Term of Award

Spring 2020

Degree Name

Doctor of Public Health in Biostatistics (Dr.P.H.)

Document Type and Release Option

Dissertation (open access)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


College of Public Health

Committee Chair

Hani Samawi

Committee Member 1

Jingjing Yin

Committee Member 2

Haresh Rochani

Committee Member 3

Xinyan Zhang

Committee Member 3 Email



The Kullback-Leibler divergence (KL), which captures the disparity between two distributions, has been considered as a measure for determining the diagnostic performance of an ordinal diagnostic test. This study applies KL and further generalizes it to comprehensively measure the diagnostic accuracy test for multi-stage (K > 2) diseases, named generalized total Kullback-Leibler divergence (GTKL). Also, GTKL is proposed as an optimal cut-points selection criterion for discriminating subjects among different disease stages. Moreover, the study investigates a variety of applications of GTKL on measuring the rule-in/out potentials in the single-stage and multi-stage levels. Intensive simulation studies are conducted to compare the performance of GTKL and other diagnostic accuracy measures, such as generalized Youden index (GYI), hypervolume under the manifold (HUM), and maximum absolute determinant (MADET). Furthermore, a comprehensive analysis of a real dataset is performed to illustrate the application of the proposed measure.

OCLC Number


Research Data and Supplementary Material