The Interaction of Genetic Predisposition and Socioeconomic Position With Type 2 Diabetes Mellitus: Cross-Sectional and Longitudinal Analyses From the Lifelines Cohort and Biobank Study

OBJECTIVE: A strong genetic predisposition for type 2 diabetes mellitus (T2DM) may aggravate the negative effects of low socioeconomic position (SEP) in the etiology of the disorder. This study aimed to examine cross-sectional and longitudinal associations and interactions of a genetic risk score (GRS) and SEP with T2DM, and to investigate whether clinical and behavioral risk factors can explain these associations and interactions.

METHODS: We used data from 13,027 genotyped participants from the Lifelines study. The GRS was based on single-nucleotide polymorphisms (SNPs) genome-wide associated with T2DM and was categorized into tertiles. SEP was measured as educational level. T2DM was based on biological markers, recorded medication use, and self-reports. Cross-sectional and longitudinal associations, and interactions, between the GRS and SEP on T2DM were examined.

RESULTS: The combination of a high GRS and low SEP had the strongest association with T2DM in cross-sectional (OR: 3.84; 95% CI: 2.28, 6.46) and longitudinal analyses (HR: 2.71; 1.39, 5.27), compared to a low GRS and high SEP. Interaction between a high GRS and a low SEP was observed in cross-sectional (relative excess risk due to interaction: 1.85; 0.65, 3.05) but not in longitudinal analyses. Clinical and behavioral risk factors mostly explained the observed associations and interactions.

CONCLUSIONS: A high GRS combined with a low SEP provides the highest risk for T2DM. These factors also exacerbated each other's impact cross-sectionally but not longitudinally. Preventive measures should target individual and contextual factors of this high-risk group to reduce the risk of T2DM.