Household and area-level social determinants of multimorbidity: a systematic review

Elizabeth Ingram, Sarah Ledden, Sarah Beardon, Manuel Gomes, Sue Hogarth, Helen Mcdonald, David P. Osborn, Jessica Sheringham

Research output: Contribution to journalReview articlepeer-review

39 Citations (SciVal)


Background No clear synthesis of evidence examining household and area-level social determinants of multimorbidity exists. This study aimed to systematically review the existing literature on associations between household and area-level social determinants of health (SDoH) and multimorbidity prevalence or incidence in the general population. Methods Six databases (MedLine, EMBASE, PsychINFO, Web of Science, CINAHL Plus and Scopus) were searched. The search was limited to peer-reviewed studies conducted in high-income countries and published in English between 2010 and 2019. A second reviewer screened all titles with abstracts and a subset of full texts. Study quality was assessed and protocol pre-registered (CRD42019135281). Results 41 studies spanning North America, Europe and Australasia were included. Household income and area-level deprivation were the most explored with fairly consistent findings. The odds of multimorbidity were up to 4.4 times higher for participants with the lowest level of income compared with the highest level. Those living in the most deprived areas had the highest prevalence or incidence of multimorbidity (pooled OR 1.42, 95% CI 1.41 to 1.42). Associations between deprivation and multimorbidity differed by age and multimorbidity type. Findings from the few studies investigating household tenure, household composition and area-level rurality were mixed and contradictory; homeownership and rurality were associated with increased and decreased multimorbidity, while living alone was found to be associated with a higher risk of multimorbidity and not associated. Conclusion Improving our understanding of broader social determinants of multimorbidity -particularly at the household level -could help inform strategies to tackle multimorbidity.

Original languageEnglish
Pages (from-to)232-241
Number of pages10
JournalJournal of Epidemiology and Community Health
Issue number3
Early online date6 Nov 2020
Publication statusPublished - 10 Feb 2021
Externally publishedYes

Bibliographical note

Funding Information:
This study is independent research funded by the National Institute for Health Research School for Public Health Research (Grant Reference Number PD-SPH -2015-10025) and the National Institute for Health Research Applied Research Collaboration (ARC) North Thames. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care.


  • Deprivation
  • Epidemiology of chronic non communicablenon-communicable diseases
  • Health inequalities
  • Public health
  • Social inequalities

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health


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