In a recent review published in the journal , a team of researchers investigated the ethical, legal, and psychosocial implications of utilizing genetic risk information in life insurance underwriting and its role in genetic discrimination (GD).
Overview
Polygenic scores (PGS) signify a breakthrough in genomics, offering insights into an individual’s susceptibility to various health conditions by aggregating the impacts of numerous disease-associated genetic variations. While the clinical potential of PGS has been extensively explored, its influence on the insurance industry, particularly in assessing risks for prevalent complex diseases, has not been thoroughly scrutinized. The integration of PGS in determining insurance premiums raises significant concerns regarding GD, which may dissuade individuals from undergoing genetic testing or participating in scientific research due to fears of insurance discrimination. Further investigation is imperative to comprehensively grasp the implications of PGS on insurance underwriting and to devise policies that combat GD while leveraging genetic insights for public health.
Global Regulatory Responses to Genetic Discrimination in Insurance
Internationally, countries have implemented diverse regulatory approaches to tackle genetic discrimination in insurance underwriting, influenced by the distinctions between community and risk-rated insurance models. These approaches encompass industry-led moratoria, as observed in Australia, collaborative government-industry agreements exemplified by the United Kingdom (UK), and legislative strategies like those in Canada. The efficacy and scope of these safeguards vary, with certain regulations targeting specific insurance types or imposing financial constraints. Notably, while some regions lack measures to restrict the utilization of genetic data in insurance, nations such as Australia are actively seeking solutions through public consultations, highlighting the widespread apprehension regarding GD and the continuous endeavors to mitigate its effects.
Clinical Utilizations and Obstacles of Polygenic Scores
PGS are increasingly valued in clinical settings, primarily for risk stratification rather than disease diagnosis. These scores have the potential to revolutionize how populations are screened for common, complex conditions such as cancer, heart disease, and diabetes, influencing treatment strategies and risk mitigation plans. Nevertheless, the efficacy of PGS is hindered by the heritability of the specific condition under consideration and the genetic homogeneity reflected in genome-wide association studies (GWAS) data, which currently skews predictions in favor of individuals of European descent. Despite these challenges, the integration of PGS into medical practice is expanding, prompting the life insurance sector to reexamine the utilization of genetic data in underwriting practices.
Polygenic Scores and Life Insurance: Navigating Genetic Risk Evaluations
Traditionally, genetic testing focused on identifying rare monogenic disorders within a limited subset of the global populace. This targeted approach, guided by varying international protocols, ensured that only individuals with a high probability of harboring pathogenic variants underwent testing, thereby mitigating the impact on life insurance underwriting. In contrast, PGS offers a more extensive application, extending beyond rare ailments to encompass common health conditions and characteristics. This broad applicability raises concerns about exacerbating GD in insurance practices, as PGS facilitates genetic risk assessments for a larger segment of the population, potentially without the protective measures afforded by existing regulations.
Clarifying Safeguards Against Genetic Discrimination
Current regulatory frameworks aimed at preventing GD often pertain to conventional genetic tests, leading to uncertainty regarding the incorporation of PGS. This ambiguity, coupled with the expansive potential of PGS, poses a risk of escalating instances and scopes of GD within life insurance underwriting. The absence of supplementary consumer protections specifically addressing PGS could compound this issue, underscoring the necessity for precise regulatory directives and expanded measures to shield against discrimination based on polygenic risks.
The Challenge of Interpreting Polygenic Scores
Despite the increasing accessibility of PGS, there is a noticeable dearth of established guidelines for interpreting and reporting these scores. This deficiency is exacerbated by the continual evolution of statistical methodologies and the ongoing influx of new GWAS data, which may alter PGS-based risk evaluations over time. The prevailing dominance of data from European populations further restricts the predictive precision of PGS for individuals of non-European ancestry. These factors underscore the intricacies of utilizing PGS in life insurance underwriting and the potential for misinterpretation, particularly when insurance providers may lack the expertise to accurately evaluate polygenic risk information.
The Future of Polygenic Scores in Insurance and Recommendations
As the integration of PGS in clinical practice and research expands, it is crucial to address its implications for life insurance underwriting to safeguard consumers against GD. This necessitates clarifying the extent to which existing protections encompass PGS, enacting legislative measures tailored to PGS, and formulating guidelines and training programs for insurers on interpreting genetic risk data. Additionally, further research is vital to delve into the GD issues that PGS may introduce.
Recommendations for the field include advocating for a prohibition on the utilization of PGS in risk-rated insurance underwriting and ensuring that regulations are adaptable, enforceable, and inclusive of both monogenic and polygenic testing.