User:Adam Harangozó (NIHR WiR)/sandbox/mltc

Health inequalities
The likelihood of having multiple long-term conditions is increased by socioeconomic inequalities. Certain groups of disadvantaged or discriminated people are more likely to struggle with earlier and more severe multimorbidity. Multimorbidity is also associated with factors that are related to socioeconomic disadvantage such as food insecurity, low level of education, living in deprived areas and having unhealthy lifestyles.

There are multiple theories on how socioeconomic inequality leads to multimorbidity but so far there is a lack of scientific evidence about the exact mechanism. Some of the potential links between the two are health-related behaviours (smoking, drinking, diet), lack of access to financial resources and housing, and the psychological response to living in difficult circumstances. Knowing the exact pathway would allow designing effective interventions that prevent or mitigate inequalities in multimorbidity.

Deprivation and poverty
Living in poverty or deprived areas is associated with higher rates of multimorbidity. Those with the lowest income have a 4 times higher chance of having multiple long-term conditions than those with the highest income. Self-management is vital in coping with multimorbidity but people living in deprivation struggle more with managing their conditions. Self-management becomes more challenging due to financial barriers, health literacy (difficulties with understanding health information) and the combined weight of multimorbidity and deprivation.

Research shows that in Scotland residents of deprived areas are affected by multiple long-term conditions 10 to 15 years earlier than people living in affluent neighborhoods. They also have a higher chance that their long-term conditions include mental health disorders. In England, according to research, people from deprived neighborhoods had complex multimorbidity (3 or more conditions) 7 years earlier than the least deprived. People living in deprived areas also have a higher risk of dying because of multimorbidity.

Ethnicity and sexual orientation
Ethnic inequalities also affect who acquires multimorbidity. In the United Kingdom, Indian, Pakistani, Bangladeshi, Black African, Black Caribbean people and those who identify as Black other, other Asian, and mixed ethnicity have a higher risk of developing multiple long-term conditions. In England, people from Pakistani and Bangladeshi backgrounds have the highest multimorbidity rates and they are twice as likely than people from the Chinese minority to have multimorbidity. Pakistani, Black African, Black Caribbean and other black ethnic groups in England are also significantly more likely to die due to having multiple long-term conditions.

Belonging to a sexual minority also means being disproportionately affected by multimorbidity, especially mental health conditions.

Mental health
According to data from the United Kingdom, people with severe mental illness are also more likely to have other, physical long-term conditions as well. Many of them have 15-20 years shorter lives compared to the general population partly because to their physical long-term conditions are not treated properly. Depression and multimorbidity are also often linked, with either causing and reinforcing the other.