Accelerometry-Derived Digital Biomarkers for Cardiometabolic Risk: A Population-Representative Tabular Benchmark with Uncertainty Quantification

Cardiometabolic diseases remain among the most persistent drivers of preventable morbidity because diabetes, hypertension, and cardiovascular disease frequently co-occur and share metabolic, vascular, demographic, and behavioral determinants. Existing machine learning studies for chronic disease prediction often emphasize discrimination on a single dataset, while underreporting label leakage, calibration, temporal robustness, external transportability, and subgroup reliability. This paper presents CardioMeta, a calibrated multi-task framework for joint prediction of diabetes, hypertension, and cardiovascular disease across population survey and electronic health record (EHR) data. The study uses NHANES for population-level model development and temporal validation, and MIMIC-IV for EHR-domain evaluation under substantial distribution shift. To reduce circular label reconstruction, the primary analysis excludes disease-defining variables from the corresponding prediction heads, while a full-clinical feature setting is retained only as sensitivity analysis. CardioMeta combines a shared cardiometabolic encoder with disease-specific gated heads and post-hoc probability calibration. In the leakage-reduced temporal validation setting, the model achieved a macro-AUROC of 0.839, macro-AUPRC of 0.536, macro-F1 of 0.614, and expected calibration error of 0.024, with modest but consistent improvements over strong gradient-boosting and neural tabular baselines. External evaluation on MIMIC-IV showed clear degradation under domain shift, while limited fine-tuning partially recovered performance. The findings indicate that the principal value of multi-task cardiometabolic modeling lies not in inflated accuracy, but in reproducible leakage control, calibrated probabilities, and transparent reliability reporting across heterogeneous healthcare data sources.

Non-alcoholic fatty liver disease (NAFLD) affects roughly 25% of global adults, posing substantial hepatic and cardiovascular risks. Yet, population-level screening tools remain inadequate. We present Method, a machine-learning framework for NAFLD risk prediction coupling gradient-boosted decision trees with conformal prediction to yield calibrated, distribution-free coverage guarantees on individual risk estimates. It integrates a mutual-information-based stability selection procedure to identify a compact, clinically interpretable feature subset via bootstrap resampling, constructing prediction sets whose marginal coverage provably exceeds a user-specified confidence level. We evaluated Method on a multicenter cohort from Guangzhou, China (primary n=2,187; external validation n=412) using 78 candidate features across demographics, metabolic biomarkers, and lifestyle factors. Method achieves an AUROC of 0.912 internally and 0.891 externally, outperforming deep neural networks, TabNet, support vector machines, and logistic regression. Conformal prediction sets achieve 91.3% empirical coverage at the 90% nominal level. A three-tier risk stratification derived from these scores separates the population into distinct groups, with the high-risk subgroup showing a 12-month progression rate 4.7 times that of the low-risk tier. The selected features -- notably waist circumference, ALT, GGT, triglycerides, fasting glucose, and BMI -- align with established metabolic risk factors, providing biological plausibility.

Cardiovascular screening models trained on national health surveys routinely report areas under the receiver operating characteristic curve (AUROC) near 0.89. We asked whether that accuracy reflects learning or target leakage, whether tabular foundation models change the answer, and whether the properties deployment requires survive joint examination. We benchmarked ten classifiers spanning linear, tree-ensemble, neural, glass-box, and tabular foundation classes for prevalent myocardial infarction in 442,067 respondents of the 2022 Behavioral Risk Factor Surveillance System across five feature tiers of decreasing leakage risk. Each was audited for discrimination, calibration, fairness at an explicit screening threshold, conformal coverage, explanation faithfulness, and inference cost, then applied -- models and thresholds frozen -- to 430,755 respondents of 2023. Removing two post-diagnostic features cost every model 0.049-0.051 AUROC, collapsing the field into a 0.0045-wide band. The glass-box explainable boosting machine was non-inferior to every alternative within a pre-specified 0.005 margin while scoring the cohort roughly 104 times faster than the strongest foundation model. One threshold detected 75.4% of women's infarctions against 89.0% of men's; editing the model's shape functions reduced the gap to 0.010. Marginal conformal prediction gave 0.86 coverage to men and 0.82 to adults over 60; Mondrian calibration repaired every stratum. Frozen models transported within 0.002 AUROC. Reported headroom in this literature is a property of the feature set, not the learner. Transparency cost nothing measurable and made fairness repair and uncertainty conditioning directly auditable. Evaluation practice, not model capacity, is the binding constraint.