우리나라 노인여성의 골다공증성 척추골절로 인한 경제적 부담 추계

강혜영,강대룡,장영화,박성은,최원정,문성환,양규현,Kang, Hye-Young,Kang, Dae-Ryong,Jang, Young-Hwa,Park, Sung-Eun,Choi, Won-Jung,Moon, Seong-Hwan,Yang, Kyu-Hyun 대한예방의학회 2008 예방의학회지 Vol.41 No.5

Objectives : To estimate the economic burden of osteoporotic vertebral fracture (VF) from a societal perspective. Methods : From 2002 to 2004, we identified all National Health Insurance claims records for women ${\geq}50$ years old with a diagnosis of VF. The first 6-months was defined as a "clearance period," such that patients were considered as incident cases if their first claim of fracture was recorded after June 30, 2002. We only included patients with ${\geq}$ one claim of a diagnosis of, or prescription for, osteoporosis over 3 years. For each patient, we cumulated the claims amount for the first visit and for the follow-up treatments for 1 year. The hospital charge data from 4 hospitals were investigated to measure the proportion of the non-covered services. Face-to-face interviews were conducted with 106 patients from the 4 study sites to measure the out-of-pocket spending outside of hospitals. Results : During 2.5 years, 131,453 VF patients were identified. The patients had an average of 3.38 visits, 0.40 admissions and 6.36 inpatient days. The per capita cost was 1,909,690 Won: 71.5% for direct medical costs, 20.6% for direct non-medical costs and 7.9% for indirect costs. The per capita cost increased with increasing age: 1,848,078 Won for those aged 50-64, 2,084,846 Won for 65-74, 2,129,530 Won for 75-84and 2,121,492 Won for those above 84. Conclusions : Exploring the economic burden of osteoporotic VF is expected to motivate to adopt effective treatment options for osteoporosis in order to prevent the incidence of fracture and the consequent costs.

유방암 조기진단을 위한 검진주기 결정에 대한 연구

정성화,강대룡,허남욱,김진흠,이순영,정상혁,남정모,Jeong, Seong-Hwa,Kang, Dae-Ryong,Hur, Nam-Wook,Kim, Jin-Heum,Lee, Soon-Young,Jung, Sang-Hyuk,Nam, Chung-Mo 대한예방의학회 2006 예방의학회지 Vol.39 No.4

Objectives: The purposes of this study were to propose a screening schedule for the early detection of breast cancer among Korean women, as based on the statistical model, and to compare the efficacy of the proposed screening schedule with the current recommendations. Methods: The development of the screening schedule for breast cancer closely followed the work of Lee and Zelen (1998). We calculated the age-specific breast cancer incidence rate from the Korea Central Cancer Registry (2003), and then we estimated the scheduling of periodic examinations for the early detection of breast cancer, using mammography, and based on the threshold method. The efficacy of the derived screening schedule was evaluated by the schedule sensitivity. Results: For estimating the screening schedule threshold method, we set the threshold value as the probability of being in the preclinical stage at age 35, the sensitivity of mammography as 0.9 and the mean sojourn time in the preclinical stage as 4 years. This method generated 14 examinations within the age interval [40, 69] of 40.0, 41.3, 42.7, 44.1, 45.4, 46.7, 48.0, 49.3, 51.0, 53.2, 55.3, 57.1, 59.0 and 63.6 years, and the schedule sensitivity was 75.4%. The proposed screening schedule detected 85.2% (74.5/87.4) of the cases that could have been detected by annual screening, but it required only about 48.7% (14.0/30.0) of the total number of examinations. We also examined the threshold screening schedules for a range of sensitivities of mammography and the mean sojourn time in the preclinical stage. Conclusions: The proposed screening schedule for breast cancer with using the threshold method will be helpful to provide guidelines for a public health program for choosing an effective screening schedule for breast cancer among Korean women.

일배체형에 기초한 연쇄분석의 통계학적 알고리즘 연구

김진흠,강대룡,이윤경,신선미,서일,남정모,Kim, Jin-Heum,Kang, Dae-Ryong,Lee, Yun-Kyung,Shin, Sun-Mi,Suh, Il,Nam, Chung-Mo 대한예방의학회 2004 예방의학회지 Vol.37 No.4

Objectives : This study was conducted to propose a new transmission/disequilibrium test(TDT) to test the linkage between genetic markers and disease-susceptibility genes based on haplotypes. Simulation studies were performed to compare the proposed method with that of Zhao et al. in terms of type I error probability and powers. Methods : We estimated the haplotype frequencies using the expectation-maximization(EM) algorithm with parents genotypes taken from a trio dataset, and then constructed a two-way contingency table containing estimated frequencies to all possible pairs of parents haplotypes. We proposed a score test based on differences between column marginals and their corresponding row marginals. The test also involved a covariance structure of marginal differences and their variances. In simulation, we considered a coalescent model with three genetic markers of biallele to investigate the performance of the proposed test under six different configurations. Results : The haplotype-based TDT statistics, our test and Zhao et al.'s test satisfied a type I error probability, but the TDT test based on single locus showed a conservative trend. As expected, the tests based on haplotypes also had better powers than those based on single locus. Our test and that of Zhao et al. were comparable in powers. Conclusion : We proposed a TDT statistic based on haplotypes and showed through simulations that our test was more powerful than the single locus-based test. We will extend our method to multiplex data with affected and/or unaffected sibling(s) or simplex data having only one parent s genotype.

모유수유 실천 및 수유기간에 영향을 미치는 요인

황원주,강대룡,서문희,정우진,Hwang, Won-Ju,Kang, Dae-Ryong,Suh, Moon-Hee,Chung, Woo-Jin 대한예방의학회 2006 예방의학회지 Vol.39 No.1

Objectives: The purpose of this study is to examine the factors affecting the rate and duration of breastfeeding. Methods: We analyzed the data from the year 2000 Korea National Fertility Survey that was collected through direct interviews. In particular, the mothers who delivered their last child and the child was under 1 year of age from January 1998 to June 2000 (N=1,066) were analyzed via a logistic model to assess the factors affecting the breastfeeding rate. Among the study subjects, those who had initiated breastfeeding (N=740) were analyzed through Cox's proportional hazard model to evaluate the factors affecting the duration of breastfeeding. Results: The multivariate logistic model showed that the delivery type and the baby's birth-weight have a statistically significant influence on the breastfeeding rate. Women who delivered their babies through Cesarean section were less likely than others to breastfeed. In contrast, the women whose babies weighed 2.5Kg or more were more likely than others to breastfeed. The results obtained from the survival analysis are as follows: the higher the mother's education level, the shorter is the breastfeeding duration. The mother's work status played a significant role in the early termination of breastfeeding. Women aged 35 or older showed a longer breastfeeding duration than the younger age groups, whereas the maternal age was not a significant factor in affecting whether or not a mother would breastfeed. Conclusions: Reducing the cases of operative delivery (Cesarean section) and low weight births, enlightening young and highly educated women on breastfeeding and improving the environment for breastfeeding on the job are important strategies to encourage women to breastfeed.

환자-대조군 연구에서 인구집단 층화가 일배체형 경향성 검정에 미치는 영향

김진흠,강대룡,임현선,남정모,Kim, Jin-Heum,Kang, Dae-Ryong,Lim, Hyun-Sun,Nam, Chung-Mo 한국통계학회 2009 응용통계연구 Vol.22 No.5

Population stratification can cause spurious associations between genetic markers and disease locus. In order to handle this population stratification in haplotype-based case-control association studies, we added population indicators as covariates to the haplotype trend regression model proposed by Zaykin et al. (2002). We investigated through simulations how both population stratification and measurement error in the estimation of true population of each individual affect type I error probabilities of the association tests based on both Zaykin et al.'s (2002) model and the proposed model. Based on those results, in the situation that there exists population stratification but there is no error in population classification of each individual, our proposed model does satisfy a type I error probability whereas Zaykin et al.'s (2002) model does not. However, as the measurement error increases, a type I error probability of our model correspondingly becomes larger than a nominal significance level. It implies that as long as uncertainty in the estimation of true population of each individual still remains, it is nearly impossible to avoid false positive in case-control association studies based on haplotypes. 환자-대조군 연관성 연구에서 후보 유전자와 질병이 연관되어 있지 않더라도 인구집단 층화로 인해 가짜 연관성이 발생할 수도 있다. 본 연구에서는 일배체형에 기초한 환자-대조군 연관성 연구에서 인구집단 층화로 인한 가짜 연관성을 해결하기 위한 방법으로, Zaykin 등 (2002)이 제안한 일배체형 경향성 모형에 인구집단 층화에 대한 정보를 추가하고자 한다. Zaykin 등 (2002)의 모형과 제안한 모형에 기초한 일배체형의 유의성 검정에서 인구집단 층화와 인구집단에 대한 관측 오차가 제1종 오류율에 미치는 영향을 모의실험을 통해 살펴보았다. 인구집단이 층화되어 있지만 각 개체가 속한 인구집단을 정확히 알 수 있을 때, Zaykin 등 (2002)의 모형에 기초한 검정은 제1종 오류율을 잘 조절하지 못했지만 본 연구에서 제안한 모형에 기초한 검정은 제1종 오류율을 잘 조절하는 것으로 나타났다. 그러나 인구집단이 층화되어 있고 관측 오차가 존재하면 제안한 모형에 기초한 검정도 제1종 오류율을 조절하지 못하고 명목 유의수준보다 큰 값을 갖는 것으로 나타났다. 따라서 단일염기다형성에 기초한 환자-대조군 연관성 연구와 마찬가지로 일배체형에 기초한 환자-대조군 연관성 연구에서도 인구집단 층화에 대한 정보를 갖고 있다할지라도 그 속에 관측 오차가 존재하면 위양성을 피하기 어렵다는 것을 알 수 있었다.

일배체형에 기초한 고혈압과 ACE 유전자의 연관성 분석

김진흠,남정모,강대룡,서일,Kim Jinheum,Nam Chung Mo,Kang Dae Ryong,Suh Il 한국통계학회 2005 응용통계연구 Vol.18 No.2

In this study we investigate the association between the haplotype block of 4 SNPs in ACE genes and hypertension with a case-control dataset of size of 277 and 40 families data collected from Kangwha studies. To this end we perform a haplotype-based case-control association study and a haplotype-based TDT study. We do the same analysis with tag-SNPs that can identify the haplotype block. Through a cladogram analysis we make the evolution-tree of haplotypes and then classify the haplotypes into a few clades by collecting haplotypes exposed to the disease to the same extent. We also discuss the association between these clades and hypertension. 본 연구에서는 강화연구(서일, 2004)를 통해 수집된 277명의 환자-대조군 자료와 40개의 가계 자료를 이용하여 ACE(angiotensin-I converting enzyme) 유전자 내에 있는 4개의 단일염기다형성(single nucleotide polymorphism; SNP)으로 이루어진 일배체형(haplotype)과 고혈압의 관련성을 알아보고자 한다. 이를 위해 일배체형에 기초한 환자-대조군의 우도비 검정과 가계 자료의 TDT(transmission/disequilibrium test) 연구를 수행하고자 한다. 또한 이 일배체형을 동정(identification)할 수 있는 tag-SNPs에 기초하여 동일한 연구를 하고자 하며, Seltman 등(2003)이 제안한 분기도(cladogram) 분석 방법을 써서 일배체형의 진화 과정에서 가깝게 위치하고 질병 발생 위험이 비슷한 클레이드(clade)를 찾아내고 이 클레이드와 고혈압의 연관성을 살펴보고자 한다.

방문요양 행위 업무량의 상대적 가치 측정

한성옥,박은철,강대룡,강임옥,Han, Seong-Ok,Park, Eun-Cheol,Kang, Dae-Ryong,Kang, Im-Ok 대한예방의학회 2008 예방의학회지 Vol.41 No.5

Objectives : The purpose of this study was to measure the workload of home visit care activities and their relative values. This study examined also factors that affect the workload of home visit care activities. Methods : The participants of this study were 126 home-helpers of 50 home visit care agencies at the 2nd Long-term Care Insurance Demonstration Project. The workload of home visit care activities was divided into total work and four dimensions ; physical efforts, mental efforts, stress and time. Home visit care activities consisted of four categories with 24 items. We used magnitude estimation method to measure their relative values of the four dimensions. The participants answered the relative values of each activities based on the reference service. We used the activity for supporting their elderly's evacuation as the reference service. Results : Most of the respondents were over 40 years old female. They consumed most their time supporting elderly's going out. They consumed their highest physical, mental efforts, and stress for activities of coping with emergency situation. The Pearson correlation coefficients showed significant relationships between workload and each dimensions. This study showed that all four dimensions are statistically significant predictors of workload of home visit care activities. Also, we found that the home-helper's career affects the workload of home visit care activities. Conclusions : The workload of home visit care activities could be explained by physical efforts, mental efforts, stress and time.

건강보험 청구자료를 이용한 우리나라 천식환자의 질병비용부담 추계

박춘선,권일,강대룡,정혜영,강혜영,Park, Choon-Seon,Kwon, Il,Kang, Dae-Ryong,Jung, Hye-Young,Kang, Hye-Young 대한예방의학회 2006 예방의학회지 Vol.39 No.5

Objectives: We estimated the asthma-related health care utilization and costs in Korea from the insurer's and societal perspective. Methods: We extracted the insurance claims records from the Korea National Health Insurance claims database for determining the health care services provided to patients with asthma in 2003. Patients were defined as having asthma if they had ${\geq}$2 medical claims with diagnosis of asthma and they had been prescribed anti-asthma medicines, Annual claims records were aggeregated for each patient to produce patient-specific information on the total utilization and costs. The total asthma-related cost was the sum of the direct healthcare costs, the transportation costs for visits to health care providers and the patient's or caregivers' costs for the time spent on hospital or outpatient visits. Results: A total of 699,603people were identified as asthma patients, yielding an asthma prevalence of 1.47%. Each asthma patient had 7.56 outpatient visits, 0.01 ED visits and 0.02 admissions per year to treat asthma. The per-capita insurance-covered costs increased with age, from 128,276 Won for children aged 1 to 14 years to 270,729 Won for those aged 75 or older. The total cost in the nation varied from 121,865 million to 174,949 million Won depending on the perspectives. From a societal perspective, direct health care costs accounted for 84.9%, transportation costs for 15.1 % and time costs for 9.2% of the total costs. Conclusions: Hospitalizations and ED visits represented only a small portion of the asthma-related costs. Most of the societal burden was attributed to direct medical expenditures, with outpatient visits and medications emerging as the single largest cost components.

Dipstick Urine Protein, as a Predictor of Cardiovascular Mortality in Korean Men: Korea Medical Insurance Corporation Study

하경수,김현창,강대룡,남정모,안성복,서일,Ha, Kyoung-Soo,Kim, Hyeon-Chang,Kang, Dae-Ryong,Nam, Chung-Mo,Ahn, Song-Vogue,Suh, Il The Korean Society for Preventive Medicine 2006 예방의학회지 Vol.39 No.5

Objectives: This study was to investigate if the dipstick proteinuria can predict cardiovascular mortality in a population of Korean men. Methods: We measured urine protein and other cardiovascular risk factors in 100059 Korean men, aged between 35-59 years in 1990 and 1992. Levels of proteinuria measured by dipstick method were trace or less, 1+, 2+, and 3+ or greater. The primary outcomes were deaths from all causes, cardiovascular disease, cancer, and others in a 12 year follow-up from 1993 to 2004. Results: The multivariate-adjusted relative risks (95% CI) for cardiovascular death according to the level of proteinuria (1+, 2+, 3+ and more) in 1990 examination were 2.18 (1.36-3.48), 2.55 (1.37-4.78), and 4.57 (2.16-9.66) respectively. The corresponding relative risks according to the level of proteinuria in 1992 examination were 2.49 (1.71-3.64), 2.64 (1.53-4.58), and 2.78 (1.15-6.73). The relative risks for cardiovascular death of men with proteinuria (1+ or greater) once and twice among the examinations were 2.18 (1.63-2.92) and 3.75 (2.27-6.18), compared with men without proteinuria in 1990 and 1992 examinations. Conclusions: Our results showed that dipstick proteinuria is associated with cardiovascular mortality in Korean men. Dipstick proteinuria could be a predictor for cardiovascular mortality.

지역사회 고혈압 환자에서 고혈압 조절 및 항고혈압제 복용에 관련된 요인

이동한,최연희,이강희,강대룡,지선하,남정모,서일,Lee, Dong-Han,Choi, Youn-Hee,Lee, Kang-Hee,Kang, Dae-Ryong,Jee, Sun-Ha,Nam, Chung-Mo,Suh, Il 대한예방의학회 2003 예방의학회지 Vol.36 No.3

Objectives : The main objectives of this study are to identify the factors associated with hypertension control and to determine the influencing factors associated with antihypertensive therapy. Methods : The study was conducted on 107 subjects who participated in the 1999 and 2002 Gwacheon Study and who had had uncontrolled hypertension (systolic$\geq$140 or diastolic$\geq$ 90mmHg) in 1999, We compared the characteristics of the controlled and uncontrolled hypertensive group and investigated the characteristics of those taking antihypertensive medication. Univariate associations between hypertension control and its characteristics and the association between antihypertension treatment and its characteristics were tested with $x^2$-test. We also peformed logistic regression analysis. Results : The participants who had their blood pressure checked within 6 months before their first measurement and those who had taken the antihypertensive medication showed significantly better hypertension control during the follow-up. The multivariate analysis showed that baseline antihypertensive therapy was the most important determinant factor of hypertension control during the follow-up. Socioeconomic level and life style did not affect hypertension control when controlled by the treatment variable in this study. The factors associated with antihypertensive therapy at follow-up were previous antihypertensive therapy, old age, and high educational level. Conclusions : Those who received antihypertensive therapy and those who had their blood pressure re-checked within 6 months both showed well controlled hypertension. The subjects with high educational level complied well with the antihypertensive regimen, but those in their forties did not.