Sociodemographic intersections and risk of multiple long-term conditions: A systematic review

by Mansuk Daniel Han, Thomas Yates, Kamlesh Khunti, Cameron Razieh, Francesco Zaccardi

Multimorbidity, or multiple long-term conditions (MLTC), is a growing public health concern with implications for quality of life, healthcare utilisation, and premature mortality. Classical explanations for MLTC often treat sociodemographic categories as independent predictors, overlooking the relational dynamics of health inequalities. This systematic review examines how MLTC outcomes vary at the intersections of sociodemographic factors within their relational context. We conducted a systematic search of PubMed, Medline, and Scopus to identify 792 studies. Four studies met inclusion criteria but none were longitudinal, which limits our ability to examine the role of intersectional effects on MLTC outcomes over the life course from this review. A narrative synthesis was conducted due to their wide heterogeneity among the MLTC outcomes of the studies included in this review. The limited evidence may potentially suggest that MLTC outcomes can vary considerably at the intersections of sociodemographic factors. All four studies in this review suggested that the association of income with MLTC outcomes can vary by what other sociodemographic factors it intersects with. The role of disability on MLTC outcomes varied when intersected with ethnicity, at least in the US racial context. A low level of education is a known MLTC risk factor, but when intersected with ethnicity for both men and women in the South African setting, definitive cumulative disadvantages were not found in the projected life expectancy. Future intersectionality-informed quantitative MLTC research should prioritise using longitudinal data and solution-linked variables to inform context-responsive interventions.