Centre for Research on Environment, Society and Health (CRESH), School of GeoSciences, University of Edinburgh, UK.
Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK; Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
Soc Sci Med. 2024 Nov;361:117379. doi: 10.1016/j.socscimed.2024.117379. Epub 2024 Oct 1.
Multimorbidity, commonly defined as the co-existence of two or more long-term conditions, is a major global public health challenge with significant impacts for health and social care systems. There is a substantial body of work identifying different individual- and household-level determinants of multimorbidity, yet the role of place-based characteristics in affecting multimorbidity remains limited. This systematic scoping review identifies place-based risk factors for multimorbidity and further synthesises the potential pathways explaining these relationships using longitudinal evidence. By systematically searching seven major databases, such as Medline, Embase, and Web of Science, using relevant search terms (e.g., MeSH) relating to place-based risk factors and multimorbidity, 76 out of 7761 studies were included for evidence synthesis. We include studies exploring the relationship between place-based risk factors and multimorbidity among the general population older than 18 years old in the setting of community-dwelling, primary, and secondary care. We identified 12 types of place-based risk factors, with the impacts of area-level deprivation/SES, pollution, and urban/rurality on multimorbidity being most frequently considered and with the most consistent findings, with people living in more deprived/low SES, highly polluted, or more urbanised areas having increased risks of multimorbidity. Further, the impact of these place-based risk factors on multimorbidity varied according to the operationalisation of the multimorbidity measure. We also identified that the impacts of other types of place-based factors on multimorbidity remain underexplored, such as social cohesion and greenspace. Finally, using these longitudinal findings, we propose a conceptual framework linking place and multimorbidity. We suggest that future studies explore a wider range of place-level environmental exposures and use more precise measures, exploit electronic health records to implement more consistent and reproducible measurements of multimorbidity, moreover, make greater use of longitudinal study designs or analytical approaches better suited to identifying causal processes.
多发病，通常定义为两种或多种长期疾病的共存，是一个重大的全球公共卫生挑战，对卫生和社会保健系统有重大影响。有大量的工作确定了多发病的不同个体和家庭层面的决定因素，但地方特征在影响多发病方面的作用仍然有限。本系统范围综述确定了多发病的基于地点的风险因素，并进一步利用纵向证据综合解释这些关系的潜在途径。通过系统地搜索七个主要数据库，如 Medline、Embase 和 Web of Science，并使用与地方风险因素和多发病相关的相关搜索词（例如 MeSH），从 7761 项研究中筛选出 76 项进行证据综合。我们包括了在社区居住、初级和二级保健中探索 18 岁以上一般人群中基于地点的风险因素与多发病之间关系的研究。我们确定了 12 种基于地点的风险因素，其中区域贫困/社会经济地位、污染和城市/农村化对多发病的影响被认为是最频繁和最一致的，生活在贫困/低社会经济地位、污染程度较高或城市化程度较高地区的人多发病的风险增加。此外，这些基于地点的风险因素对多发病的影响因多发病衡量标准的操作化而有所不同。我们还发现，其他类型的基于地点的因素对多发病的影响仍未得到充分探索，例如社会凝聚力和绿地。最后，我们使用这些纵向发现，提出了一个将地点和多发病联系起来的概念框架。我们建议未来的研究探索更广泛的地方环境暴露，并使用更精确的措施，利用电子健康记录实施更一致和可重复的多发病测量，此外，更多地使用纵向研究设计或更适合识别因果过程的分析方法。
