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Primary health care utilisation and its costs among middle-aged smokers

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To study and compare the utilisation of primary health care services among 46-year-old current smokers, ex-smokers and never-smokers, and to estimate the corresponding costs.


This population-based cohort study is based on the Northern Finland Birth Cohort 1966, which is a longitudinal research program in Finland’s two northernmost provinces. The study is based on data collected at the 46-year follow-up, during which a total of 4997 individuals completed questionnaires on their primary health care service utilisation. Primary health care covered visits to both occupational and public health care (typically community health centres).


Current smokers visited primary health care professionals more often per year than never-smokers, regardless of gender (RR 1.24, 95 % confidence interval 1.10–1.43 for men; RR 1.10, 1.01–1.22 for women). When primary health care services were categorised based on the type of service provided, current smokers of both genders were more likely to visit a dentist (RR 1.56, 1.32–1.84 for men; RR 1.34, 1.15–1.55 for women) or a physician (RR 1.20, 1. 03–1.40 for men; RR 1.15, 1.02–1.30 for women) than their never-smoking counterparts (BMI adjusted for). For men, the total annual costs of primary health care visits were 28 % higher for current smokers versus never-smokers (P < 0.001). For women, the difference was 21 % (P < 0.01).


Smokers visit primary health care professionals more often already at the age of 46, before the expected diagnosis of fatal smoking-related illnesses. This phenomenon not only predicts an elevated incidence of serious illnesses in later life (such as cardiovascular disease), but also causes an economic burden on the health care system.

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We would like to acknowledge Juha Laine, adjunct professor in Health Economics at the University of Eastern Finland, for his valuable advice in preparing the manuscript.

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Correspondence to Jaana Keto.

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Hanna Ventola works for a medical agency that provides consultation to several pharmaceutical companies, including Pfizer Oy Finland. Jaana Keto works for a medical agency that provides consultation to several pharmaceutical companies, including Pfizer Oy Finland. Tero Ylisaukko-oja is the CEO of a medical agency (MedEngine Oy). Tero Ylisaukko-oja has also worked as a consultant for Pfizer Oy Finland, Oy Bristol-Myers Squibb (Finland) Ab, Otsuka Pharmaceutical Scandinavia AB, Takeda Oy, and Teva Finland Oy. Markku Timonen has been reimbursed by Oy Bristol-Myers Squibb (Finland) Ab, H. Lundbeck A/S, Pfizer Oy Finland, and Servier Finland Oy for attending four conferences; has been reimbursed by Astra Zeneca, Oy Bristol-Myers Squibb (Finland) Ab, Eli Lilly, Pfizer Oy, and Servier Finland Oy for speaking on different educational occasions; has received advisory board fees from H. Lundbeck A/S and Pfizer Oy Finland for four meetings; and is a minor shareholder in Valkee Ltd. Kari Linden is an employee of Pfizer Oy Finland. Juha Auvinen: no disclosures. Sirkka Keinänen-Kiukaanniemi: no disclosures. Jari Jokelainen: no disclosures.


This study was sponsored by Pfizer Oy Finland. The Northern Finland Birth Cohort 1966 received financial support from the Academy of Finland, University Hospital Oulu, University of Oulu, Finland, ERDF European Regional Development Fund—Well-being and health: Research in the Northern Finland Birth Cohort 1966 (Grant no. 539/2010 A31592, 01.01.2011-31.12.2013).

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Keto, J., Ventola, H., Jokelainen, J. et al. Primary health care utilisation and its costs among middle-aged smokers. Eur J Health Econ 18, 351–360 (2017).

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