Machine learning approaches to identify the link between heavy metal exposure and ischemic stroke using the US NHANES data from 2003 to 2018.

Purpose: There is limited understanding of the link between exposure to heavy metals and ischemic stroke (IS). This research aimed to develop efficient and interpretable machine learning (ML) models to associate the relationship between exposure to heavy metals and IS. Methods: The data of this research were obtained from the National Health and Nutrition Examination Survey (US NHANES, 2003-2018) database. Seven ML models were used to identify IS caused by exposure to heavy metals. To assess the strength of the models, we employed 10-fold cross-validation, the area under the curve (AUC), F1 scores, Brier scores, Matthews correlation coefficient (MCC), precision-recall (PR) curves, and decision curve analysis (DCA) curves. Following these tests, the best-performing model was selected. Finally, the DALEX package was used for feature explanation and decision-making visualization. Results: A total of 15,575 participants were involved in this study. The best-performing ML models, which included logistic regression (LR) (AUC: 0.796) and XGBoost (AUC: 0.789), were selected. The DALEX package revealed that age, total mercury in blood, poverty-to-income ratio (PIR), and cadmium were the most significant contributors to IS in the logistic regression and XGBoost models. Conclusion: The logistic regression and XGBoost models showed high efficiency, accuracy, and robustness in identifying associations between heavy metal exposure and IS in NHANES 2003-2018 participants.