Heterogenous associations of polygenic indices of 35 traits with mortality

Reviewer #1 (Public review):

Lahtinen et al. evaluated the association between polygenic scores and mortality. This question has been intensely studied (Sakaue 2020 Nature Medicine, Jukarainen 2022 Nature Medicine, Argentieri 2025 Nature Medicine), where most studies use PRS as an instrument to attribute death to different causes. The presented study focuses on polygenic scores of non-fatal outcomes and separates the cause of death into "external" and "internal". The majority of the results are descriptive, and the data doesn't have the power to distinguish effect sizes of the interesting comparisons: (1) differences between external vs. internal (2) differences between PGI effect and measured phenotype. I have two main comments:

(1) The authors should clarify whether the p-value reported in the text will remain significant after multiple testing adjustment. Some of the large effects might be significant; for example, Figure 2C (note that the small prediction accuracy of PGI in older age groups has been extensively studied, see Jiang, Holmes, and McVean, 2021, PLoS Genetics).

(2) The authors might check if PGI+Phenotype has improved performance over Phenotype only. This is similar to Model 2 in Table 1, but slightly different.

Reviewer #2 (Public review):

Summary:

This study provides a comprehensive evaluation of the association between polygenic indices (PGIs) for 35 lifestyle and behavioral traits and all-cause mortality, using data from Finnish population- and family-based cohorts. The analysis was stratified by sex, cause of death (natural vs. external), age at death, and participants' educational attainment. Additional analyses focused on the six most predictive PGIs, examining their independent associations after mutual adjustment and adjustment for corresponding directly measured baseline risk factors.

Strengths:

Large sample size with long-term follow-up.

Use of both population- and family-based analytical approaches to evaluate associations.

Weaknesses:

It is unclear whether the PGIs used for each trait represent the most current or optimal versions based on the latest GWAS data.

If the Finnish data used in this study also contributed to the development of some of the PGIs, there is a risk of overestimating their associations with mortality due to overfitting or "double-dipping." Similar inflation of effect sizes has been observed in studies using the UK Biobank, which is widely used for PGI construction.