What the evidence actually shows. The strongest quantitative test of cross-ancestry PRS generalization in this corpus is X-Wing, which reports median relative RΒ² improvements of 4.6β35.2% in East Asians (vs PRS-CSx and XPASS) and up to 119.1% in Africans, across 31 traits in East Asians but only 13 traits in admixed Americans and Africans (). Critically, the 119.1% African gain comes from a very low baseline (target N=6,490 for Africans vs ~360k Europeans in training), so large relative gains can coexist with clinically negligible absolute accuracy β a framing bias the skeptical reader must catch.
Why the baseline is untrustworthy for non-European populations. Every training cohort in this corpus is ancestry-narrow: PRS-PGx uses only European IMPROVE-IT data (nβ5,661) and explicitly limits generalizability (); STREAM-PRS trains on only N=404 non-Finnish Europeans and acknowledges admixed populations are unsupported (). The high-accuracy schizophrenia PRS (ACC β₯ 0.95) is restricted to Ashkenazi Jewish ancestry with leave-one-out cross-validation that risks optimism in a founder population ().
Counterpoints the field under-weights. (1) The PLCO geneβenvironment study found significant interaction P-values (0.009β0.031) for selenium, aspirin, ibuprofen, and vegetables modifying a 20-SNP prostate risk score β but across 48 tests with no multiple-comparison correction reported, in non-Hispanic white men only (). (2) Even the myopia ExGRS, spanning Han Chinese and European cohorts, assumes fixed allelic effects across ancestries β the exact assumption portability studies repeatedly falsify (). (3) A blindspot almost never discussed: PRS themselves leak ancestry-correlated genotype information (94.6% median genotype recovery), and identifiability varies by ancestry group ().
What would change this verdict. X-Wing's authors supply the falsification criterion themselves: gains vanishing once LD-reference mismatches are properly handled would collapse the portability claim (). Missing from all records: absolute RΒ²/AUC for non-European targets on matched traits, heritability differences across ancestries, and any pre-registered multi-ancestry clinical validation. Confidence: moderate-to-high that relative gains are genuine; low confidence they translate to clinically useful absolute risk in non-European populations.
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