In the recent report from the US Government Accountability Office on direct-to-consumer genetic tests, much was made of the fact that risk predictions from DTC genetic tests may not be applicable to individuals from all ethnic groups. This observation was not new to the report – it has been commented on by numerous critics ever since the inception of the personal genomics industry.
So, why does risk prediction accuracy vary between individuals and what can be done to combat this? Are the DTC companies really to blame?
To explore these questions it is first necessary to understand what is meant by the odds ratio (OR). In genetic case-control association studies the OR typically represents the ratio of the odds of disease if allele A is carried compared to if allele B is carried. If all else is equal, genetic loci with a higher OR are more informative for disease prediction – so getting an accurate estimate is extremely important if prediction underpins your business model. However, getting an accurate estimate of OR is far from easy because many, often unmeasured, factors can cause OR estimates to vary. In this post I will try to break down the concept of a single, fixed odds ratio for a disease association, and highlight a number of factors that can cause odds ratios to vary using examples from the scientific literature.