Evidence mapPaperPMID 42001125Full record

ArticleInternational journal for equity in health2026

The structural roots of multimorbidity: social inequalities, health disparities, and systemic challenges in Southern Spain.

Javier Alvarez-Galvez, Carlos Villalba Del Valle, Helena De Sola Perea, Esther Ortega-Martin

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Article in International journal for equity in health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed
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1 · What the graph read from it

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3 · Its place in the literature

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1 citing paper in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

4 authors.

Javier Alvarez-GalvezComputational Social Science DataLab (CS2 DataLab), University Institute for Sustainable Social Development, University of Cádiz, Jerez de la Frontera, 11405, Spain. javier.alvarezgalvez@uca.es.
Carlos Villalba Del ValleVall d'Hebron University Hospital, Barcelona, Spain.
Helena De Sola PereaDepartment of General Economy (Sociology), Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, 11009, Spain.
Esther Ortega-MartinComputational Social Science DataLab (CS2 DataLab), University Institute for Sustainable Social Development, University of Cádiz, Jerez de la Frontera, 11405, Spain.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMultimorbidity-the co-occurrence of two or more chronic health conditions-has become a major public health challenge in ageing societies. However, most research continues to frame it as a clinical or epidemiological issue, overlooking the role of social determinants and healthcare system dynamics. This study investigates the patterns, experiences, and structural implications of multimorbidity in southern Spain, aiming to uncover how health inequalities shape disease profiles and care experiences in one of the most deprived regions of the country.

methodsWe employed a mixed-methods sequential explanatory design. The quantitative phase was based on a cross-sectional telephone survey of 1,592 individuals aged 50 and over with multimorbidity. Latent Class Analysis (LCA) was used to identify multimorbidity patterns based on 33 chronic conditions. Associations with sociodemographic factors and healthcare utilisation were analysed using chi-square tests. The qualitative phase consisted of 18 semi-structured interviews with healthcare professionals and patients, analysed thematically to explore lived experiences, care trajectories, and institutional barriers.

resultsFive multimorbidity patterns were identified: unspecific, cardiometabolic, musculoskeletal, musculoskeletal-mental, and complex multimorbidity. These patterns showed clear social stratification: complex and musculoskeletal-mental profiles were more prevalent among low-income individuals, women, and residents in deprived areas. Healthcare utilisation also varied across patterns, with higher service use in more complex profiles. Qualitative findings revealed that multimorbidity was experienced as a cycle of physical decline, emotional vulnerability, and systemic neglect. Patients faced difficulties in treatment adherence, experienced long waiting times, and often relied on informal caregiving, predominantly by women. Healthcare professionals highlighted systemic fragmentation, lack of coordination, and the inadequacy of clinical guidelines for complex cases.

conclusionsMultimorbidity in this context is not merely a clinical challenge but a socially embedded condition shaped by structural inequality and institutional failures. Health systems must move beyond single-disease logic and adopt integrated, equity-oriented models of care that consider the syndemic nature of multimorbidity. This study highlights the need to incorporate social determinants into chronic care strategies and to prioritise the lived experiences of patients and caregivers in future health policy and planning.

Indexed as

Chronic DiseaseMultimorbiditySocial Determinants of HealthSocioeconomic Disparities in HealthAgedCross-Sectional StudiesFemaleHumansLow Socioeconomic StatusMaleMiddle AgedPatient Acceptance of Health CareSpainChronic disease managementHealthcare utilisationMixed-methodsMultimorbidity

Identifiers

PMID42001125
PMCPMC13235128

What Socratic holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.