표제지
국문요약
Abstract
목차
I. 서론 18
1. 연구배경 및 필요성 18
2. 연구 목적 21
II. 이론적 배경 22
1. 구강 질환과 암 발생 위험 22
2. 구강 질환과 암 사망 위험 24
3. 구강 질환이 암에 영향을 미치는 작용기전 26
III. 연구대상 및 방법 30
1. 연구 모형 30
2. 자료원 31
1) 전국민 건강검진 및 건강보험 청구 자료 31
2) 통계청 사망 원인 자료 32
3. 연구 대상 및 설계 34
4. 분석 변수 35
1) 독립 변수 35
2) 결과 변수 38
3) 공변량 40
4) 하위군 분석 41
5. 분석 방법 42
IV. 연구결과 44
1. 연구 대상 선정 44
2. 대상자의 일반적 특성 45
3. 구강 질환별 일반적 특성 48
1) 치은염 48
2) 치아 상실 50
3) 치아 우식 52
4) 구내염 54
4. 구강 질환에 따른 암 발생 위험 57
1) 전체 암 57
2) 세부 암 발생률 및 발생 위험 72
3) 하위군 분석 78
5. 구강 질환에 따른 암 사망 위험 99
1) 암 사망자수 및 암 사망률 99
2) 암 사망 위험 100
3) 암 특성별 하위군 분석 106
V. 고찰 109
1. 연구 방법에 대한 고찰 109
2. 연구 결과에 대한 고찰 111
1) 전체 암 발생 위험 111
2) 세부 암 발생 위험 112
3) 전체 암 사망 위험 115
4) 세부 암 사망 위험 115
5) 암 특성별 추가 분석 - 소화기 및 혈액 림프 관련 암 116
3. 연구의 제한점 117
1) 고려되지 못한 교란 요인 117
2) 구강 검진 측정 변수와 추적관찰 기간의 한계 118
3) 암 병기(stage) 및 이차 암을 포함하지 못한 한계 118
4) 임상적 매커니즘 분석 연구 필요 118
VI. 결론 120
1. 결과 요약 120
2. 정책적 제언 121
참고문헌 123
부록 131
Table 1. Database used for the study 33
Table 2. Patient selection criteria 34
Table 3. Definition and measurement method of periodontal disease 35
Table 4. Variables for periodontal disease 37
Table 5. Outcomes and ICD-10 Code 39
Table 6. Cancer incidence of common site, both sexes, 2019 39
Table 7. Definition of covariates 40
Table 8. Definition of sub-groups 41
Table 9. Characteristics of study population 46
Table 10. Characteristics by gingivitis 49
Table 11. Characteristics by tooth loss 51
Table 12. Characteristics by dental caries 53
Table 13. Characteristics by stomatitis 55
Table 14. Incidence rate of all-site cancer 58
Table 15. Incidence rate and risk of all-site cancer in gingivitis compared to non-gingivitis according to sex and age group 63
Table 16. Incidence rate and risk of all-site cancer in tooth loss compared to no-tooth loss according to sex and age group 65
Table 17. Incidence rate and risk of all-site cancer in dental caries compared to no-dental caries according to sex and age group 67
Table 18. Incidence rate and risk of all-site cancer in stomatitis compared to non-stomatitis according to sex and age group 69
Table 19. Risk of all-site cancer incidence in periodontal diseases compared to non-periodontal diseases 71
Table 20. Risk of site-specific cancer incidence in gingivitis compared to non-gingivitis 74
Table 21. Risk of site-specific cancer incidence in tooth loss compared to no-tooth loss 75
Table 22. Risk of site-specific cancer incidence in dental caries compared to no-dental caries 76
Table 23. Risk of site-specific cancer incidence in stomatitis compared to non-stomatitis 77
Table 24. Sub-group analysis: risk of all-site and site-specific cancer incidence according to age group 79
Table 25. Incidence rate and risk of thyroid cancer in periodontal disease compared to non-periodontal disease according to sex and age group over 50years old 82
Table 26. Incidence rate and risk of lung cancer in periodontal disease compared to non-periodontal disease according to sex and age group over 50years old 83
Table 27. Incidence rate and risk of stomach cancer in periodontal disease compared to non-periodontal disease according to sex and age group over 50years old 84
Table 28. Incidence rate and risk of colorectal cancer in periodontal disease compared to non-periodontal disease according to sex and age group over 50years old 85
Table 29. Incidence rate and risk of liver cancer in periodontal disease compared to non-periodontal disease according to sex and age group over 50years old 86
Table 30. Sub-group analysis: risk of all-site and site-specific cancer incidence according to income level 89
Table 31. Sub-group analysis: risk of all-site and site-specific cancer incidence according to BMI 90
Table 32. Sub-group analysis: risk of all-site and site-specific cancer incidence according to FBS 92
Table 33. Sub-group analysis: risk of all-site and site-specific cancer incidence according to smoking 94
Table 34. Sub-group analysis: risk of gastrointestinal cancer incidence according to periodontal disease 97
Table 35. Sub-group analysis: risk of hematopoietic and lymphatic cancer incidence according to periodontal disease 98
Table 36. Top 5 cancer deaths among national health screening program examinee (2010-2019) 99
Table 37. Risk of cancer mortality in gingivitis compared to non-gingivitis 102
Table 38. Risk of cancer mortality in tooth loss compared to no-tooth loss 103
Table 39. Risk of cancer mortality in dental caries compared to no-dental caries 104
Table 40. Risk of site-specific cancer mortality in stomatitis compared to non-stomatitis 105
Table 41. Sub-group analysis: risk of gastrointestinal cancer mortality according to periodontal disease 106
Table 42. Sub-group analysis: risk of hematopoietic and lymphatic cancer mortality according to periodontal disease 107
Table 43. Sub-group analysis: risk of cancer type mortality according to periodontal disease 108
Figure 1. Possible mechanism for the link between periodontal disease and cancer 26
Figure 2. Possible mechanism for the link between periodontal disease and systemic diseases 28
Figure 3. Study framework 30
Figure 4. Diagram for study design 34
Figure 5. Flowchart for the study population 44
Figure 6. K-M Plot of all-site cancer incidence in gingivitis vs. non-gingivitis 59
Figure 7. K-M Plot of all-site cancer incidence in tooth loss vs. no-tooth loss 59
Figure 8. K-M Plot of all-site cancer incidence in dental caries vs. no-dental caries 60
Figure 9. K-M Plot of all-site cancer incidence in stomatitis vs. non-stomatitis 60
Figure 10. Incidence rate of all-site cancer in gingivitis compared to non-gingivitis according to sex and age group 64
Figure 11. Incidence rate of all-site cancer in tooth loss compared to no-tooth loss according to sex and age group 66
Figure 12. Incidence rate of all-site cancer in dental caries compared to no-dental caries according to sex and age group 68
Figure 13. Incidence rate of all-site cancer in stomatitis compared to non-stomatitis according to sex and age group 70
Figure 14. Summary of top 5 site-specific cancer incidence hazard ratio according to sex and age group over 50years old 87
Figure 15. Summary of site-specific cancer incidence hazard ratio among the sub-groups 96