Decoding the genetic architecture of hernia through genome-wide association and multi-trait analyses.

Hernias affect millions of individuals worldwide and represent a significant public health burden, yet the genetic mechanisms underlying hernia development and the extent to which they are shared across anatomical subtypes remains incompletely understood. We performed a multi-population genome-wide association meta-analysis of five hernia subtypes and identified 243 genome-wide significant loci, including 173 novel associations. Gene prioritization implicated genes involved in extracellular matrix organization, elastic fiber assembly, and embryologic development as key effectors of hernia susceptibility. Further analyses demonstrated substantial overlap in the genomic architecture of hernia, including 30 causal variants that were shared across different hernia subtypes. We employed genomic structural equation modeling to formally model this relationship, which identified two distinct latent genetic factors corresponding to putative midline fusion defects (ventral, umbilical, diaphragmatic) and inguinofemoral hernias (inguinal, femoral). Mendelian randomization analyses confirmed causal roles for body mass index, visceral adipose tissue, and abdominal subcutaneous adipose tissue in hernia development while also identifying candidate therapeutic targets. Together, these findings delineate the shared and distinct genetic architecture of hernia subtypes providing a mechanistic foundation to enable precision risk stratification and inform the development of novel preventative and therapeutic strategies.