Interpreting Mendelian-randomization estimates of the effects of categorical exposures such as disease status and educational attainment

Laurence J M S Howe*, Matt J Tudball, George Davey Smith, Neil M Davies

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

11 Citations (Scopus)
28 Downloads (Pure)


Mendelian randomization has been previously used to estimate the effects of binary and ordinal categorical exposures - e.g. type 2 diabetes or educational attainment defined by qualification - on outcomes. Binary and categorical phenotypes can be modelled in terms of liability, an underlying latent continuous variable with liability thresholds separating individuals into categories. Genetic variants influence an individual’s categorical exposure via their effects on liability, thus Mendelian randomization analyses with categorical exposures will capture effects of liability which act independent of exposure category.

Methods and results
We discuss how groups where the categorical exposure is invariant can be used to detect liability effects acting independently of exposure category. For example, associations between an adult educational attainment polygenic score (PGS) and BMI measured before the minimum school leaving age (e.g. age 10), cannot indicate the effects of years in full-time education on this outcome. Using UK Biobank data, we show that a higher educational attainment PGS is strongly associated with lower smoking initiation and higher odds of glasses use at age 15. These associations were replicated in sibling models. An orthogonal approach using the raising of the school leaving age (ROSLA) policy change found that individuals who chose to remain in education to age 16 before the reform likely had higher liability to educational attainment than those who were compelled to remain in education to 16 after the reform, and had higher income, lower pack years of smoking, higher odds of glasses use and lower deprivation in adulthood. These results suggest that liability to educational attainment associates with health and social outcomes independent of years in full-time education.

Mendelian randomization studies with non-continuous exposures should be interpreted in terms of liability, which may affect the outcome via changes in exposure category and/or independently.
Original languageEnglish
Article numberdyab208
JournalInternational Journal of Epidemiology
Early online date27 Sept 2021
Publication statusE-pub ahead of print - 27 Sept 2021


  • Mendelian randomization
  • liability
  • categorical exposures
  • educational attainment


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