Simulation study results
We report the observed type I error probabilities of the different approaches for testing HWP at two different significance levels for all the scenarios (i.e., the different combinations of prevalence values for the primary disease and secondary phenotype). In addition to the 0.05 nominal significance level used for candidate gene association studies, we considered the nominal significant level 0.0001, which is used as a threshold for HWP testing in genome-wide association studies
[7]. All the results were evaluated based on 1,000,000 replicates. For the common SNPs (MAF

=

40%), the results associated with SNP
1, SNP
2, SNP
3, and SNP
4 are reported in , , , , respectively. For the less common SNPs (MAF

=

10%), the results are reported in , , , , respectively. Four existing approaches for testing HWP and the two proposed approaches were studied: LRT_t and mHWP_t are the LRT approach
[2] and the mHWP exact test
[3], respectively, which use the presence and absence of the secondary phenotype as cases and controls; LRT_d and mHWP_d use the presence and absence of the primary disease as cases and controls; the eLRT approach proposed in this article is an extension of the LRT approach proposed by Li and Li
[2]; and the emHWP exact test proposed in this article is an extension of the mHWP exact test proposed by Wang and Shete
[3].
| Table 2Estimated type I error probability for test of deviation from HWP of SNP1, a causal SNP to both primary disease and secondary phenotype (MAF = 40%), at 0.05 and 0.0001 significance levels in simulation studies* using different (more ...) |
| Table 3Estimated type I error probability for test of deviation from HWP of SNP2, a causal SNP to primary disease but unassociated with secondary phenotype (MAF = 40%), at 0.05 and 0.0001 significance levels in simulation studies* (more ...) |
| Table 4Estimated type I error probability for test of deviation from HWP of SNP3, a causal SNP to secondary phenotype but unassociated with primary disease (MAF = 40%), at 0.05 and 0.0001 significance levels in simulation studies* (more ...) |
| Table 5Estimated type I error probability for test of deviation from HWP of SNP4, a SNP unassociated with secondary phenotype and primary disease (MAF = 40%), at 0.05 and 0.0001 significance levels in simulation studies* using (more ...) |
| Table 6Estimated type I error probability for test of deviation from HWP of SNP1, a causal SNP to both primary disease and secondary phenotype (MAF = 10%), at 0.05 and 0.0001 significance levels in simulation studies* using different (more ...) |
| Table 7Estimated type I error probability for test of deviation from HWP of SNP2, a causal SNP to primary disease but unassociated with secondary phenotype (MAF = 10%), at 0.05 and 0.0001 significance levels in simulation studies* (more ...) |
| Table 8Estimated type I error probability for test of deviation from HWP of SNP3, a causal SNP to secondary phenotype but unassociated with primary disease (MAF = 10%), at 0.05 and 0.0001 significance levels in simulation studies* (more ...) |
| Table 9Estimated type I error probability for test of deviation from HWP of SNP4, a SNP unassociated with secondary phenotype and primary disease (MAF = 10%), at 0.05 and 0.0001 significance levels in simulation studies* using (more ...) |
reports the type I error probabilities of different approaches for testing HWP for SNP
1 (MAF

=

40%) at 0.05 and 0.0001 significance levels. SNP
1 was associated with both the primary disease and the secondary phenotype in the simulations. The LRT approach and the mHWP exact test using individuals with presence and absence of the secondary phenotype as cases and controls (LRT_t and mHWP_t) provided similar type I error rates, and neither could control the type I error rate in most of the scenarios. Both approaches also performed very similarly when using individuals with presence and absence of the primary disease as cases and controls (LRT_d and mHWP_d); both could control the type I error rate in more scenarios than LRT_t and mHWP_t but still resulted in an inflated type I error rate in many scenarios. Finally, the newly proposed eLRT approach and emHWP exact test both controlled the type I error rate well. For example, when prevalence values of both the primary disease and secondary phenotype were 0.3, given a 0.05 significance level, the type I error rates of the LRT_t, mHWP_t, LRT_d, and mHWP_d approaches were 0.207040, 0.215840, 0.118910, and 0.125500, respectively, which were all highly inflated; the type I error rates of the eLRT and emHWP approaches were 0.050629 and 0.045782, respectively, which agreed very well with the nominal significance value of 0.05. When the nominal significance level was 0.0001 and both
fD and
fT were set as 0.3, we observed a similar trend in type I errors: the type I error rates of the existing approaches were 0.003054, 0.002029, 0.000867 and 0.000449, respectively, which were highly inflated, whereas the type I error rates of the eLRT and emHWP approaches were 0.000162 and 0.000019, respectively, which agreed very well with the nominal significance value of 0.0001.
When the genetic variant was only associated with the primary disease (SNP
2, ), the LRT approach and the mHWP exact test using individuals with presence and absence of primary disease as cases and controls (LRT_d and mHWP_d) could conserve the type I error rates for all the scenarios. This was expected because SNP
2 was associated with the primary disease only, and this assumption was the focus in the original studies of these two approaches
[2],
[3]. However, LRT_t and mHWP_t led to inflated type I error rates. And again, we observed that the type I error rates were well controlled by both of the proposed approaches, eLRT and the emHWP exact test.
When the genetic variant was only associated with the secondary phenotype (SNP3, ), it was not surprising to see that the LRT approach and the mHWP exact test using individuals with presence and absence of the secondary phenotype as cases and controls (LRT_t and mHWP_t) could control the type I error rates in all scenarios. However, LRT_d and mHWP_d led to inflated type I error rates in many situations. As in the results for SNP1 and SNP2, both the proposed approaches (eLRT and emHWP) still controlled type I error rates well for all scenarios.
Last, when the genetic variant was not associated with the primary disease or the secondary phenotype (SNP4, ), all of the approaches controlled the type I error rates well for all scenarios.
Therefore, the results reported in , , , for the common SNPs (MAF

=

40%) show that the proposed eLRT and emHWP approaches could control the type I error rates for all SNPs with different types of associations with primary or secondary phenotypes and all scenarios with different prevalence values. It also should be noted that when the primary disease was less common (e.g.,


=

0.1 ~ 0.5) and the secondary phenotype was very common (e.g.,


=

0.5 ~ 0.7), the eLRT approach tended to have a larger type I error rate than the emHWP exact test, which means that the emHWP exact test is more likely to keep the promising genetic variants than the eLRT approach in these situations. It is possible that actual studies of primary disease and secondary phenotype could fall within these ranges of prevalence values. For example, in a study of overweight based on data collected for studying type 2 diabetes, the prevalence of type 2 diabetes (primary disease) was about 10% in the U.S.
[8] and the prevalence of overweight was about 66% in the U.S.
[9]. In this situation, the emHWP test would be preferable to the eLRT approach. At a very low nominal significance level (0.0001), the eLRT, but not the emHWP, approach had a slightly inflated type I error rate. Thus, the emHWP exact test is also more likely to keep the promising genetic variants than the eLRT approach at a low nominal significance level.
When the SNPs of interest were less common (MAF

=

10%, , , , ), we observed similar trends in the results for all SNPs with different associations. As expected, the inflation in type I error rates of the existing approaches was not as significant as that for common SNPs (MAF

=

40%, , , , ). Especially, we noticed that the LRT_d and mHWP_d approaches could conserve the type I error better in many, but not all, situations. For example, for SNP
1 (, associated with both the primary disease and secondary phenotype), when the prevalence values of both primary disease and secondary phenotype were 0.3, given a 0.05 significance level, the type I error rates of the different existing approaches were 0.072453, 0.066110, 0.058761, and 0.053680, respectively, whereas the type I error rates of the proposed approaches were 0.049599 and 0.035411, respectively, which were well-controlled at the 0.05 level. The performance of the emHWP exact test for the less common SNPs was very similar to that for the common SNPs at both the 0.05 and 0.0001 significance levels for all scenarios. However, the eLRT approach had inflated type I error rates at the 0.0001 level of significance in some situations for the less common SNPs. This observation further suggested that the emHWP exact test is more favorable than the eLRT approach in these situations.
Although the previously proposed LRT approach and mHWP exact test would work for certain SNPs in some scenarios, in reality, the HWP tests are performed before the association tests. Therefore, one would not know the underlying real associations of SNPs with the primary disease and/or secondary phenotype when performing the HWP tests, and the existing approaches might lead to the removal of genetic variants potentially associated with the primary disease and/or secondary phenotype. In contrast, the proposed emHWP test performed uniformly well at controlling the type I error rates for all four SNPs with different associations to the primary disease and secondary phenotype in all scenarios.
We also conducted simulation studies to evaluate the performances of all the approaches to HWP testing for the unmatched case-control study of primary disease and reported the type I error results in Supporting Information
Tables S1,
S2,
S3,
S4. We considered common SNPs with MAF

=

40% and defined different prevalence values for primary disease and secondary phenotype in the general population, ranging from 10% to 90%. The type I errors were evaluated at a nominal significance level of 0.05. All the results were based on 1,000 replicates, each with 1,000 primary disease cases and 1,000 randomly sampled controls. As in the frequency-matched case-control studies, the proposed eLRT approach and the emHWP exact test were both able to control the type I error rates for all SNPs and all scenarios in the unmatched case-control studies. Therefore, the proposed eLRT approach and emHWP exact test are robust for different study designs. In addition, the LRT approach and the mHWP exact test using individuals with presence and absence of primary disease as cases and controls also performed well for all SNPs and all scenarios, as expected.
Application to lung cancer data
To examine the performance of the proposed eLRT and emHWP approaches, we also applied them to the case-control study of lung cancer frequency-matched on smoking status. This analysis included 2,291 individuals, with 1,154 lung cancer patients and 1,137 controls frequency-matched to the cases by age, sex, and smoking status
[10]. The data were collected for a case-control study of lung cancer. All the case and control subjects were ever smokers: 1,260 former smokers and 1,031 current smokers. All the individuals were Caucasian. Lung cancer cases were accrued at The University of Texas MD Anderson Cancer Center and were histologically confirmed. Controls were ascertained through a multi-specialty physician practice from the same area. Questionnaire data were obtained by personal interview in the original study. This study was approved by the institutional review board at MD Anderson Cancer Center, and all participants provided written informed consent (LAB10-0347). In the lung cancer genome-wide association study, 317,498 tagging SNPs were genotyped
[11]. We only included the autosomal SNPs in this study. We further excluded the SNPs with MAF < 0.05, and therefore, 300,738 SNPs were left in the analysis.
We were interested in determining how many SNPs would be rejected in the quality check procedure using the different approaches for testing HWP. From the simulation studies, we found that the LRT approach and mHWP exact test performed very similarly; therefore, we only reported the results obtained using the LRT approach with either (1) the presence and absence of lung cancer as cases and controls (LRT_d) or (2) current and former smokers as cases and controls (LRT_t). To evaluate eLRT and emHWP, we first obtained the prevalence values of lung cancer

and current smokers

in ever smokers from the literature (0.14 and 0.498, respectively)
[12],
[13]. We then estimated the conditional probability of lung cancer cases given current smokers in the ever smokers as 0.2545
[12]. Therefore, we could calculate the estimated joint probabilities of lung cancer and smoking status

, where
i,
j
=

0, 1, with 1 representing lung cancer patients and current smokers and 0 representing lung cancer-free controls and former smokers. For example,


=

0.2545 × 0.14

=

0.0356 and


=

0.14 – 0.0356

=

0.1044.

and

can then be calculated accordingly. reports the numbers of SNPs that would be rejected and removed in the quality check procedure using the different HWP testing approaches, including LRT_d, LRT_t, eLRT, and emHWP, at different commonly used nominal significance levels (from 0.005 to 0.000001) in genome-wide association studies. We observed that for all significance levels, the proposed eLRT and emHWP approaches always rejected fewer SNPs than the LRT approach. The emHWP approach always rejected the fewest SNPs, whereas LRT_t always rejected the most SNPs, among all four approaches. For example, when the nominal significance level was 0.0001, 1,121 and 812 SNPs would be rejected and removed by using the LRT_t and LRT_d, respectively, whereas only 798 and 637 SNPs would be rejected and removed by using the proposed eLRT and emHWP approaches, respectively. Compared with the LRT_t approach, the emHWP approach would keep 484 more SNPs for further analysis of the association of lung cancer and/or smoking status.
| Table 10Numbers of SNPs rejected using different approaches for testing HWP in the case-control genetic association study of lung cancer frequency-matched on smoking behavior. |