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Background People with multiple long-term conditions have a greater risk of developing dementia than people without. However, few studies have reported findings by sex or socioeconomic status, despite knowledge that men and women are affected differently by disease and have different life expectancies. This study aimed to determine inequalities in risk of dementia and death in people with multiple long-term conditions.Methods Cox regression and competing risk of death models were used to generate hazard ratios (HRs) for risk of dementia and death by sex and socioeconomic status, using a real-world database of GP health records from Clinical Practice Research Datalink (CPRD).Results Of 846,203 people included in the study, 57% were female. The mean age of acquiring two or more long-term conditions was 3 years earlier in areas of high deprivation compared to areas of low deprivation, and consistently one year earlier for men vs women. People from areas of low deprivation had the highest risk of dementia because those in areas of high deprivation did not live long enough to receive a dementia diagnosis. The most deprived men and women had a 78% (HR=1.78, 95% CI 1.74-1.81) and 67% (HR=1.67, 95% CI 1.63-1.70) greater risk of death respectively compared to their least deprived counterparts.Conclusion People with multiple long-term conditions experience unequal risk for dementia and death depending on sex and area-level deprivation. Those living in greatest deprivation did not live long enough to receive a dementia diagnosis, indicating that prevention measures for life-limiting diseases in these groups need further attention. Analyses which account for the competing risk of death are important in older populations, and in populations with multiple conditions, where death may prevent observation of the outcome of interest.