Finding health in a disadvantaged place: Ethnic differences in multimorbidity by neighbourhood deprivation in England and Wales

This paper brings together research on ethnic inequalities in multimorbidity and differences in multimorbidity by neighbourhood deprivation to ask whether minority ethnic populations in England and Wales face health inequality when living in deprived neighbourhoods. We use four waves of Understanding Society data collected between 2018 and 2023 to identify the presence of two or more chronic conditions (i.e. multimorbidity). An ethnic group-specific neighbourhood deprivation index (EGDI) is linked to individual respondents for 93,568 person waves. Adjusted logistic regression models show that the Bangladeshi and Pakistani minority ethnic groups have 25 % lower probabilities of multimorbidity compared with the White British group. Underdiagnosis of conditions might explain some of this difference in the Bangladeshi group. The relationship between multimorbidity and neighbourhood deprivation was strongest for the health domain of EGDI. For the summary EGDI score, those living in the most deprived neighbourhoods are 1.4 times more likely to report multimorbidity compared with those living elsewhere. South Asian minority ethnic groups appear to be insulated, by 10 percentage points, from these negative neighbourhood effects, relative to the White British majority. These findings are largely consistent for all cause multimorbidity and physical only multimorbidity and an alternative neighbourhood deprivation measurement for all people (i.e. not ethnic-group specific). Our findings suggest that a holistic approach to population health, bringing together medical specialisms and broad public health policy, is required to improve diagnosis of chronic conditions across ethnic groups and to reduce the negative effects of the health context for all.