How characteristics of place affect multimorbidity: a systematic scoping review

Abstract Background Multimorbidity has become a global public health challenge. Increasing work has identified different individual- and household-level determinants of multimorbidity; however, our understanding of how characteristics of place affect multimorbidity remains limited. This scoping review aims to identify the place-based risk factors of multimorbidity and to synthesis evidence (longitudinal in particular) on how place-based risk factors affect multimorbidity. Methods Following PRISMA-ScR guidelines, a predefined search strategy (https://osf.io/bf84m) was run across 7 major databases in 2023, with a double screening and data extraction process. English-language peer-reviewed studies exploring the relationship between place-based characteristics (from neighbourhood to region) and multimorbidity among the general population aged over 18 years old were included from 2010 to 2023. Results Out of 7761 records, 129 underwent full-text review, resulting in 76 included studies (15 longitudinal). We identified 12 types of place-based risk factors of multimorbidity, with area-level deprivation/SES, pollution, and urban/rurality most frequently examined. Fairly consistent findings suggested that people in more deprived, polluted, or urbanised areas were more likely to be multimorbid, which may further vary by multimorbidity definitions/measurements. Other place-based risk factors, such as social cohesion and greenspace availability, were linked to different single health conditions, but their associations with multimorbidity were underexplored. Finally, we proposed a potential theoretical framework that links place and multimorbidity through multiple pathways based on the synthesised evidence. Conclusions There remains only a partial understanding of how ‘place’ affects multimorbidity. Future studies should employ more precise measures for both place-based risk factors and multimorbidity and use longitudinal designs and analytical approaches for more causal insights. Key messages • This is the first scoping review that proposed a theoretical framework that demonstrates the links between place and multimorbidity. • This study will greatly benefit local policymaking and public health intervention initiation.