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The interaction of socioeconomic position and type 2 diabetes mellitus family history: a cross-sectional analysis of the Lifelines Cohort and Biobank Study.

The interaction of socioeconomic position and type 2 diabetes mellitus family history: a cross-sectional analysis of the Lifelines Cohort and Biobank Study.
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van Zon SK, Snieder H, Bültmann U, Reijneveld SA,


van Zon SK, Snieder H, Bültmann U, Reijneveld SA, (click to view)

van Zon SK, Snieder H, Bültmann U, Reijneveld SA,

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BMJ open 2017 04 077(4) e015275 doi 10.1136/bmjopen-2016-015275
Abstract
BACKGROUND
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.

METHODS
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).

RESULTS
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.

CONCLUSION
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.

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