British surname origins, population structure and health outcomes – an observational study of English hospital records

BackgroundPopulation and social structure act as important confounders on pathways linking genotypes to health outcomes. This study examines whether the historical, geographical origins of British surnames – as markers of population structure - are associated with differential health outcomes today. MethodsWe coded the hospital admissions of more than 30 million patients in England between 1999 and 2013 to their surname origin and divided their diagnoses into 125 major disease categories. A base population dataset was constructed with patients’ first admission of any kind. Age- and sex-standardised odds ratios were calculated with logistic regression using patients with ubiquitous English surnames such as “Smith” as reference. Using a data mining approach, we scanned the results for “signals”, where a branch of related surname origins all had significantly higher or lower risk than the reference group. We subsequently studied the age- and sex-standardised incidence for each signal across the density of the surname origin (quintiles) as well as quintiles of area deprivation. ResultsWe identified a signal with Scottish surnames (alcohol-related disorders) and three with different branches of English surnames (disorders of teeth and jaw, fractures, upper gastrointestinal disorders). For the three English surname groups, the risk was only different to patients with other surnames in the quintile with the highest density of that group. Differential risk remained when studied across quintiles of area deprivation. ConclusionsThe study shows that surname origins are associated with diverse health outcomes and may thus act as combined markers of population structure over and above area deprivation.