Multi-level Latent Variable Models for Coheritability Analysis in Electronic Health Records

Abstract Electronic health records (EHRs) linked with familial relationship data offer a unique opportunity to investigate the genetic architecture of complex phenotypes at scale. However, existing heritability and coheritability estimation methods often fail to account for the intricacies of familial correlation structures, heterogeneity across phenotype types, and computational scalability. We propose a robust and flexible statistical framework for jointly estimating heritability and genetic correlation among continuous and binary phenotypes in EHR-based family studies. Our approach builds on multi-level latent variable models to decompose phenotypic covariance into interpretable genetic and environmental components, incorporating both within- and between-family variations. We derive iteration algorithms based on generalized equation estimations (GEE) for estimation. Simulation studies under various parameter configurations demonstrate that our estimators are consistent and yield valid inference across a range of realistic settings. Applying our methods to real-world EHR data from a large, urban health system, we identify significant genetic correlations between mental health conditions and endocrine/metabolic phenotypes, supporting hypotheses of shared etiology. This work provides a scalable and rigorous framework for coheritability analysis in high-dimensional EHR data and facilitates the identification of shared genetic influences in complex disease networks. Competing Interest Statement The authors have declared no competing interest. Funding Statement MH123487, NS073671 and TL1TR001875 Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee/IRB of Columbia University Irving Medical Center gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data produced in the present study are available upon reasonable request to the authors. Abbreviations - ANA - anti-nuclear antibodies - APC - antigen-presenting cells - IRF - interferon regulatory factor