Neighbourhood social cohesion, loneliness and multimorbidity: Evidence from a UK longitudinal panel study

Laurence Rowley-Abel; Chunyu Zhang; Kimberly More; Eleojo Abubakar; Chris Dibben; Jamie R. Pearce; Alan Marshall

doi:10.1016/j.healthplace.2025.103414

Neighbourhood social cohesion, loneliness and multimorbidity: Evidence from a UK longitudinal panel study

Laurence Rowley-Abel, Chunyu Zhang, Kimberly More, Eleojo Abubakar, Chris Dibben, Jamie R. Pearce, Alan Marshall

University of Edinburgh

Research output: Contribution to journal › Article › peer-review

Abstract

In the context of population ageing, multimorbidity is an increasingly prevalent public health issue that has a substantial impact on both individuals and healthcare systems. Alongside the literature looking at risk factors at the individual level, there is a growing body of research examining the role of neighbourhoods in the development of multimorbidity. However, most of this work has focused on physical features of place such as air pollution and green space, while social features of place have been largely overlooked. In this study, we therefore explored neighbourhood cohesion as a social neighbourhood characteristic that could influence multimorbidity risk. Additionally, we analysed how loneliness may help to explain any relationship between neighbourhood cohesion and multimorbidity, given the emergence of loneliness as an important risk factor for multimorbidity in individual-level studies. Using Understanding Society, a UK household longitudinal panel study of approximately 40,000 households, we conducted both multilevel cross-sectional and longitudinal analyses to model these relationships. We found that there is a substantial association between greater neighbourhood cohesion and lower multimorbidity risk (odds ratio (OR) for second most cohesive quintile versus least cohesive quintile = 0.75, p < .01), even after controlling for a wide range of socio-economic factors, health behaviours and physical features of place. This cross-sectional result was confirmed by longitudinal analysis of individuals with no health conditions at baseline who moved between neighbourhoods over a nine-year follow-up period. Movers who experienced a decrease in cohesion had greater odds of becoming multimorbid compared to movers who did not experience a decrease in cohesion (OR = 1.68, p = .057). Controlling for loneliness substantially attenuates the odds ratios for neighbourhood cohesion, and in a mediation analysis we found a significant indirect effect of neighbourhood cohesion on multimorbidity risk acting through loneliness, suggesting it is a plausible mechanism through which the social environment influences the development of multiple long-term health conditions.

Original language	English
Article number	103414
Journal	Health & Place
Volume	91
Early online date	17 Jan 2025
DOIs	https://doi.org/10.1016/j.healthplace.2025.103414
Publication status	Published - 31 Jan 2025

Data Availability Statement

The code to reproduce all analysis is available in the following GitHub repository: www.github.com/lrowleyabel/Neighbourhood-Cohesion-and-Multimorbidity. Understanding Society data is available to researchers through the UK Data Service. The relevant studies are Study Number 6614 and Study Number 7248. All other data is publicly available.

Funding

This project was funded by the National Institute for Health Research (NIHR) Artificial Intelligence and Multimorbidity: Clustering in Individuals, Space and Clinical Context (AIM-CISC) grant NIHR202639. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. This research was funded by the Legal & General Group (research grant to establish the independent Advanced Care Research Centre at University of Edinburgh). The funder had no role in conduct of the study, interpretation or the decision to submit for publication. The views expressed are those of the authors and not necessarily those of Legal & General. This research was funded by the Arts and Humanities Research Council (AHRC) Phase 3 of Researching Evidence-based Alternatives in Living, Imaginative, Traumatised, Integrated, Embodied Systems (REALITIES) grant AH/Z505456/1. The views expressed are those of the authors and not necessarily those of the AHRC.

Funders	Funder number
Arts and Humanities Research Council

Keywords

Air pollution
Cohesion
Deprivation
Green space
Loneliness
Multimorbidity
Neighbourhoods

ASJC Scopus subject areas

Health(social science)
Sociology and Political Science
Life-span and Life-course Studies

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.healthplace.2025.103414Licence: CC BY

Cite this

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title = "Neighbourhood social cohesion, loneliness and multimorbidity: Evidence from a UK longitudinal panel study",

abstract = "In the context of population ageing, multimorbidity is an increasingly prevalent public health issue that has a substantial impact on both individuals and healthcare systems. Alongside the literature looking at risk factors at the individual level, there is a growing body of research examining the role of neighbourhoods in the development of multimorbidity. However, most of this work has focused on physical features of place such as air pollution and green space, while social features of place have been largely overlooked. In this study, we therefore explored neighbourhood cohesion as a social neighbourhood characteristic that could influence multimorbidity risk. Additionally, we analysed how loneliness may help to explain any relationship between neighbourhood cohesion and multimorbidity, given the emergence of loneliness as an important risk factor for multimorbidity in individual-level studies. Using Understanding Society, a UK household longitudinal panel study of approximately 40,000 households, we conducted both multilevel cross-sectional and longitudinal analyses to model these relationships. We found that there is a substantial association between greater neighbourhood cohesion and lower multimorbidity risk (odds ratio (OR) for second most cohesive quintile versus least cohesive quintile = 0.75, p < .01), even after controlling for a wide range of socio-economic factors, health behaviours and physical features of place. This cross-sectional result was confirmed by longitudinal analysis of individuals with no health conditions at baseline who moved between neighbourhoods over a nine-year follow-up period. Movers who experienced a decrease in cohesion had greater odds of becoming multimorbid compared to movers who did not experience a decrease in cohesion (OR = 1.68, p = .057). Controlling for loneliness substantially attenuates the odds ratios for neighbourhood cohesion, and in a mediation analysis we found a significant indirect effect of neighbourhood cohesion on multimorbidity risk acting through loneliness, suggesting it is a plausible mechanism through which the social environment influences the development of multiple long-term health conditions.",

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AU - Pearce, Jamie R.

AU - Marshall, Alan

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Neighbourhood social cohesion, loneliness and multimorbidity: Evidence from a UK longitudinal panel study

Abstract

Data Availability Statement

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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