Objectives: The present study examined the prevalence and patterns of non-communicable disease multimorbidity by wealth quintile among adults in South Africa. Methods: The South African National Income Dynamics Study Wave 5 was conducted in 2017 to examine the livelihoods of individuals and households. We analysed data in people aged 15 years and older (N = 27,042), including self-reported diagnosis of diabetes, stroke, heart disease and anthropometric measurements. Logistic regression and latent class analysis were used to analyse factors associated with multimorbidity and common disease patterns. Results: Multimorbidity was present in 2.7% of participants. Multimorbidity was associated with increasing age, belonging to the wealthiest quintile group, increasing body mass index and being a current smoker. Having secondary education was protective against multimorbidity. Three disease classes of multimorbidity were identified: Diabetes and Hypertension; Heart Disease and Hypertension; and Stroke and Hypertension. Conclusion: Urgent reforms are required to improve health systems responsiveness to mitigate inequity in multimorbidity patterns in the adult population of South Africa as a result of income inequality.