The association of built and natural environment features with multimorbidity: a systematic review
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.
Methods: 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.
Results: 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.
Conclusions: 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.
Key messages: • There is consistent evidence that air pollutants are associated with multimorbidity prevalence.
• There is a lack of evidence about the association of other built and natural environment exposures with multimorbidity.
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BibTeX
@article{carr2026association,
title = {{The association of built and natural environment features with multimorbidity: a systematic review}},
author = {A L Carr and P Broadbent and J R Olsen and V Wells and F S Mair and F K Ho and B D Jani},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1071},
url = {https://doi.org/10.1093/eurpub/ckag169.1071},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - The association of built and natural environment features with multimorbidity: a systematic review
AU - A L Carr
AU - P Broadbent
AU - J R Olsen
AU - V Wells
AU - F S Mair
AU - F K Ho
AU - B D Jani
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1071
UR - https://doi.org/10.1093/eurpub/ckag169.1071
AB - 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. Methods: 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. Results: 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. Conclusions: 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. Key messages: • There is consistent evidence that air pollutants are associated with multimorbidity prevalence. • There is a lack of evidence about the association of other built and natural environment exposures with multimorbidity.
SN - 1101-1262
SN - 1464-360X
ER -