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.