A Comparative Benchmark of Federated Learning Strategies for Mortality Prediction on Heterogeneous and Imbalanced Clinical Data

Machine learning models hold significant potential for predicting in-hospital mortality, yet data privacy constraints and the statistical heterogeneity of real-world clinical data often hamper their development. Federated Learning (FL) offers a privacy-preserving solution, but its performance under non-Independent and Identically Distributed (non-IID) and imbalanced conditions requires rigorous investigation. The study presents a comparative benchmark of five federated learning strategies: FedAvg, FedProx, FedAdagrad, FedAdam, and FedCluster for mortality prediction. Using the large-scale MIMIC-IV dataset, we simulate a realistic non-IID environment by partitioning data by clinical care unit. To address the inherent class imbalance of the task, the SMOTE-Tomek technique is applied to each client's local training data. Our experiments, conducted over 50 communication rounds, reveal that the regularization-based strategy, FedProx, consistently outperformed other methods, achieving the highest F1-Score of 0.8831 while maintaining stable convergence. While the baseline FedAvg was the most computationally efficient, its predictive performance was substantially lower. Our findings indicate that regularization-based FL algorithms like FedProx offer a more robust and effective solution for heterogeneous and imbalanced clinical prediction tasks than standard or server-side adaptive aggregation methods. The work provides a crucial empirical benchmark for selecting appropriate FL strategies for real-world healthcare applications.