Problems in the assessment of relative risk of chronic disease among biological relatives of affected individuals

A question often asked in regard to a chronic disease is whether the risk to a biological relative of a case is elevated, and if so by how much the risk is altered. To answer this question, data may be collected directly with genetic objectives in mind by ascertaining populations of pedigrees. More often, the initial assessment of the question comes from family history data collected in an incidental manner in the course of a case-control or similar type of study. This paper discusses some limitations to the inferences which can be derived from such casual family history data. These include (i)poor statistical properties of standard relative risk measures, (ii) interpretational problems of observed relative risks when affected cases arise from genetic as well as nongenetic causes and when genes may not always be expressed in individuals in whom they are present, and (iii)confounding effects which may occur when a high risk allele alters the age of onset pattern of the disease. These problems result largely from a loss of design control over the degree of exposure of individuals ascertained and can lead to a small observed relative risk value even when genetic factors are important. Suggestions for handling such casual family history data are offered.