건강위험요인 상태변화에 따른 고혈압 건강위험평가 모형 개발 = Health Risk Appraisal Model for Assessing Hypertension by Changing Health Risk Factors

국문 초록 (Abstract)

본 연구의 목적은 다년간의 건강검진 및 문진 자료를 이용하여 고혈압 건강위험평가 모형을 개발하기 위한 것이다. 2010년 고혈압 미발생 수검자 11,632명을 대상으로 이들의 2009~2010년 건강행태, 신체계측 및 생화학검사 결과와 같은 건강위험요인상태변화가 2011~2012년 고혈압 발생에 미치는 영향을 파악하기 위해 로지스틱 회귀분석으로서 고혈압 건강위험평가 모형을 개발하였다. 그 결과, 개발된 고혈압 건강위험평가 모형을 통해 연령, 가족력, 음주습관 변화, 허리둘레 변화, 혈압 및 중성지방 수치의 변화가 주요 위험요인으로 선별되었다(C-통계량 =0.81[남=0.78, 여=0.87]). 특히 고혈압전단계(120-139/80-89 mmHg) 수준을 유지하는 경우, 정상 수준을 유지하는 사람에 비해 3-4년 이내 고혈압 발생위험이 16.52배(95% CI, 9.36-29.16) 높았다. 건강행태, 신체계측, 생화학검사의 변화 정도를 위험 요인으로 구성한 고혈압 발생 예측 모형은 환자뿐만 아니라 임상의료인과 보건정책가에게도 유용하게 이용될 수 있을 것이며, 추후 외적 타당도 연구가 수행되어야 할 것이다.

다국어 초록 (Multilingual Abstract)

This study aimed to develop a health risk appraisal model for predicting hypertension incidence by using measures based on multi-year (2008-2012) data of individuals who underwent a general health examination. A total of 11,632 subjects with a normal blood pressure in 2010 were enrolled to observe changes of health behavior, anthropometric measurements, and laboratory results from 2009 through 2010 affecting hypertension incidence in 2011-2012. A hypertension risk score model was developed using logistic regression. Also, the C-statistic (95% confidence interval) was used to develop the best-fitting prediction model. Hypertension risk model consisted of age, family history of hypertension, and changes in drinking behavior, visceral obesity, blood pressure level, and triglycerides level (C-statistic=0.81[male=0.78, female=0.87]). The incidence rate of hypertension was positively associated with change (◁) in blood pressure level, especially sustaining level of prehypertension (odds ratio [95% CI], 16.52 [9.36-29.16]), independently from other risk factors. The health risk model will be helpful for clinicians and policy makers as well as individuals to prevent hypertension.

참고문헌 (Reference)

1 정영호, "효과적인 만성질환 관리방안 연구" 한국보건사회연구원 2013

2 신호철, "한국형 건강위험평가 도구의 개발 세미나" 23 (23): 260-295, 2002

3 통계청, "장래인구추계 2010년~2060년" 통계청 2011

4 용왕식, "고혈압 발생 예측 모형 개발" 한국보건교육건강증진학회 23 (23): 13-28, 2006

5 윤희숙, "경제현안분석: 고령화를 준비하는 건강보험 정책의 방향" 한국개발연구원 2013

6 조비룡, "개편된 일반건강검진 제도에적합한 HRA 개발" 질병관리본부 2008

7 Kivimäki, M., "Validating the Framingham Hypertension Risk Score : results from the Whitehall II study" 54 (54): 496-501, 2009

8 Tohidi, M., "Triglycerides and triglycerides to high-density lipoprotein cholesterol ratio are strong predictors of incident hypertension in Middle Eastern women" 26 (26): 525-532, 2012

9 Pearson, T. A., "The prediction of midlife coronary heart disease and hypertension in young adults : the Johns Hopkins multiple risk equations" 6 : 23-28, 1990

10 Conroy, R. M., "SCORE Project Group. Estimation of ten-year risk of fatal cardiovascular disease in Europe : the SCORE project" 24 : 987-1003, 2003

11 Paynter, N. P., "Prediction of incident hypertension risk in women with currently normal blood pressure" 122 : 464-471, 2009

12 Fava C., "Prediction of blood pressure changes over time and incidence of hypertension by a genetic risk score in Swedes" 61 : 319-326, 2013

13 Chien, K. L., "Prediction models for the risk of new-onset hypertension in ethnic Chinese in Taiwan" 25 : 294-303, 2011

14 Lim, N. K., "Predicting the risk of incident hypertension in a Korean middle-aged population : Korean genome and epidemiology study" 15 (15): 344-349, 2013

15 Park, G. M., "Model for assessing cardiovascular risk in a korean population" 7 (7): 944-951, 2014

16 Benetos, A., "Influence of age, risk factors, and cardiovascular and renal disease on arterial stiffness : clinical applications" 15 : 1101-1108, 2002

17 OECD, "Health at a Glance 2013: OECD Indicators" OECD 25-171, 2013

18 Williams, R. R., "Genetic basis of familial dyslipidemia and hypertension:15-year results from Utah" 6 (6): 319-327, 1993

19 Vasan, R. S., "Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham Heart Study : a cohort study" 358 : 1682-1686, 2001

20 Djousse, L., "Alcohol consumption and risk of hypertension: does the type of beverage or drinking pattern matter?" 62 (62): 603-605, 2009

21 Parikh, N. I., "A risk score for predicting near-year incidence of hypertension : The Framingham Heart Study" 148 (148): 102-110, 2008

22 보건복지부, "2012 국민건강통계 : 국민건강영양조사 제5기 3차년도" 질병관리본부 2013