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연구 배경
많은 나라에서 구강건강 증진을 위한 인식 제고와 다양한 예방 사업을 하고 있으나 구강질환은 여전히 공중보건의 중요한 문제이다(Petersen PE, 2003). 우리나라의 직장 구강보건사업은 비교적 규모가 큰 사업장의 정규직 근로자를 중심으로 이루어지고 있어, 중소기업 또는 비정규직 근로자에 대한 구강예방사업이 취약하다(윤미숙 외, 2012). 구강질환은 다른 만성질환보다 생명에 미치는 위험이 낮다고 인식되어있을 뿐만 아니라(안은숙 외, 2016), 근로자는 경제활동으로 인해 구강건강을 관리할 시간적 여유가 부족하다(김예황 외, 2019). 근로자는 일반적으로 근로시간이 길수록 흡연율이 나 음주율이 증가하고 신체활동이 감소하여 건강이 악화된다(정세환 외, 2018; Seok, H., 2016). 우리나라의 2018년 기준 연간 근로시간은 평균 1,993시간으로 OECD 회원 국가의 평균 보다 259시간 길다(OECD, 2020). 주 48시간 이상 근무하는 근로자의 비율도 우리나라는 45%로 터키(57%)에 이어 두 번째로 높다. 이에 비해 미국과 유럽은 각각 19%, 15%로 우리와는 큰 차이를 보인다(Euro found & ILO, 2019). 근로시간이 길면 이직률이 높아지고 노동생산성은 낮아지며(김기민, 2019), 미충족 의료 경험률이 높아지는 경향을 보인다(Seok, H. 외, 2016). 따라서 근로자의 삶의 질 향상과 기업의 생산성을 향상시키기 위하여(ILO, 2007), 구강건강증진에 필요한 근무시간 조정이 필요하다(최윤화, 2006). 미충족 의료는 경제적 부담뿐만 아니라 시간적 제약, 정보 부족, 의료기관의 접근성 등 다양한 요인의 영향을 받는다(김수정 외, 2011; 이민경외, 2015). 그러나 미충족 의료는 근로시간 외 근로 관련 변수를 포함한 연구는 아직 부족하며, 장시간 근로와 치과 미충족 의료 경험을 다룬 연구는 거의 없다. 따라서 이 연구는 다양한 관련 변수를 포함하여, 임금근로자의 장시간 근로와 치과 미충족 의료의 관련성을 확인하고자 하였다.
연구 방법
연구대상은 국민건강영양조사 원시자료(2012-2018)에서 추출한 만 19세 이상의 치과치료가 필요했던 임금 근로자이다. 치과 미충족 의료 경험률의 차이는 카이제곱과 t-검정으로, 장시간 근로와 치과 미충족 의료의 관련성은 다중회귀분석으로 확인하였다.
연구 결과
대상자의 치과 미충족 의료 경험율은 2,819명 중 50.6%로였는데, 이중 시간적 이유(35.2%)가 가장 높았고, 다음이 경제적인 이유(34.2%)였다. 인구사화학적 특성과 근로 관련 특성을 보정한 결과, 주당 40시간 이하 근무자에 비해 40시간 초과 52시간 이하(OR 1.13, 95% CI 0.91-1.41) 또는 52시간 초과(OR 1.22, 95% CI 0.97-1.55) 근무자가 치과 미충족 의료를 경험할 위험이 높았으나 통계적으로 유의하지는 않았다. 근로시간에 따른 경제적 이유의 치과 미충족 의료는 40시간 이하에 비해 52시간 초과 근로자가 경험할 가능성이 높았으나 통계적으로 유의하지 않았다(OR 1.13, 95% CI 0.80-1.61).또한 시간이 부족해 치과치료를 받지 못했다는 대상자에서는 40시간 이하에 비해 40시간 초과 52시간 이하(OR 1.53, 95% CI 1.15-2.04) 또는 52시간 초과(OR 1.82, 1.31-2.53) 근무자가 치과 미충족 의료를 경험했을 가능성이 높았다.
결론
이 연구는 자료원의 한계로 근로시간 길이만 반영하였지만, 임금근로자의 장시간 근로와 치과 미충족 의료의 관련성을 분석한 결과, 장시간 근로가 치과 치료를 받을 시간을 내기 어렵게 했을 가능성을 확인하였다. 앞으로는 근로시간의 길이 외에도 근무 유연성 등 다양한 특성을 고려한 치과 미충족 의료 경험에 대한 연구가 필요할 것이다.
많은 나라에서 구강건강 증진을 위한 인식 제고와 다양한 예방 사업을 하고 있으나 구강질환은 여전히 공중보건의 중요한 문제이다(Petersen PE, 2003). 우리나라의 직장 구강보건사업은 비교적 규모가 큰 사업장의 정규직 근로자를 중심으로 이루어지고 있어, 중소기업 또는 비정규직 근로자에 대한 구강예방사업이 취약하다(윤미숙 외, 2012). 구강질환은 다른 만성질환보다 생명에 미치는 위험이 낮다고 인식되어있을 뿐만 아니라(안은숙 외, 2016), 근로자는 경제활동으로 인해 구강건강을 관리할 시간적 여유가 부족하다(김예황 외, 2019). 근로자는 일반적으로 근로시간이 길수록 흡연율이 나 음주율이 증가하고 신체활동이 감소하여 건강이 악화된다(정세환 외, 2018; Seok, H., 2016). 우리나라의 2018년 기준 연간 근로시간은 평균 1,993시간으로 OECD 회원 국가의 평균 보다 259시간 길다(OECD, 2020). 주 48시간 이상 근무하는 근로자의 비율도 우리나라는 45%로 터키(57%)에 이어 두 번째로 높다. 이에 비해 미국과 유럽은 각각 19%, 15%로 우리와는 큰 차이를 보인다(Euro found & ILO, 2019). 근로시간이 길면 이직률이 높아지고 노동생산성은 낮아지며(김기민, 2019), 미충족 의료 경험률이 높아지는 경향을 보인다(Seok, H. 외, 2016). 따라서 근로자의 삶의 질 향상과 기업의 생산성을 향상시키기 위하여(ILO, 2007), 구강건강증진에 필요한 근무시간 조정이 필요하다(최윤화, 2006). 미충족 의료는 경제적 부담뿐만 아니라 시간적 제약, 정보 부족, 의료기관의 접근성 등 다양한 요인의 영향을 받는다(김수정 외, 2011; 이민경외, 2015). 그러나 미충족 의료는 근로시간 외 근로 관련 변수를 포함한 연구는 아직 부족하며, 장시간 근로와 치과 미충족 의료 경험을 다룬 연구는 거의 없다. 따라서 이 연구는 다양한 관련 변수를 포함하여, 임금근로자의 장시간 근로와 치과 미충족 의료의 관련성을 확인하고자 하였다.
연구 방법
연구대상은 국민건강영양조사 원시자료(2012-2018)에서 추출한 만 19세 이상의 치과치료가 필요했던 임금 근로자이다. 치과 미충족 의료 경험률의 차이는 카이제곱과 t-검정으로, 장시간 근로와 치과 미충족 의료의 관련성은 다중회귀분석으로 확인하였다.
연구 결과
대상자의 치과 미충족 의료 경험율은 2,819명 중 50.6%로였는데, 이중 시간적 이유(35.2%)가 가장 높았고, 다음이 경제적인 이유(34.2%)였다. 인구사화학적 특성과 근로 관련 특성을 보정한 결과, 주당 40시간 이하 근무자에 비해 40시간 초과 52시간 이하(OR 1.13, 95% CI 0.91-1.41) 또는 52시간 초과(OR 1.22, 95% CI 0.97-1.55) 근무자가 치과 미충족 의료를 경험할 위험이 높았으나 통계적으로 유의하지는 않았다. 근로시간에 따른 경제적 이유의 치과 미충족 의료는 40시간 이하에 비해 52시간 초과 근로자가 경험할 가능성이 높았으나 통계적으로 유의하지 않았다(OR 1.13, 95% CI 0.80-1.61).또한 시간이 부족해 치과치료를 받지 못했다는 대상자에서는 40시간 이하에 비해 40시간 초과 52시간 이하(OR 1.53, 95% CI 1.15-2.04) 또는 52시간 초과(OR 1.82, 1.31-2.53) 근무자가 치과 미충족 의료를 경험했을 가능성이 높았다.
결론
이 연구는 자료원의 한계로 근로시간 길이만 반영하였지만, 임금근로자의 장시간 근로와 치과 미충족 의료의 관련성을 분석한 결과, 장시간 근로가 치과 치료를 받을 시간을 내기 어렵게 했을 가능성을 확인하였다. 앞으로는 근로시간의 길이 외에도 근무 유연성 등 다양한 특성을 고려한 치과 미충족 의료 경험에 대한 연구가 필요할 것이다.
목차
국문요지 ······························································································································································ ⅵ제 1장 서 론 ·························································································································································· 1제1절 연구의 필요성 ·············································································································································· 1제2절 연구 목적 ···················································································································································· 2제 2장 이론적 배경 및 선행연구 ······························································································································ 3제1절 임금근로자의 구강건강 ································································································································· 3제2절 임금근로자의 장시간 근로 ····························································································································· 6제3절 치과 미충족 의료 ······································································································································· 10제 3장 연구 방법 ················································································································································· 14제1절 연구 자료 및 대상자 ··································································································································· 14제2절 연구 가설 및 모형 ······································································································································ 16제3절 주요변수의 조작적 정의 ······························································································································ 18제4절 분석방법 ··················································································································································· 22제 4장 연구 결과 ················································································································································· 23제1절 임금근로자의 일반적 특성 ·························································································································· 23제2절 임금근로자의 미충족 의료 현황 ··················································································································· 29제3절 연구 대상자의 주당 근로시간 ······················································································································ 38제4절 장시간 근로와 치과 미충족 의료 경험의 관련성 ····························································································· 46제 5장 고찰 및 결론 ············································································································································· 57제1절 주요결과 해석과 다른 연구와의 비교 ············································································································ 57제2절 연구의 한계 및 의의 ··································································································································· 62제3절 결론 ·························································································································································· 63참고문헌 ····························································································································································· 64부록 ··································································································································································· 69Abstract ···························································································································································· 93
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