Neighbourhood social gifting and multiple long-term conditions: a nationally representative analysis of the Scottish population aged 40-75 years

Little is known regarding the relationship between the local social environment and multiple long-term conditions (MLTC, also referred to as multimorbidity). We investigated the association between social gifting, the neighbourhood-level latent willingness to gift time for community reciprocity, and four measures of MLTC presence ('2+ long-term conditions (LTCs)', mental-physical MLTC, '3+ LTCs' and complex MLTC). We further explored variations in these relationships across types of urban-rural settlement. We linked participants of the Scottish Longitudinal Study who participated in Census 2011, aged 40-75, with no MLTC before 2010 (n = 98 296), to their hospitalisation records (2010-19) and an established neighbourhood-level index reflecting social gifting. Two-level logistic regression was used to model the onset of MLTC (2010-19), accounting for the clustered data structure of individuals nested within neighbourhoods. Lower social gifting was associated with increased odds of MLTC in all measures, except for '2+ LTCs', with the strongest association observed for mental-physical MLTC. There was a statistically significant interaction between social gifting and types of urban-rural settlement for mental-physical MLTC but not for other measures of MLTC, suggesting that social gifting was more strongly associated with mental-physical MLTC in urban than other areas. The findings highlight the important role of the local social environment in the development of MLTC. Policies targeted at supporting neighbourhood-level social cohesion and social participation may benefit population health, particularly for mental-physical MLTC in urban areas where observed associations were strongest.