fig4

Figure 4. SHAP interpretation of the ANN model. (A) SHAP bar plot showing feature importance ranked by mean absolute SHAP values; (B) SHAP beeswarm summary plot illustrating the distribution of SHAP values for each feature. Red indicates high feature values, blue indicates low feature values, and the horizontal position represents the impact on model output; (C) SHAP scatter dependence plots for key variables, demonstrating the marginal effects of nine predictors on predicted CKM multimorbidity risk; (D) Waterfall plot for predicting non-CKM multimorbidity patient (class 0), showing how individual feature contributions drove the low-risk prediction; (E) Force plot for predicting CKM multimorbidity patient (class 1), visualizing the feature contributions that pushed the prediction toward high risk. SHAP: SHapley Additive exPlanations; ANN: artificial neural network; CKM: cardiovascular-kidney-metabolic.