Youden index and the optimal threshold for markers with mass at zero

Enrique F. Schisterman, David Faraggi, Benjamin Reiser, Jessica Hu

Research output: Contribution to journalArticlepeer-review


The Youden Index is often used as a summary measure of the receiver operating characteristic curve. It measures the effectiveness of a diagnostic marker and permits the selection of an optimal threshold value or cutoff point for the biomarker of interest. Some markers, while basically continuous and positive, have a spike or positive mass of probability at the value zero. We provide a flexible modeling approach for estimating the Youden Index and its associated cutoff point for such spiked data and compare it with the standard empirical approach. We show how this modeling approach can be adjusted to take covariate information into account. This approach is applied to data on the Coronary Calcium Score, a marker for atherosclerosis.

Original languageEnglish
Pages (from-to)297-315
Number of pages19
JournalStatistics in Medicine
Issue number2
StatePublished - 30 Jan 2008


  • Box-Cox power transformations
  • Coronary Calcium Score
  • Diagnostic markers
  • Mixture model
  • ROC curve
  • Sensitivity
  • Specificity

ASJC Scopus subject areas

  • Epidemiology
  • Statistics and Probability


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