Incorporating External Risk Information with the Cox Model under Population Heterogeneity: Applications to Trans-Ancestry Polygenic Hazard Scores

Polygenic hazard score (PHS) models designed for European ancestry (EUR) individuals provide ample information regarding survival risk discrimination. Incorporating such information can improve the performance of risk discrimination in an internal small-sized non-EUR cohort. However, given that external EUR-based model and internal individual-level data come from different populations, ignoring population heterogeneity can introduce substantial bias. In this paper, we develop a Kullback-Leibler-based Cox model (CoxKL) to integrate internal individual-level time-to-event data with external risk scores derived from published prediction models, accounting for population heterogeneity. Partial-likelihood-based KL information is utilized to measure the discrepancy between the external risk information and the internal data. We establish the asymptotic properties of the CoxKL estimator. Simulation studies show that the integration model by the proposed CoxKL method achieves improved estimation efficiency and prediction accuracy. We applied the proposed method to develop a trans-ancestry PHS model for prostate cancer and found that integrating a previously published EUR-based PHS with an internal genotype data of African ancestry (AFR) males yielded considerable improvement on the prostate cancer risk discrimination.