사회경제적 형태에 따른 치매 유병률 변화: 건강보험, 의료급여 대상자를 중심으로

Abstract

Background: Dementia is a critical health concern in Korea as the population ages and lives longer. Socioeconomic disadvantages have been identified as a risk factor for dementia. Our study aimed to estimate the prevalence of dementia by socioeconomic status in Korea by analyzing hospital utilization rates. Methods: We examined National Health Insurance claims data in the Health Insurance Review & Assessment Service (HIRA) from 2008 to 2016 and identified all dementia cases. We calculated crude age- and sex-standardized prevalence by socioeconomic status. Health insurance types (Medical Aid and National Health Insurance beneficiaries) were used as socioeconomic status indicators. Results: The age- and sex-standardized prevalence for dementia by health insurance type consistently increased, which was prominent among patients aged ≥85 years from 2008 to 2016. Rate ratio of age- and sex-standardized prevalence in Medical Aid beneficiaries (904.1–1,793.3 per 100,000 individuals, from 2008 to 2016) was approximately three times higher than that in National Health Insurance beneficiaries (311.0–622.6). Among patients aged <60 years, rate ratio difference of the age- and sex-standardized prevalence was estimated at 15.4 times in 2008 (15.2 in National Health Insurance and 233.6 in Medical Aid) and 26.5 times in 2016 (21.4 in National Health Insurance and 565.8 in Medical Aid). Conclusion: The rate ratio of age- and sex-standardized prevalence for dementia in Medical Aid beneficiaries was approximately three times higher than that in National Health Insurance beneficiaries from 2008 to 2016. Moreover, difference in prevalence of early onset dementia (<60 years of age) highly increased. Therefore, Korean healthcare policy must prioritize dementia prevention and treatment according to socioeconomic status (Medical Aid beneficiaries), specifically for early onset dementia.