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JKM > Volume 37(1); 2016 > Article
Lee, Park, and Lee: Characteristics of Toxicity Occurring in Outpatients at Korean Medical Clinics in Korean

Abstract

Research Methods:

This research analyzed the data on those aged 20 and older from the Report on Korean Medicine Usage Research, which was conducted in 2011. The definitions of toxicity were defined by the presence of toxicity listed in the survey. The questions used in analysis were sex, age, household income, health insurance, medical fees, satisfaction rates on treatments, as well as the types of diseases and the presence of toxicity from treatments. The analysis was done through frequency analysis using SAS 9.2 and Fisher’s Exact Test.

Results:

Toxicity occurred in 2.1% patients out of the 3518 studied. The types of toxicity were skin problems, such as hives and pruritus (34.7%), gastrointestinal problems (20.8%), neurological diseases (4.2%), liver(1.4%), kidney toxicity(1.4%), and others (22.2%). There were no differences in toxicity by sex, age, household income and the types of health insurances. However, toxicity were positively correlated with the increase in standard of education (p=0.0124). In addition, as treatment costs increased (p<0.0001) and satisfaction rates decreased, toxicity increased (p<0.0001). Toxicity increased in patients with low back pain (p=0.0429), hwabyung (p=0.0392), lumbar sprain (p=0.0004), correction body type (p=0.0118), growth (p=0.0045), and from motor accidents (p=0.0448). In logistic regression analysis, Toxicity were positively correlated with medical fees, and cancer treatment and negatively correlated with satisfaction rate on treatments.

Conclusion:

The toxicity that occurred in outpatients who used Korean medical clinics mostly happened in skin, digestive organs, nerves, livers, and kidneys toxicity. The occurrences differed by the Educational lengths, expensive costs of treatments, low satisfaction rates of the treatments, and cancer.

Table 1.
Toxicity of frequency and types in subject of study      unit: person(%)
도 (%)
부작용 유무 및 종류
부작용 및 독성유무 있다 72(2.1)
없다 3,446(97.9)
부작용 및 독성의 종류 배탈, 설사 등의 소화기질환 15(20.8)
두드러기, 가려움증 등의 피부질환 25(34.7)
마비 등의 신경계질환 3(4.2)
간기능 이상 1(1.4)
신장기능 이상 1(1.4)
기타 16(22.2)
무응답 11(15.3)
Table 2.
Sociodemographic characteristics of toxicity        unit; person(%)
부작용 유무 p-value
인구사회적 변수 있다 없다
성별 남자 17(1.7) 1,003(98.3) 0.3091
여자 55(2.2) 2,443(97.8)
연령별 20대 11(2.49) 430(97.51) 0.077
30대 13(2.15) 591(97.85)
40대 19(2.25) 827(97.75)
50대 19(2.95) 626(97.05)
60대 이상 10(1.02) 972(98.98)
혼인상태 미혼 6(1.6) 370(98.4) 0.4401
기혼(결혼 후 정상생활) 61(2.25) 2,651(97.75)
사별(기혼 후) 4(1.08) 366(98.92)
이혼/별거(기혼 후) 1(1.67) 59(98.33)
교육정도 중학교 졸업 이하 15(1.28) 1,153(98.72) 0.0124
고등학교 21(1.85) 1,117(98.15)
대졸이상 36(2.97) 1,176(97.03)
직업 있다 34(1.93) 1,730(98.07) 0.6166
없다 38(2.17) 1,716(97.83)
건강보험 종류 지역가입자 26(1.96) 1,301(98.04) 0.9047
직장가입자 42(2.07) 1,987(97.93)
의료급여 4(2.47) 158(97.53)
소득수준 100만원 이하 10(1.44) 684(98.56) 0.1676
101∼200 만원 10(1.37) 721(98.63)
201∼300 만원 20(2.62) 744(97.38)
301 만원 이상 32(2.41) 1,297(97.59)
Table 3.
Toxicity of subjective health status, number of treatment, medical fees, satisfaction rates on treatments      unit; person(%)
부작용 %
건강수준, 진료횟수및 진료비, 진료만족도 있다 없다 p-value
주관적 건강 좋음(매우 좋음+좋음) 22(2.32) 926(97.68) 0.7828
보통 30(1.96) 1,501(98.04)
나쁨(나쁨+매우 나쁨) 20(1.92) 1,019(98.08)
최근 3개월간 외래 한방 진료 횟수 1∼3회 24(1.96) 1,199(98.04) 0.6916
4∼5회 16(2.63) 593(97.37)
6∼10회 12(2.09) 563(97.91)
11∼15회 5(1.27) 388(98.73)
16∼20회 6(2.82) 207(97.18)
21 회 이상 9(1.78) 496(98.22)
외래진료비 60 만원 미만 48(1.54) 3,066(98.46) <0.0001
60 만원 이상 23(6.1) 354(93.9)
진료만족도 만족(매우 만족+만족) 51(1.77) 2,836(98.23) <0.0001
보통 15(2.89) 504(97.11)
불만족(불만족+매우 불만족) 5(11.63) 38(88.37)
잘 모름 1(1.45) 68(98.55)
Table 4.
Toxicity of sociodemographic characteristics and Treatment Satisfaction Rates.      unit: person(%)
소화기계 피부계 신경계 간 기능 신장 기능 기타
인구사회학적특성 및 진료만족도
성별 남자 4(28.57) 5(35.71) 0(0) 0(0) 0(0) 5(35.71)
여자 11(23.40) 20(42.55) 3(6.38) 1(2.13) 1(2.13) 11(23.40)
연령 20대 3(27.27) 4(36.36) 1(9.09) 0(0) 0(0) 3(27.27)
30대 3(25.00) 6(50.00) 0(0) 0(0) 0(0) 3(25.00)
40대 4(26.67) 9(60.00) 0(0) 0(0) 0(0) 2(13.33)
50대 5(27.78) 5(27.78) 1(5.56) 0(0) 1(5.56) 6(33.33)
60대 이상 0(0) 1(20.00) 1(20.00) 1(20.00) 0(0) 2(40.00)
혼인상태 미혼 2(40.00) 1(20.00) 0(0) 0(0) 0(0) 2(40.00)
기혼(결혼 후 정상생활) 13(24.53) 23(43.40) 3(5.66) 1(1.89) 1(1.89) 12(22.64)
사별(결혼 후) 0(0) 1(50.00) 0(0) 0(0) 0(0) 1(50.00)
이혼/별거(결혼 후) 0(0) 0(0) 0(0) 0(0) 0(0) 1(100.00)
교육정도 중학교 이하 2(22.22) 2(22.22) 0(0) 1(11.11) 1(11.11) 3(33.33)
고등학교 5(23.81) 10(47.62) 1(4.76) 0(0) 0(0) 5(23.81)
대졸이상 8(25.81) 13(41.94) 2(6.45) 0(0) 0(0) 8(25.81)
직업유무 있다 8(26.67) 13(43.33) 1(3.33) 0(0.00) 0(0.00) 8(26.67)
없다 7(22.58) 12(38.71) 2(6.45) 1(3.23) 1(3.23) 8(25.81)
건강보험종류 지역가입자 6(30.00) 5(25.00) 1(5.00) 1(5.00) 1(5.00) 6(30.00)
직장가입자 8(21.62) 18(48.65) 2(5.41) 0(0) 0(0) 9(24.32)
의료급여 1(25.00) 2(50.00) 0(0) 0(0) 0(0) 1(25.00)
소득수준 100만원 이하 1(16.67) 1(16.67) 0(0) 0(0) 0(0) 4(66.67)
101∼200 만원 4(50.00) 3(37.5) 0(0) 1(12.5) 0(0) 0(0)
201∼300 만원 3(18.75) 8(50.00) 0(0) 0(0) 1(6.25) 4(25.00)
301 만원 이상 7(22.58) 13(41.94) 3(9.68) 0(0) 0(0) 8(25.81)
진료만족도 만족(매우 만족+만족) 10(23.81) 20(47.62) 1(2.38) 1(2.38) 1(2.38) 9(21.43)
보통 2(15.38) 3(23.08) 2(15.38) 0(0) 0(0) 6(46.15)
불만족(불만족+매우 불만족) 3(60.00) 2(40) 0(0) 0(0) 0(0) 0(0)
잘 모름 0(0.00) 0(0) 0(0) 0(0) 0(0) 1(100.00)
Table 5.
Toxicity of therapy method and effectiveness      unit: person(%)
부작용 유무 P-Value
치료방법 있다 없다
탕약 효과 있음(매우 효과 있음+효과 있음) 28(2.98) 912(97.02) 0.1462
보통 6(3.23) 180(96.77)
효과 없음(거의 없음+전혀 없음) 3(10.71) 25(89.29)
잘 모름 2(2.63) 74(97.37)
한약제제 효과 있음(매우 효과 있음+효과 있음) 13(3.37) 373(96.63) 0.6668
보통 4(4.35) 88(95.65)
효과 없음(거의 없음+전혀 없음) 1(7.69) 12(92.31)
잘 모름 0(0) 19(100)
효과 있음(매우 효과 있음+효과 있음) 56(1.99) 2,762(98.01) 0.6802
보통 10(2.51) 388(97.49)
효과 없음(거의 없음+전혀 없음) 2(4.17) 46(95.83)
잘 모름 2(2.15) 91(97.85)
효과 있음(매우 효과 있음+효과 있음) 21(1.97) 1,043(98.03) 0.8182
보통 5(2.19) 223(97.81)
효과 없음(거의 없음+전혀 없음) 0(0) 17(100)
잘 모름 0(0) 26(100)
부항 효과 있음(매우 효과 있음+효과 있음) 12(1.13) 1,050(98.87) 0.2896
보통 3(1.38) 215(98.62)
효과 없음(거의 없음+전혀 없음) 1(5.26) 18(94.74)
잘 모름 1(3.57) 27(96.43)
추나 효과 있음(매우 효과 있음+효과 있음) 12(4.38) 262(95.62) 0.4592
보통 0(0) 43(100)
효과 없음(거의 없음+전혀 없음) 0(0) 5(100)
잘 모름 0(0) 9(100)
물리요법 효과 있음(매우 효과 있음+효과 있음) 31(1.7) 1,788(98.3) 0.2482
보통 8(2.4) 326(97.6)
효과 없음(거의 없음+전혀 없음) 2(6.25) 30(93.75)
잘 모름 1(1.69) 58(98.31)
Table 6.
Toxicity of the types of disease        unit: person(%)
질병치료 유무 p-value
질병명 및 질병치료 없다 있다
고혈압 72(2.09) 0(0.00) 0.2287
관절염 56(1.89) 16(2.85) 0.1438
요통 61(2.33) 11(1.22) 0.0429
당뇨 40(2.07) 0(0.00) 0.4114
중풍 71(2.11) 1(0.63) 0.1936
천식 72(2.06) 0(0.00) 0.5622
화병 68(1.97) 4(5.41) 0.0392
위장장애 64(1.98) 8(2.75) 0.3768
감기 66(1.98) 6(3.37) 0.2003
아토피 71(2.04) 1(3.13) 0.6651
72(2.05) 0(0.00) 0.6471
오십견 66(1.97) 6(3.57) 0.1526
발목 삠 66(2.08) 6(1.72) 0.6490
근육부상 62(2.09) 10(1.83) 0.6993
허리 삠 52(1.71) 20(4.18) 0.0004
골절 69(2.00) 3(4.92) 0.1101
다이어트 70(2.04) 2(2.11) 0.9674
피부미용 71(2.04) 1(2.70) 0.7769
체형교정 70(2.00) 2(10.00) 0.0118
체질개선 68(1.99) 4(4.12) 0.1429
보약 66(1.99) 6(2.97) 0.3396
71(2.02) 1(20.00) 0.0045
교통사고 66(1.95) 6(4.44) 0.0448
Table 7.
Logistic regression on toxicity according to each model
모델 Model 11) Model 22) model 33)
혼란변수 OR(CI) p-value OR(CI) p-value OR(CI) p-value
절편 −4.289 <.0001 −4.060 <.0001 −4.2025 <.0001
성별 남자 ref ref ref
여자 1.396(0.767, 2.542) 0.275 1.327(0.720, 2.446) 0.3643 1.394(0.748, 2.596) 0.2952
연령별 20대 ref ref ref
30대 0.748(0.309, 1.814) 0.5212 0.726(0.298, 1.770) 0.4815 0.754(0.301,1.889) 0.5472
40대 0.891(0.370, 2.142) 0.7963 0.773(0.314, 1.903) 0.5755 0.837(0.333, 2.102) 0.7043
50대 1.416(0.555, 3.610) 0.4663 1.366(0.524, 3.561) 0.5236 1.513(0.569, 4.027) 0.4068
60대 이상 0.542(0.166, 1.774) 0.3115 0.589(0.177, 1.965) 0.3895 0.700(0.206, 2.384) 0.5687
혼인상태 미혼 0.562(0.208, 1.522) 0.2571 0.542(0.198, 1.481) 0.2325 0.592(0.213, 1.645) 0.3149
기혼 ref ref ref
사별 0.814(0.253, 2.619) 0.7295 0.806(0.248, 2.616) 0.7194 0.769(0.231, 2.555) 0.6679
이혼/별거 0.747(0.096, 5.784) 0.7799 0.905(0.116, 7.067) 0.9238 0.900(0.115, 7.062) 0.9199
교육정도 중학교 이하 0.782(0.353, 1.731) 0.5439 0.763(0.338, 1.723) 0.5153 0.822(0.362, 1.867) 0.6395
고등학교 ref ref ref
대졸이상 2.007(1.097, 3.671) 0.0237 1.697(0.904, 3.187) 0.1000 1.624(0.861, 3.061) 0.1340
직업유무 ref ref ref
아니오 1.361(0.796, 2.327) 0.2595 1.286(0.741, 2.230) 0.3715 1.300(0.743, 2.274) 0.3583
건강보험종류 지역가입자 ref ref ref
사업 가입자 0.994(0.598, 1.653) 0.9828 1.058(0.626, 1.786) 0.8337 1.097(0.646, 1.860) 0.7327
의료급여 1.664(0.540, 5.126) 0.3747 2.076(0.665, 6.484) 0.2085 1.833(0.584, 5.754) 0.2991
소득수준 100만원 이하 ref ref ref
101∼200만원 0.743(0.283, 1.948) 0.5455 0.605(0.224, 1.633) 0.3214 0.535(0.195, 1.468) 0.2247
201∼300만원 1.235(0.497, 3.069) 0.6489 1.125(0.451, 2.805) 0.8007 1.026(0.410, 2.570) 0.9559
301 만원 이상 0.935(0.373, 2.346) 0.8860 0.733(0.288, 1.868) 0.5153 0.727(0.284, 1.862) 0.5062
주관적 건강 매우 좋음+좋음 1.319(0.737, 2.359) 0.3510 1.323(0.734, 2.384) 0.3522
보통 ref ref
나쁨+매우 나쁨 1.100(0.592, 2.043) 0.7638 1.097(0.585, 2.057) 0.7729
외래진료횟수 1∼3회 ref ref
4∼5회 1.230(0.632, 2.395) 0.5418 1.212(0.619, 2.374) 0.5745
6∼10회 0.821(0.390, 1.732) 0.6051 0.745(0.344, 1.614) 0.4557
11∼15회 0.547(0.199, 1.506) 0.2429 0.519(0.186, 1.451) 0.2113
16∼20회 1.043(0.393, 2.766) 0.9325 1.008(0.373, 2.722) 0.9877
21회 이상 0.534(0.220, 1.297) 0.1658 0.516(0.211, 1.265) 0.1483
외래진료비 60만원 미만 ref ref
60만원 이상 4.210(2.312, 7.666) <.0001 4.080(2.211, 7.528) <.0001
진료만족도 매우 만족+만족 0.715(0.385, 1.328) 0.288 0.652(0.349, 1.219) 0.1803
보통 ref ref
불만족+매우 불만족 4.621(1.503, 14.204) 0.0075 4.771(1.528, 14.899) 0.0072
잘 모름 0.566(0.071, 4.488) 0.5900 0.543(0.067, 4.432) 0.5690
요통치료 유병(ref : 정상) 0.598(0.304, 1.179) 0.1376
화병치료 유병(ref : 정상) 1.948(0.622, 6.101) 0.2525
암치료 유병(ref : 정상) 2.238(1.266, 3.957) 0.0056
체형교정치료 유병(ref : 정상) 2.776(0.505, 15.275) 0.2405
키치료 유병(ref : 정상) 6.202(0.441, 87.243) 0.1761
교통사고후유증치료 유병(ref : 정상) 2.192(0.884, 5.439) 0.0905

1) Model 1: 인구사회적 특성(성별, 연령, 혼인상태, 교육정도, 직업유무, 건강보험종류, 소득수준)

2) Model 2: Model 1+ 주관적 건강감, 외래진료횟수 외래진료비, 진료만족도

3) Model 3: Model 2 + 허리삠, 화병, 암, 체형교정, 키, 교통사고 후유증

4) CI :신뢰구간 (Confidence Interval)

참고문헌

1.. Wikipedia. Side effect. 2014. Available at: URL:https://en.wikipedia.org/wiki/Side_effect.


2.. U.S. Department Of Health and Human Services, Traditional Chinese Medicine: An Introduction. 2010.


3.. World Health Organization. New WHO guidelines to promete proper use of alternative medicines. 2004.


4.. Ko SG, Jang BE, Choi JS. ADR of Herbal Medicines. Korean Journal of Oriental Physiology & Pathology. 2004; 18:4. 957–964.


5.. Zhou S, Koh HL, Gao Y, Gong ZY, Lee EJD. Herbal bioactivation : The good, the bad and the ugly. Life Science. 2004; 74:935–968.
crossref

6.. Ernst E. Toxic heavy metals and undeclared drugs in Asian herbal medicine. Trends in pharmacological sciences. 2002; 23:3. 136–139.
crossref

7.. Bensoussan A, Myers SP, Drew AK, Whyte IM, Dawson AH. Development of a Chinese herbal medicine toxicology database. Journal of Toxicology and Clinical Toxicology. 2002; 40:2. 159–167.
crossref

8.. Greensfelder L. Alternative medicine. Herbal product linked to cancer. Science. 2000; 288:1946


9.. Haller CA, Benowitz NL. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. NEJM. 2000; 343:1833–1838.
crossref

10.. Kessler DA. Cancer and herbs. NEJM. 2000; 342:1742–1743.
crossref

11.. McRae CA, Agarwal K, Mutimer D, Bassendine MF. Hepatitis associated with Chinese herbs. European Journal of Gastroenterology and Hepatology. 2002; 14:669–562.
crossref

12.. Stedman C. Herbal hepatotoxicity. Seminars in Liver Disease. 2002; 22:2. 195–206.
crossref

13.. Villegas JF, Barabe DN, Stein RA, Lazar E. Adverse effects of herbal treatment of cardiovascular disease: what the physician must know. Heart Disease. 2001; 3:3. 169–175.
crossref

14.. Zaacks SM, Klein L, Tan CD, Rodriguez ER, Leikin JB. Hypersensitivity myocarditis associated with ephedra use. J of Toxico and Clin Toxicol. 1999; 37:4. 485–489.
crossref

15.. Woo YJ, Chung SY, Park BJ. Current Status of Spontaneous Adverse Reactions Reporting System on Herbal Medicine in China, Japan, Korea and WHO. J Int Korean Med. 2014; 35:2. 111–118.


16.. Ministry of Health and Welfares. Usage and Consumption of Korean Medicine. 2011.


17.. Park TS, Lee SY. An introduction to categorical data analysis. Freeaca. 1999.


18.. Yoo TW, Kim BI, Kim JB, Kim DJ, Kim JW, Baik SK, et al. The Survey for the Actual Condition of Drug Medication and Development of Health Care Cost Associated with Toxic Liver Injury in Korean; A Multicenter Study for the Detection and the Development of Nationwide Reporting System of Toxic Liver Injury. The Korean Journal of Hepatology. 2007; 13:1. 34–43.


19.. Seo JC, Jeon WJ, Park SS, Kim SH, Lee KM, Chae HB, et al. Clinical experience of 48 acute toxic hepatitis patients. The Korean Journal of Hepatology. 2006; 12:1. 74–81.


20.. Jang JS, Seo EG, Han C, Chae HB, Kim SJ, Lee JD, et al. Four cases of toxic liver injury associated with dictamnus dasycarpus. The Korean Journal of Hepatology. 2008; 14:1. 206–212.
crossref

21.. Ministry of Health and Welfares. Usage and Consumption of Korean Medicine. 2014.


22.. Korean Institute for Health and Social Affairs. Usage and Consumption of Korean Medicine and Perception in Korea. 2012.


23.. Rolf T, Axel E. Herbal hepatotoxicity i n traditional and modern medicine: actual key issue and new encouraging steps. Frontiers in Pharmacology. 2015; 6:72


24.. Li Z, Jingbo Y, Xinmin L, Zuguang Y, Xiaohui Y. Ronald Meyboom, Kelvin Chan, Debbie Shaw, Pierre Duez, Pharmacovigilance practice and risk control of Traditional Chinese Medicine drugs in China: Current status and future perspective. Journal of Ethnopharmacology. 2012; 140:519–525.
crossref

25.. Choi HJ. The side effects of using herbal medicine with western medicine. Jornal of Korean society of hospital pharmacists. 2003; 20:2. 1–9.


26.. Kim YH, Kim JH. The Benefits of the National Health Insurance and Oriental Medical Services. The Journal of Oriental Medical Preventive. 2007; 11:1. 139–151.


27.. Kim NJ. Expand and development insurance coverage of Korean traditional medicine. Korea Institute of Oriental Medicine. 1996.


28.. Shin YD. Research on the present coverage of health insurance of Korean traditional medicine and its activation Plan. Kyung Hee University. 2000.


29.. Zhu Y, Niu M, Chen J, Zou ZS, Ma ZJ, Liu SH, et al. Specialized Committee for Drung-Induced Liver Disease Chinese Pharmacological Society. Comparison between Chinese herbal medicine and western medicine-induced liver injury of 1985 patients. Journal of Gastroenterology and Hepatology. 2016.


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