구강건강행태도치주건강인식에유의한영향을미치는것으로나타났다. 그러나, 본인이 치주질환이있다 라고인식하는정도에거주지역은통계적으로유의한차이를보이지않았다. 고혈압환자의주관적치주건강수준에영향을미치는요인으로성별, 연령, 결혼상태, 교육수준, 경제활동유무, 소득수준, 민간의료보험가입여부, 라이프스타일, 구강건강관리행태에서점심식사후칫솔질, 구강검진경험, 치석제거경험으로나타났다. 연구결과를토대로고혈압환자의구강건강관리행태와주관적치주건강수준의상관관계가있음이확인되었다. 향후단면적연구보다치주질환에영향을미치는요인들의인과성을규명하는종단적연구를통해건강한사람에비해치주질환에취약한집단의구강건강증진을위한대안마련이필요할것이다. References 1. Caban-Martinez AJ, Lee DJ, Fleming LE, et al.: Dental care access and unmet dental care needs among U.S. workers: the National Health Interview Survey, 1997 to 2003. J Am Dent Assoc 138: 227-230, 2007. 2. WHO: A global brief on hypertension silent killer, global 107
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