The risk of acute coronary events and out-of-hospital deaths among primary care non-users in Finland
Abstract
Background: Acute coronary events are major contributors to ill health. Primary care (PC) plays a key role in identifying and managing cardiovascular risk. We therefore aimed to examine associations between PC non-usage and acute coronary syndrome (ACS) hospitalisations and out-of-hospital deaths due to coronary heart disease (OOH-CHD deaths) in Finland.
Methods: Cohort study of 2,592,220 individuals aged 40–79 years residing in mainland Finland in 2021–2023 with no prior ACS. National registers provided individual data on primary care usage, hospitalisations, causes of death, income, living arrangements, and place of residence. Outcomes were incident ACS hospitalisations and OOH-CHD deaths in 2024. PC non-usage was based on records from 2021 until experiencing an outcome or end of follow-up. Incidence Rate Ratios (IRRs) were estimated using multilevel Poisson regression models with regional authority as a random effect.
Results: In 2024, we identified 7,365 ACS hospitalisations and 1,452 OOH-CHD deaths, of which 4.0% and 13.5% occurred among 121,499 PC non-users. After adjusting for sociodemographics, ACS incidence in the main model was lower in PC non-users than in users (IRR 0.74, 95%CI 0.66–0.83), whereas OOH-CHD deaths were more frequent among non-users (2.10, 1.80–2.45). For both outcomes IRRs were lower among women, affluent individuals and those cohabiting. Contrasts from age–PC usage interaction models indicated that among those aged 40–49 years, ACS incidence was lower in non-users (0.40, 0.24–0.68), whereas OOH-CHD deaths were significantly more frequent among non-users only at ages 60–69 and 70–79 years (2.02, 1.56–2.60 and 2.26, 1.84–2.77).
Conclusions: Our findings highlight that older adult PC non-users may carry unidentified cardiovascular risks, not apparent in low ACS incidence but reflected in excess out-of-hospital coronary deaths. This emphasises the need to reduce barriers to PC access and develop approaches to reach non-users for risk assessment.
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BibTeX
@article{satokangas2026risk,
title = {{The risk of acute coronary events and out-of-hospital deaths among primary care non-users in Finland}},
author = {M Satokangas},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.283},
url = {https://doi.org/10.1093/eurpub/ckag169.283},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - The risk of acute coronary events and out-of-hospital deaths among primary care non-users in Finland
AU - M Satokangas
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.283
UR - https://doi.org/10.1093/eurpub/ckag169.283
AB - Background: Acute coronary events are major contributors to ill health. Primary care (PC) plays a key role in identifying and managing cardiovascular risk. We therefore aimed to examine associations between PC non-usage and acute coronary syndrome (ACS) hospitalisations and out-of-hospital deaths due to coronary heart disease (OOH-CHD deaths) in Finland. Methods: Cohort study of 2,592,220 individuals aged 40–79 years residing in mainland Finland in 2021–2023 with no prior ACS. National registers provided individual data on primary care usage, hospitalisations, causes of death, income, living arrangements, and place of residence. Outcomes were incident ACS hospitalisations and OOH-CHD deaths in 2024. PC non-usage was based on records from 2021 until experiencing an outcome or end of follow-up. Incidence Rate Ratios (IRRs) were estimated using multilevel Poisson regression models with regional authority as a random effect. Results: In 2024, we identified 7,365 ACS hospitalisations and 1,452 OOH-CHD deaths, of which 4.0% and 13.5% occurred among 121,499 PC non-users. After adjusting for sociodemographics, ACS incidence in the main model was lower in PC non-users than in users (IRR 0.74, 95%CI 0.66–0.83), whereas OOH-CHD deaths were more frequent among non-users (2.10, 1.80–2.45). For both outcomes IRRs were lower among women, affluent individuals and those cohabiting. Contrasts from age–PC usage interaction models indicated that among those aged 40–49 years, ACS incidence was lower in non-users (0.40, 0.24–0.68), whereas OOH-CHD deaths were significantly more frequent among non-users only at ages 60–69 and 70–79 years (2.02, 1.56–2.60 and 2.26, 1.84–2.77). Conclusions: Our findings highlight that older adult PC non-users may carry unidentified cardiovascular risks, not apparent in low ACS incidence but reflected in excess out-of-hospital coronary deaths. This emphasises the need to reduce barriers to PC access and develop approaches to reach non-users for risk assessment.
SN - 1101-1262
SN - 1464-360X
ER -