Shaping Cities, Shaping Health: Unravelling the Urban Built Environment’s Role in Multimorbidity – A systematic Review and Meta-Analysis

Abstract

Introduction: Multimorbidity has become a critical public health challenge in urban areas, affecting nearly 2.5 billion people, with the built environment playing a key role by shaping both living conditions and environmental exposures. While previous studies have examined either single health outcomes related to the built environment or multimorbidity with other exposures, none has comprehensively investigated the built environment's role as a primary exposure to multimorbidity. Therefore, this study aims to assess the impact of urban built environment on multimorbidity, providing not only stronger evidence to support healthier urban development and public health strategies but also valuable insights for the public to mitigate health risks and improve quality of life.
Methods: Following PRISMA guidelines, we conducted a meta-analysis from multiple databases, with independent screening, selection, and extraction by authors. Risk of bias was assessed using the ROBINS-E tool. Subgroup analyses were performed using Review Manager 5.4.1, with statistical significance determined at p-value < 0.05.
Result: Our findings revealed significant overall association between urban built environments and multimorbidity (OR = 1.30, 95% CI [1.17, 1.44], p < 0.00001), demonstrating that cumulative environmental exposures collectively elevate disease risk. Nearest roads emerged as the most consistent risk factor (OR = 1.17, 95% CI [1.03, 1.33], p = 0.01). In contrast, one of the individual factors such as air pollution (OR = 1.09, 95% CI [0.97, 1.22], p = 0.15) showed insignificant associations. High heterogeneity across subgroups (I² > 75%) underscores the context-dependant nature of these relationships, suggesting that built environment effects vary by urban design and population characteristics.
Conclusion: This study shows that urban design affects multimorbidity, with living near roads being the most harmful. Additionally, it validates the exposome concept, revealing how multiple environmental exposures interact to shape health outcomes. Further research is needed to better understand these connections and create effective solutions.