title: The interaction of socioeconomic position and type 2 diabetes mellitus family history: a cross-sectional analysis of the Lifelines Cohort and Biobank Study.
abstract: Low socioeconomic position (SEP) and family history of type 2 diabetes mellitus (T2DM) contribute to increased T2DM risk, but it is unclear whether they exacerbate each other's effect. This study examined whether SEP reinforces the association of T2DM family history with T2DM, and whether behavioural and clinical risk factors can explain this reinforcement.
  
  
  
  We used cross-sectional data on 51 725 participants from Lifelines. SEP was measured as educational level and was self-reported, just as family history of T2DM. T2DM was diagnosed based on measured fasting plasma glucose and glycated haemoglobin, combined with self-reported disease and recorded medication use. We assessed interaction on the additive scale by calculating the relative excess risk due to interaction (RERI).
  
  
  
  ORs of T2DM were highest for males (4.37; 95% CI 3.47 to 5.51) and females (7.77; 5.71 to 10.56) with the combination of low SEP and a family history of T2DM. The RERIs of low SEP and a family history of T2DM were 0.64 (-0.33 to 1.62) for males and 3.07 (1.53 to 4.60) for females. Adjustment for behavioural and clinical risk factors attenuated associations and interactions, but risks remained increased.
  
  
  
  Low SEP and family history of T2DM are associated with T2DM, but they also exacerbate each other's impact in females but not in males. Behavioural and clinical risk factors partly explain these gender differences, as well as the associations underlying the interaction in females. The exacerbation by low SEP of T2DM risks in T2DM families deserves attention in prevention and community care.
authors.affiliation: Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands s.k.r.van.zon@umcg.nl.
authors.forename: Sander K R
authors.initials: SK
authors.lastname: van Zon
authors.affiliation: Department of Epidemiology, Unit of Genetic Epidemiology and Bioinformatics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Harold
authors.initials: H
authors.lastname: Snieder
authors.affiliation: Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Ute
authors.initials: U
authors.lastname: Bültmann
authors.affiliation: Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Sijmen A
authors.initials: SA
authors.lastname: Reijneveld
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000235:genetics; D004522:Educational Status; D015444:Exercise; D005260:Female; D020022:Genetic Predisposition to Disease; D015438:Health Behavior; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D012923:Social Class
keywords: Public health