{
  "abstract": "Background: Evidence is limited on whether features of the built and natural environment are associated with multimorbidity (≥ 2 long-term conditions). Improved understanding of these could inform prevention strategies.\n\nMethods: This systematic review and meta-analysis examined the evidence of built and natural environment associations with multimorbidity prevalence and incidence (PROSPERO CRD 42024621458). Four databases were searched from inception to October 2024. Eligible studies analysed a built or natural environment exposure, multimorbidity prevalence or incidence, and were conducted in community-dwelling adults. Reference screening, data extraction, and risk-of-bias (RoB) assessment were conducted independently. Vote counting was used to synthesise association directions and standardised air pollution estimates were summarised in forest plots, with pooled estimates calculated for exposure-outcome combinations reported in ≥ 3 studies.\n\nResults: Twenty-two studies (78 associations) were included that analysed 31 built or natural environment exposures. Studies measured air pollution (12 studies/58 associations), features that support active travel (6 studies/8 associations), green space/park availability (5 studies/5 associations), food environment features (2 studies/2 associations), and ‘other features’ (5 studies/5 associations). Pooled estimates found that multimorbidity prevalence was associated with 10 µg/m3 increase in PM2.5 (OR 1.22, 95% CI 0.99, 1.51), but there was less support for the association of PM2.5 with multimorbidity incidence (HR 1.68, 95% CI 0.78, 3.62). Study heterogeneity was substantial and most associations were at high/very high RoB. Findings for built and natural environment features other than air pollution were mixed.\n\nConclusions: There was consistent evidence on the associations between air pollution and multimorbidity prevalence, but evidence on other built and natural environment exposures and multimorbidity incidence is lacking.\n\nKey messages: • There is consistent evidence that air pollutants are associated with multimorbidity prevalence.\n\n• There is a lack of evidence about the association of other built and natural environment exposures with multimorbidity.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "abstract",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "name": "A L Carr"
    },
    {
      "name": "P Broadbent"
    },
    {
      "name": "J R Olsen"
    },
    {
      "name": "V Wells"
    },
    {
      "name": "F S Mair"
    },
    {
      "name": "F K Ho"
    },
    {
      "name": "B D Jani"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/28kxbrrcvbh01.bib",
  "cited_by": 0,
  "doi": "10.1093/eurpub/ckag169.1071",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13697548/",
  "id": "28kxbrrcvbh01",
  "issns": [
    "1101-1262",
    "1464-360X"
  ],
  "landing_url": "https://doi.org/10.1093/eurpub/ckag169.1071",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "6. Poster Displays"
    ],
    [
      "heading",
      "AcademicSubjects/MED00860"
    ],
    [
      "heading",
      "AcademicSubjects/SOC01210"
    ],
    [
      "heading",
      "AcademicSubjects/SOC02610"
    ],
    [
      "heading",
      "DB. Chronic diseases, multimorbidity and non-communicable diseases"
    ],
    [
      "openalex",
      "2713|Chronic Disease Management Strategies"
    ]
  ],
  "openalex": "W7223665988",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13697548/pdf/?tool=EBI",
  "pmcid": "PMC13697548",
  "pmid": null,
  "published": "2026-10-01",
  "publisher": "Oxford University Press",
  "ris": "https://research.draconitic.com/paper/28kxbrrcvbh01.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:35Z",
      "native_id": "PMC13697548",
      "source": "pmc",
      "url": "https://doi.org/10.1093/eurpub/ckag169.1071"
    },
    {
      "first_seen": "2026-10-30T12:21:45Z",
      "native_id": "PMC:PMC13697548",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13697548"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Chronic Disease Management Strategies",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "The association of built and natural environment features with multimorbidity: a systematic review",
  "title_text": "The association of built and natural environment features with multimorbidity: a systematic review",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:34:34Z",
  "url": "https://research.draconitic.com/paper/28kxbrrcvbh01",
  "venue": "The European Journal of Public Health",
  "versions": []
}