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Blood pressure as well as other factors such as age and cholesterol and their interactions may lead to increased risk of certain diseases. When using a dichotomized variable to determine a diagnosis, if the interactions with other variables are not considered, then an incorrect threshold for the continuous variable may be selected. In this paper, we compare single dichotomization with joint dichotomization; the process of simultaneously optimizing cutpoints for multiple variables. A simulation study shows that simultaneous dichotomization of continuous variables is more accurate in recovering both \u2018true\u2019 thresholds given they exist.<\/jats:p>","DOI":"10.1515\/ijb-2021-0071","type":"journal-article","created":{"date-parts":[[2022,5,10]],"date-time":"2022-05-10T14:20:21Z","timestamp":1652192421000},"page":"613-625","source":"Crossref","is-referenced-by-count":4,"title":["A comparison of joint dichotomization and single dichotomization of interacting variables to discriminate a disease outcome"],"prefix":"10.1515","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3803-679X","authenticated-orcid":false,"given":"Sybil Prince","family":"Nelson","sequence":"first","affiliation":[{"name":"Department of Mathematics , Washington and Lee University , 204\u00a0W Washington St , Lexington , VA 24450 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viswanathan","family":"Ramakrishnan","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences , Medical University of South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Nietert","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences , Medical University of South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Kamen","sequence":"additional","affiliation":[{"name":"Department of Medicine , Medical University of South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Ramos","sequence":"additional","affiliation":[{"name":"Department of Medicine , Medical University of South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethany","family":"Wolf","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences , Medical University of South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2022,5,10]]},"reference":[{"key":"2025121209004786409_j_ijb-2021-0071_ref_008","unstructured":"Lobo, I. 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PMID: 29763036."},{"key":"2025121209004786409_j_ijb-2021-0071_ref_014","doi-asserted-by":"crossref","unstructured":"SCORE2 working group and ESC Cardiovascular risk collaboration. SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. Eur Heart J 2021;42:2439\u201354. https:\/\/doi.org\/10.1093\/eurheartj\/ehab309.","DOI":"10.1093\/eurheartj\/ehab309"},{"key":"2025121209004786409_j_ijb-2021-0071_ref_007","unstructured":"Kraemer, HC. Risk ratios, odds ratio, and the test QROC. In: Evaluating medical tests. Newbury Park, CA: SAGE Publications, Inc; 1992:103\u201313 pp."},{"key":"2025121209004786409_j_ijb-2021-0071_ref_019","doi-asserted-by":"crossref","unstructured":"Youden, WJ. Index for rating diagnostic tests. 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