Interpretable Predictive Modeling for Medical Data Using Boolean Rule-aware Regression

Abstract

PurposeIn clinical practice, accurate prediction of disease risk must be accompanied by transparent, human-understandable explanations to support diagnostic confidence, guide therapeutic decisions, and meet ethical and regulatory standards. While deep neural networks achieve high predictive performance in tasks such as cancer detection and diabetes risk stratification, their black-box nature prevents clinicians from understanding the reasoning behind predictions, severely limiting trust and safe integration into patient care. MethodsWe present Regression-Based Boolean Rule (RBBR), a framework that automatically derives clinically interpretable Boolean rules directly from patient data. RBBR generates human-readable conjunctions (logical AND combinations) of up to three clinical features, transforms them into inputs for ridge regression to predict binary or multi-class disease outcomes, estimates rule importance via regularized coefficients, and selects the most parsimonious and predictive rule sets using the Bayesian Information Criterion. ResultsApplied to six real-world medical datasets (lung cancer screening and staging, Wisconsin and diagnostic breast cancer, heart failure, and early-stage diabetes risk), RBBR consistently produced concise, clinically meaningful rules - e.g., gender-specific symptom combinations in diabetes, distinct histopathological subpopulations in breast cancer, and symptom-risk factor interactions in lung cancer - with strong explanatory power (R2 up to 0.92) and competitive discrimination. ConclusionBy delivering logical, transparent decision rules aligned with clinical reasoning (if symptom A and B, then high risk), RBBR bridges the gap between predictive accuracy and bedside usability, enabling clinicians to validate predictions, identify high-risk patients, stratify subpopulations, and enhance shared decision-making in routine care.