We consider the problem of learning risk scores to prioritize individuals for scarce resources or interventions, from historical observational data affected by unobserved confounding. Decisions about who receives scarce resources are often guided by risk scores based on recorded characteristics, such as responses to a survey. These risk scores are increasingly being learned directly from observational data: historical records of individuals' characteristics, allocation decisions, and outcomes. Standard methods such as inverse propensity weighting (IPW), which corrects for the bias introduced by the historical allocation policy, can be used to learn accurate risk scores if the historical decision process is fully explained by the recorded characteristics. In practice, however, historical decisions often depend on unrecorded information, causing learned risk scores to systematically under-prioritize exactly the individuals whose unrecorded circumstances drove past prioritization. We propose a method for learning risk scores that are robust to this kind of unobserved confounding, building on IPW. Since propensity weights cannot be reliably estimated under unobserved confounding, we instead treat them as belonging to an uncertainty set determined by the observable data and domain-informed estimates of the degree of confounding, combining sensitivity analysis from causal inference with Wasserstein distributionally robust optimization. The resulting robust risk score learning problem admits a sample-based approximation that we reformulate as an exponential cone program compatible with off-the-shelf solvers. We demonstrate the effectiveness of our approach on semi-synthetic data derived from datasets in the UCI Machine Learning Repository. Our method improves calibration by up to 29.2% over traditional benchmarks and up to 11.1% over the state of the art, without compromising other metrics.
Many clinical risk scores are deployed as additive rules with nonnegative integer points assigned to relevant binary predictive features. These integer weights not only make the score easier to use in practice but also promote sparsity in the resulting prediction model. Such risk scores are often derived by first fitting a regression model and then rounding the estimated coefficients to the nearest integer after appropriate scaling. This approach is computationally fast but does not guarantee optimality of the resulting score. Alternatively, one may search over all possible integer weights to directly optimize a value function by posing the problem as an integer programming task. However, the associated computational burden can be substantial, especially when the value function is nonconcave or even discontinuous. In this paper, we develop new machine learning algorithms that employ a flexible greedy optimization strategy to learn such additive scoring directly under explicit and sensible optimality objectives. We apply the proposed method to a large electronic health record (EHR) cohort in Epic Cosmos to construct an integer-weighted comorbidity score for measuring the risk of post-discharge mortality. We also conduct a simulation study to examine the finite-sample operating characteristics.
Risk scores are an interpretable and actionable class of machine learning models with applications in medicine, insurance, and risk management. Unlike most computational methods, risk scores are designed to be computed by a human by attributing points to a data sample based on a limited set of criteria. The most common approaches for generating risk scores use linear regressions to estimate the effect of selected variables. We propose a simple and effective approach towards building compact and predictive risk scores. We provide an algorithm based on gradient boosting that is capable of modeling nonlinear effects, along with a C++ implementation with Python and R bindings. Through extensive empirical evaluation on twelve tabular datasets spanning regression, classification, and time-to-event tasks, we show that our method achieves competitive predictive performance while producing substantially more compact scores than regression-based alternatives, with 60% fewer rules for classification tasks and 16% fewer rules for time-to-event tasks on average, compared to AutoScore.
We introduce and study the problem of calibrating conditional risk, which involves estimating the expected loss of a prediction model conditional on input features. We analyze this problem in both classification and regression settings and show that it is fundamentally equivalent to a standard regression task. For classification settings, we further establish a connection between conditional risk calibration and individual/conditional probability calibration, and develop theoretical insights for the performance metric. This reveals that while conditional risk calibration is related to existing uncertainty quantification problems, it remains a distinct and standalone machine learning problem. Empirically, we validate our theoretical findings and demonstrate the practical implications of conditional risk calibration in the learning to defer (L2D) framework. Our systematic experiments provide both qualitative and quantitative assessments, offering guidance for future research in uncertainty-aware decision-making.