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. 2013 Apr 24;8(4):e62177.
doi: 10.1371/journal.pone.0062177. Print 2013.

Twin and sibling studies using health insurance data: the example of attention deficit/hyperactivity disorder (ADHD)

Ingo Langner  1 , Edeltraut Garbe, Tobias Banaschewski, Rafael T Mikolajczyk
Affiliations

Twin and sibling studies using health insurance data: the example of attention deficit/hyperactivity disorder (ADHD)

Ingo Langner et al. PLoS One. .

Abstract

Background and aims: Twin studies are used to assess the contribution of genetic factors to the aetiology of diseases. To show the feasibility of such research on the basis of health insurance data, we analysed twin and sibling data on the attention deficit/hyperactivity disorder (ADHD) in the German Pharmacoepidemiological Research Database (GePaRD).

Methods: The GePaRD consists of data from four statutory health insurances, including around 17% of the total population of Germany. Among those insured in 2005, we identified 286,653 non-twin sibling pairs and 12,486 twin pairs. Each pair consisted of an index child (6 to 12 years old) and a co-sibling of equal age or up to five years older. ADHD cases were identified by hospital or ambulatory ICD-10 diagnoses (F90.0 or F90.1) and prescriptions. We estimated tetrachoric correlations, percentage of concordant pairs, concordance rates, and heritability. Weighted estimates for the indirect assessment of mono- and dizygotic pairs were derived.

Results: TETRACHORIC CORRELATIONS WERE HIGHEST FOR TWIN PAIRS OF THE SAME SEX (MALES: 0.85, 95% CI 0.81-0.89; females: 0.81, 95% CI 0.73-0.88) and lowest for opposite-sex non-twin sibling pairs (0.43, 95% CI 0.41-0.45). Heritability estimates were 0.88 (95% CI: 0.79-0.97) for males and 0.77 (95% CI: 0.60-0.95) for females.

Conclusions: The study clearly reproduced the well-known strong genetic component in the aetiology of ADHD. This approach could be used for further assessments of genetic components in other diseases.

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Conflict of interest statement

Competing Interests: Tobias Banaschewski served in an advisory or consultancy role for Bristol Myers-Sqibb, Desitin, Lilly, Medice, Novartis, Pfizer, Shire, UCB and Viforpharma. He received conference attendance support and conference support or received speaker’s fees by Lilly, Janssen McNeil, Medice, Novartis, Shire, UCB. He is/has been involved in clinical trials conducted by Lilly, Shire and Novartis. The present work is unrelated to the stated grants and relationships. Edeltraut Garbe served in an advisory or consultancy role for Novartis, Bayer-Schering and Nycomed. She received research funds for epidemiological studies from Bayer-Schering, Glaxo, Mundipharma, Sanofi-Pasteur and Sanofi-Aventis. The present work is unrelated to the stated relationships. The other authors declare that they have no conflict of interest. All authors accepted the final revised version of the manuscript. The analysis is based on routinely collected and pseudonymised data; therefore no ethical commission approval was required. Permission for use of the health insurance data was granted by the responsible data protection authorities. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Age distribution of index children of twin and non-twin pairs by sex.
Figure 2
Figure 2. Age difference between the index child and the belonging co-sibling within.
See this image and copyright information in PMC

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