ADuLT: An efficient and robust time-to-event GWAS

Proportional hazards models have previously been proposed to analyse time-to-event phenotypes in genome-wide association studies(GWAS). While proportional hazards models have many useful applications, their ability to identify genetic associations under different generative models where ascertainment is present in the analysed data is poorly understood. This includes widely used study designs such as case-control and case-cohort designs (e.g. the iPSYCH study design) where cases are commonly ascertained.Here we examine how recently proposed and computationally efficient Cox regression for GWAS perform under different generative models with and without ascertainment. We also propose the age-dependent liability threshold model (ADuLT), first introduced as the underlying model for the LT-FH++ method, as an alternative approach for time-to-event GWAS. We then benchmark ADuLT with SPACox and standard case-control GWAS using simulated data with varying degrees of ascertainment. We find Cox regression GWAS to underperform when cases are strongly ascertained (cases are oversampled by a factor larger than 5), regardless of the generative model used. In contrast, we found ADuLT to be robust to case-control ascertainment, while being much faster to run. We then used the methods to conduct GWAS for four psychiatric disorders, ADHD, Autism, Depression, and Schizophrenia in the iPSYCH case-cohort sample, which has a strong case-ascertainment. Summarising across all four mental disorders, ADuLT found 20 independent genome-wide significant associations, while case-control GWAS found 17 and SPACox found 8, consistent with our simulation results.As more genetic data are being linked to electronic health records, robust GWAS methods that can make use of age-of-onset information have the opportunity to increase power in analyses. We find that ADuLT to be a robust time-to-event GWAS method that performs on par with or better than Cox-regression GWAS, both in simulations and real data analyses of four psychiatric disorders. ADuLT has been implemented in an R package called LTFHPlus, and is available on GitHub.