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Large-scale trans-ethnic replication and discovery of genetic associations for rare diseases with self-reported medical data

A key challenge in the study of rare disease genetics is assembling large case cohorts for well- powered studies. We demonstrate the use of self-reported diagnosis data to study rare diseases at scale. We performed genome-wide association studies (GWAS) for 33 rare diseases using self-reported diagnosis phenotypes and re-discovered 29 known associations to validate our approach. In addition, we performed the first GWAS for Duane retraction syndrome, vestibular schwannoma and spontaneous pneumothorax, and report novel genome-wide significant associations for these diseases. We replicated these novel associations in non-European populations within the 23andMe, Inc. cohort as well as in the UK Biobank cohort. We also show that mixed model analyses including all ethnicities and related samples increase the power for finding associations in rare diseases. Our results, based on analysis of 19,084 rare disease cases for 33 diseases from 7 populations, show that large-scale online collection of self-reported data is a viable method for discovery and replication of genetic associations for rare diseases. This approach, which is complementary to sequencing-based approaches, will enable the discovery of more novel genetic associations for increasingly rare diseases across multiple ancestries and shed more light on the genetic architecture of rare diseases.