Individual Risk
Open accessAbstract
J Clin Hypertens (Greenwich). 2012;14:261–264. ©2012 Wiley Periodicals, Inc. Patients don’t have an “individual risk” or unique probability of an outcome. Outside Mendelian inheritance, risks are conditional probabilities and differ as the risk factors included differ, at times substantially. This lack of reliability is an inherent limitation and is not resolved by including additional risk factors. Groups of like individuals need to be assembled to measure the probability of an outcome. Many groups, like any individual, can be identified, eg, groups of the same age, sex, race, or any combination of these attributes (or any others). That each of these groups may have different risk means there is no such thing as individual risk. This issue was identified by John Venn in 1866 and is known as the reference class problem. Models relate risk factors to outcomes in populations. The number calculated for an individual should not be reported as their individual or true risk, nor should it be used as the sole criterion for clinical decisions. Instead, Feinstein proposed relying on clinically important subgroups. An example would be utilizing an individual’s blood pressure as the primary determinant of hypertension treatment decisions, not an unreliable individual risk estimate.
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Any given individual's risk is model-dependent; each different way of defining similarity leads to a different risk estimate-and often a very different risk estimate-for a given individual.
“any given individual’s “risk” is model-dependent. Each different way of defining similarity leads to a different risk estimate–and often a very different risk estimate–for a given individual10,11.”
From Predictably unequal: understanding and addressing concerns that algorithmic clinical prediction may increase health disparities (2020) · cites this paper as [11]
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- Authors
- Stern, R. H.
- Affiliations
- University of Michigan (US)
- Corresponding author
- Stern, Ralph H.
- ORCID
- Stern, Ralph H.
- Venue
- The Journal of Clinical Hypertension
- Publisher
- Wiley
- Published
- 2012-02-13
- Volume
- 14
- Issue
- 4
- Pages
- 261-264
- ISSN
- 1524-6175 (ISSN-L)
- 1751-7176
- PMC
- PMC8108880
- OpenAlex
- W2327535897
- Cited by
- 21
- References
- 16
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 1 · 2021: 1 · 2020: 6 · 2019: 3 · 2018: 1 · 2017: 2 · 2016: 1 · 2014: 2
- FWCI
- 0.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Hypertension (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Topics
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- individual risk, reference class problem, conditional probability, risk factors, blood pressure, clinical decision-making
- MeSH terms
- Humans, Models, Theoretical, Predictive Value of Tests, Probability, Prognosis, Biomarkers, Risk Assessment
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