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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
  1. Sander K.R. van Zon1,
  2. Harold Snieder2,
  3. Ute Bültmann1,
  4. Sijmen A. Reijneveld1
  1. 1 Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  2. 2 Department of Epidemiology, Unit of Genetic Epidemiology and Bioinformatics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  1. Correspondence to drs Sander K.R. van Zon; s.k.r.van.zon{at}


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.

  • Public health

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  • Contributors SZ, HS, UB and SR conceived the study. SZ analysed the data and wrote the initial draft. HS, UB and SR contributed to the conception and design of the initial draft. All authors made substantial contributions to the final draft and approved its submission.

  • Funding The Lifelines Cohort Study, and generation and management of GWAS genotype data for the Lifelines Cohort Study is supported by the Netherlands Organization of Scientific Research NWO (grant 175.010.2007.006), the Ministry of Economic Affairs, the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the Northern Netherlands Collaboration of Provinces (SNN), the Province of Groningen, University Medical Center Groningen, the University of Groningen, Dutch Kidney Foundation and Dutch Diabetes Research Foundation.

  • Competing interests None declared.

  • Ethics approval Medical Ethics Committee of the University Medical Center Groningen.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Lifelines is a facility that is open for all researchers. Information on application and data access procedure is summarised on