# Interpretable Fine-Gray Deep Survival Model for Competing Risks: Predicting Post-Discharge Foot Complications for Diabetic Patients in Ontario

arXiv: https://arxiv.org/abs/2511.12409 · HTML: https://mlsanity.com/paper/2511.12409/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 7 of its 25 references that are in the map.
- First posted on arXiv 16 Nov 2025.

## Builds on (most cited first, 7 of 7)

- [A Unified Approach to Interpreting Model Predictions](https://mlsanity.com/paper/1705.07874/) (2017)
- ["Why Should I Trust You?": Explaining the Predictions of Any Classifier](https://mlsanity.com/paper/1602.04938/) (2016)
- [Optuna: A Next-generation Hyperparameter Optimization Framework](https://mlsanity.com/paper/1907.10902/) (2019)
- [Fooling LIME and SHAP: Adversarial Attacks on Post hoc Explanation Methods](https://mlsanity.com/paper/1911.02508/) (2019)
- [Neural Additive Models: Interpretable Machine Learning with Neural Nets](https://mlsanity.com/paper/2004.13912/) (2020)
- [Neural Fine-Gray: Monotonic neural networks for competing risks](https://mlsanity.com/paper/2305.06703/) (2023)
- [SurvNAM: The machine learning survival model explanation](https://mlsanity.com/paper/2104.08903/) (2021)

## Abstract (arXiv)

Model interpretability is crucial for establishing AI safety and clinician trust in medical applications for example, in survival modelling with competing risks. Recent deep learning models have attained very good predictive performance but their limited transparency, being black-box models, hinders their integration into clinical practice. To address this gap, we propose an intrinsically interpretable survival model called CRISPNAM-FG. Leveraging the structure of Neural Additive Models (NAMs) with separate projection vectors for each risk, our approach predicts the Cumulative Incidence Function using the Fine-Gray formulation, achieving high predictive power with intrinsically transparent and auditable predictions. We validated the model on several benchmark datasets and applied our model to predict future foot complications in diabetic patients across 29 Ontario hospitals (2016-2023). Our method achieves competitive performance compared to other deep survival models while providing transparency through shape functions and feature importance plots.