Estimation of morbid risk and age at onset with missing information

Investigators of genetic illnesses are currently employing life-table techniques to estimate the lifetime risk of disease and the age-at-onset distribution. This methodology assumes that onset ages are known for affected individuals and that censoring ages are known for unaffected individuals. We extend these methods to incorporate affected individuals with unknown onset ages and unaffected persons with unknown censoring ages and illustrate how conventional life-table methods can produce seriously biased estimates, particularly of lifetime risk. The methodology is not restricted to genetic illnesses and can be applied to more complex illnesses with unknown etiology. We present an example for Huntington disease, which is generally assumed to be a Mendelian autosomal dominant disease, yielding estimates of lifetime risk of .503 +/- .70 and mean onset age of 47.7 +/- 3.1 years for offspring with a single affected parent. When conventional life-table techniques are employed, these estimates are .238 +/- .032 and 43.2 +/- 2.2.