{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T04:04:18Z","timestamp":1790049858527,"version":"4.0.1"},"update-to":[{"DOI":"10.12688\/wellcomeopenres.25227.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000}}],"reference-count":40,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Medical Research Council","award":["MC_UU_00022\/2"],"award-info":[{"award-number":["MC_UU_00022\/2"]}],"id":[{"id":"https:\/\/ror.org\/05gd75v11","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Wellcome funding","award":["316728\/Z\/24\/Z"],"award-info":[{"award-number":["316728\/Z\/24\/Z"]}]},{"name":"the European Research Council","award":["949582"],"award-info":[{"award-number":["949582"]}],"id":[{"id":"https:\/\/ror.org\/0472cxd90","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["wellcomeopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Wellcome Open Res"],"abstract":"<ns3:p>Background Multiple long-term conditions (MLTC) or multimorbidity is increasing among populations worldwide in the last decades. Less is known about the prevalence, incidence, socio-demographic patterning and combinations of long-term conditions among different ethnic groups globally. This systematic review protocol plans to review the current literature to understand the incidence, patterns, prevalence, and impact of MLTC in different ethnic populations. Methods This systematic review will include quantitative studies (cohort studies, cross-sectional, case-control, and baseline data from Randomised Control Trials) reporting on MLTC among adults across different ethnic groups in all settings (primary care, community or hospital). The following databases will be searched: Ovid MEDLINE, EMBASE, PsycINFO, CINAHL, ASSIA and COCHRANE CENTRAL using a combination of search terms including MLTC or multimorbidity and ethnicity. The exposure of interest is ethnicity, and included studies will report on at least one of these outcomes by ethnicity or a proxy of it: 1. prevalence and incidence of MLTC; 2. MLTC types (combinations or patterns of conditions including physical-only, mental and physical and complex multimorbidity, which is three or more (3+) chronic conditions across 3+ body system), and 3. health related outcomes (healthcare utilisation and mortality). Two reviewers will screen potential articles by titles\/abstracts and full texts independently. A synthesis without meta-analysis approach to comprehensively summarise the key attributes and findings reported from each included study will be employed initially. Meta-analysis will be conducted where data allow, to estimate the risk of MLTC in minority ethnic groups vs majority ethnicity. Discussion Some studies suggest people from ethnic minority backgrounds have a greater burden of MLTC, yet they are usually underserved in health research. Synthesising primary studies that focus on MLTC and ethnicity in this review will provide a global overview of prevalence or incidence data and their reported health outcomes among diverse ethnic populations.<\/ns3:p>","DOI":"10.12688\/wellcomeopenres.25227.2","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T08:34:07Z","timestamp":1786955647000},"page":"215","update-policy":"https:\/\/doi.org\/10.12688\/wellcomeopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Ethnic differences in the patterns, incidence and prevalence of multiple long-term conditions: a systematic review protocol."],"prefix":"10.12688","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6269-6600","authenticated-orcid":false,"given":"Irene F.","family":"Bossman","sequence":"first","affiliation":[{"name":"General Practice and Primary Care Glasgow Scotland University of Glasgow School of Health and Wellbeing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5639-0130","authenticated-orcid":false,"given":"Barbara I.","family":"Nicholl","sequence":"additional","affiliation":[{"name":"General Practice and Primary Care Glasgow Scotland University of Glasgow School of Health and Wellbeing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6593-9092","authenticated-orcid":false,"given":"Srinivasa Vittal","family":"Katikireddi","sequence":"additional","affiliation":[{"name":"Health Economics & Health Technology Assessment Glasgow Scotland University of Glasgow School of Health and Wellbeing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Browne","sequence":"additional","affiliation":[{"name":"General Practice and Primary Care Glasgow Scotland University of Glasgow School of Health and Wellbeing"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie","family":"Wells","sequence":"additional","affiliation":[{"name":"Glasgow Scotland University of Glasgow MRC\/CSO Social and Public Health Sciences Unit"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine A","family":"O'Donnell","sequence":"additional","affiliation":[{"name":"General Practice and Primary Care Glasgow Scotland University of Glasgow School of Health and Wellbeing"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"53-68","DOI":"10.1016\/j.arr.2017.05.003","article-title":"Evidence on multimorbidity from definition to intervention: an overview of systematic reviews.","volume":"37","author":"X Xu","year":"2017","journal-title":"Ageing Res Rev."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"374-380","DOI":"10.1093\/ageing\/afx201","article-title":"Projections of multi-morbidity in the older population in England to 2035: estimates from the Population Ageing and Care Simulation (PACSim) model.","volume":"47","author":"A Kingston","year":"2018","journal-title":"Age Ageing."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"37-43","DOI":"10.1016\/S0140-6736(12)60240-2","article-title":"Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.","volume":"380","author":"K Barnett","year":"2012","journal-title":"Lancet."},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1004300","article-title":"Ethnic differences in early onset multimorbidity and associations with health service use, long-term prescribing, years of life lost, and mortality: a cross-sectional study using clustering in the UK Clinical Practice Research Datalink.","volume":"20","author":"F Eto","year":"2023","journal-title":"PLoS Med."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"182-189","DOI":"10.1093\/eurpub\/cky098","article-title":"Defining and measuring multimorbidity: a systematic review of systematic reviews.","volume":"29","author":"M Johnston","year":"2019","journal-title":"Eur J Public Health."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"353","DOI":"10.3390\/ijerph19010353","article-title":"Multimorbidity in the elderly: a systematic bibliometric analysis of research output.","volume":"19","author":"X Zhou","year":"2021","journal-title":"Int J Environ Res Public Health."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1025-1053","DOI":"10.1007\/s10654-019-00568-5","article-title":"Do replicable profiles of multimorbidity exist? 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regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis.","volume":"57","author":"S Chowdhury","year":"2023","journal-title":"EClinicalMedicine."},{"key":"ref32","first-page":"1-12","article-title":"The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.","volume":"2","author":"J Peterson","year":"2011"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1111\/jre.13405","article-title":"Risk of Bias evaluation of cross-sectional studies: adaptation of the Newcastle-Ottawa Scale.","author":"M Carra","year":"2025","journal-title":"J Periodontal Res."},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l6890","article-title":"Synthesis Without Meta-analysis (SWiM) in systematic reviews: reporting guideline.","volume":"368","author":"M Campbell","year":"2020","journal-title":"BMJ."},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d4002","article-title":"Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials.","volume":"343","author":"J Sterne","year":"2011","journal-title":"BMJ."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"629-634","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test.","volume":"315","author":"M Egger","year":"1997","journal-title":"BMJ."},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.1016\/j.cegh.2023.101484","article-title":"Introduction to the GRADE tool for rating certainty in evidence and recommendations.","volume":"25","author":"M Prasad","year":"2024","journal-title":"Clin Epidemiol Glob Health."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"302-317","DOI":"10.1177\/01410768241233109","article-title":"Reporting and 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status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/wellcomeopenres.30289.r164699, Atul Anand, University of Edinburgh\/BHF Centre for Cardiovascular Science, Edinburgh, 25 Aug 2026, version 2, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/11-215\/v2#referee-response-164699","order":0,"name":"referee-response-164699","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.30289.r166850, Rachel Cooper, Newcastle University, Newcastle upon Tyne, England, 17 Sep 2026, version 2, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/11-215\/v2#referee-response-166850","order":1,"name":"referee-response-166850","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.30289.r165745, Fabiola Eto, Queen Mary University of London, London, England, 22 Sep 2026, version 2, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/11-215\/v2#referee-response-165745","order":2,"name":"referee-response-165745","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"IB is a fellow on the Multimorbidity PhD programme for Health Professionals, which is supported by the Wellcome Trust (223499\/Z\/21\/Z). SVK also acknowledges funding from the Medical Research Council (MC_UU_00022\/2), the Scottish Government Chief Scientist Office (SPHSU17) and the European Research Council (949582). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}