title: Primary health care utilisation and its costs among middle-aged smokers.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Medical Faculty, Center for Life Course Health Research, University of Oulu, PO Box 5000, 90014, Oulu, Finland. jaana.keto@helsinki.fi.
authors.forename: Jaana
authors.initials: J
authors.lastname: Keto
authors.affiliation: Department of Pharmacology, Institute of Biomedicine, University of Helsinki, Haartmaninkatu 8, 00014, Helsinki, Finland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Ventola
authors.affiliation: Medical Faculty, Center for Life Course Health Research, University of Oulu, PO Box 5000, 90014, Oulu, Finland.
authors.forename: Jari
authors.initials: J
authors.lastname: Jokelainen
authors.affiliation: Medical Faculty, Center for Life Course Health Research, University of Oulu, PO Box 5000, 90014, Oulu, Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Timonen
authors.affiliation: Pfizer Oy, Tietokuja 4, 00330, Helsinki, Finland.
authors.forename: Kari
authors.initials: K
authors.lastname: Linden
authors.affiliation: Medical Faculty, Center for Life Course Health Research, University of Oulu, PO Box 5000, 90014, Oulu, Finland.
authors.forename: Tero
authors.initials: T
authors.lastname: Ylisaukko-Oja
authors.affiliation: Medical Faculty, Center for Life Course Health Research, University of Oulu, PO Box 5000, 90014, Oulu, Finland.
authors.forename: Sirkka
authors.initials: S
authors.lastname: Keinänen-Kiukaanniemi
authors.affiliation: Medical Faculty, Center for Life Course Health Research, University of Oulu, PO Box 5000, 90014, Oulu, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Auvinen
mesh_terms: D000367:Age Factors; D003729:Dental Care / Q000706:statistics & numerical data; D005260:Female; D005387:Finland / Q000453:epidemiology; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data*; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology*; D012959:Socioeconomic Factors
keywords: Costs of smoking; Ex-smokers; Primary health care service utilisation; Smoking; Visits to primary health care professionals