Imputation of race and ethnicity categories using continental genetic ancestry from real-world genomic testing data

The incompleteness of race and ethnicity information in real-world data (RWD) hampers its utility in promoting healthcare equity. This study introduces two methods—one heuristic and the other machine learning-based—to impute race and ethnicity from continental genetic ancestry using tumor profiling data. Analyzing de-identified data from over 100,000 cancer patients sequenced with the Tempus xT panel, we demonstrate that both methods outperform existing geolocation and surname-based methods, with the machine learning approach achieving high recall (range: 0.783-0.997) and precision (range: 0.913-0.981) across four mutually exclusive race and ethnicity categories. This work presents a novel pathway to enhance RWD utility in studying racial disparities in healthcare.