Abstract
Introduction: Multimorbidity poses a current global health challenge due to its increasing prevalence and burden on individuals and health systems. Evidence suggests that more socially disadvantaged individuals share a disproportionate burden of multimorbidity. The evidence on the relationship between area-level socioeconomic disadvantage and multimorbidity is unclear. Thus, the aim of the current study is to synthesise evidence on the association between area-level socio-economic disadvantage and multimorbidity. Methods: A systematic review was conducted of published literature from inception to January 2020. Search strategy was applied to identify evidence on PubMed (Medline), Ovid (Medline, Embase, Psycinfo) and Web of Science. Studies were selected according to the inclusion and exclusion criteria. Newcastle Ottawa Scale for observational studies was used for quality assessment of included studies. Evidence was synthesised narratively. Results: We identified eight out of 2588 studies identified in the search as per the inclusion and exclusion criteria. Out of the eight studies, five studies confirmed a positive association between area-level socio-economic disadvantage and multimorbidity, two studies presented a negative association, and one study presented no association. Three studies found individuals in deprived areas to have higher multimorbidity than those in affluent areas. Two studies established that individuals in rural areas had higher multimorbidity than their urban counterparts. Two studies found individuals in urban areas to have a higher multimorbidity than those in rural areas. Conclusion: Evidence shows that association between area-level socioeconomic disadvantage and multimorbidity exist. Except for area of residence, clear positive associations were confirmed between area deprivation and multimorbidity.
 
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Highlights
Multimorbidity, defined as the existence of two or more chronic conditions in an individual at the same time [1,2,3,4,5], is a current global challenge on the health care systems and a public health concern [3, 6, 7]
We identified few studies that examined the relationship between area-level socioeconomic disadvantage and multimorbidity
We have found that an association between area-level socioeconomic disadvantage and multimorbidity exists
Summary
Multimorbidity, defined as the existence of two or more chronic conditions in an individual at the same time [1,2,3,4,5], is a current global challenge on the health care systems and a public health concern [3, 6, 7]. The argument is based on multimorbidity as earlier defined with a focus on the individual as a whole in relation to primary health care. Among them includes medical care and technologies for early detection and treatment of conditions improved, life expectancy. These have resulted in an increasing size in the ageing population who contributes the greatest proportion of multimorbidity [3]. Outcomes of multimorbidity leads to complex health needs accounting for an increase in the proportion of health care workload and expenditure, burdening health systems [10, 11]
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