British surname origins, population structure and health outcomes—an observational study of hospital admissions

AbstractPopulation structure is a confounder on pathways linking genotypes to health outcomes. This study examines whether the historical, geographical origins of British surnames are associated with health outcomes today. We coded hospital admissions of over 30 million patients in England between 1999 and 2013 to their British surname origin and divided their diagnoses into 125 major disease categories (of which 94 were complete-case). A base population 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 (alpha = .05; Benjamini–Hochberg false discovery rate (FDR) = .05). The results were scanned for “signals”, where a branch of related surname origins all had significantly higher or lower risk. Age- and sex-standardised admission (alpha = .05) was calculated for each signal across area deprivation and surname origin density quintiles. Signals included three branches of English surnames (disorders of teeth and jaw, fractures, upper gastrointestinal disorders). Although the signal with fractures was considered unusual overall, 2 out of the 9 origins in the branch would only be significant at a FDR > .05: OR 0.92 (95% confidence interval 0.86–0.98) and 0.70 (0.55–0.90). The risk was only different in the quintile with the highest density of that group. Differential risk remained when studied across quintiles of area deprivation. The study shows that surname origins are associated with diverse health outcomes and thus act as markers of population structure over and above area deprivation.