The use of machine learning to guide clinical decision making has the potential to worsen existing health disparities. Several recent works frame the problem as that of algorithmic fairness, a framework that has attracted considerable attention and criticism. However, the appropriateness of this framework is unclear due to both ethical as well as technical considerations, the latter of which include trade-offs between measures of fairness and model performance that are not well-understood for predictive models of clinical outcomes. To inform the ongoing debate, we conduct an empirical study to characterize the impact of penalizing group fairness violations on an array of measures of model performance and group fairness. We repeat the analyses across multiple observational healthcare databases, clinical outcomes, and sensitive attributes. We find that procedures that penalize differences between the distributions of predictions across groups induce nearly-universal degradation of multiple performance metrics within groups. On examining the secondary impact of these procedures, we observe heterogeneity of the effect of these procedures on measures of fairness in calibration and ranking across experimental conditions. Beyond the reported trade-offs, we emphasize that analyses of algorithmic fairness in healthcare lack the contextual grounding and causal awareness necessary to reason about the mechanisms that lead to health disparities, as well as about the potential of algorithmic fairness methods to counteract those mechanisms. In light of these limitations, we encourage researchers building predictive models for clinical use to step outside the algorithmic fairness frame and engage critically with the broader sociotechnical context surrounding the use of machine learning in healthcare.
Technical University of Denmark（丹麦技术大学）；Pioneer Centre for AI（人工智能先锋中心）；University of Copenhagen（哥本哈根大学）；Rigshospitalet（哥本哈根大学国立医院）
Recent work on algorithmic fairness has largely focused on the fairness of discrete decisions, or classifications. While such decisions are often based on risk score models, the fairness of the risk models themselves has received considerably less attention. Risk models are of interest for a number of reasons, including the fact that they communicate uncertainty about the potential outcomes to users, thus representing a way to enable meaningful human oversight. Here, we address fairness desiderata for risk score models. We identify the provision of similar epistemic value to different groups a…
University of Cambridge（剑桥大学）；MRC Biostatistics Unit, University of Cambridge（剑桥大学医学研究委员会生物统计组）；Sapienza University of Rome（罗马第一大学）；The Alan Turing Institute（阿兰·图灵研究所）；Technical University of Munich（慕尼黑工业大学）；Helmholtz Munich（亥姆霍兹慕尼黑中心）
While interest in the application of machine learning to improve healthcare has grown tremendously in recent years, a number of barriers prevent deployment in medical practice. A notable concern is the potential to exacerbate entrenched biases and existing health disparities in society. The area of fairness in machine learning seeks to address these issues of equity; however, appropriate approaches are context-dependent, necessitating domain-specific consideration. We focus on clinical trials, i.e., research studies conducted on humans to evaluate medical treatments. Clinical trials are a rela…
Algorithmic fairness and privacy are essential pillars of trustworthy machine learning. Fair machine learning aims at minimizing discrimination against protected groups by, for example, imposing a constraint on models to equalize their behavior across different groups. This can subsequently change the influence of training data points on the fair model, in a disproportionate way. We study how this can change the information leakage of the model about its training data. We analyze the privacy risks of group fairness (e.g., equalized odds) through the lens of membership inference attacks: inferr…
Algorithmic risk assessments are increasingly used to help humans make decisions in high-stakes settings, such as medicine, criminal justice and education. In each of these cases, the purpose of the risk assessment tool is to inform actions, such as medical treatments or release conditions, often with the aim of reducing the likelihood of an adverse event such as hospital readmission or recidivism. Problematically, most tools are trained and evaluated on historical data in which the outcomes observed depend on the historical decision-making policy. These tools thus reflect risk under the histo…
MPI-SWS（马克斯·普朗克软件系统研究所）；Saarland University（萨尔兰大学）；University of Maryland（马里兰大学）；Cambridge University（剑桥大学）；Alan Turing Institute（艾伦·图灵研究所）
As algorithms are increasingly used to make important decisions that affect human lives, ranging from social benefit assignment to predicting risk of criminal recidivism, concerns have been raised about the fairness of algorithmic decision making. Most prior works on algorithmic fairness normatively prescribe how fair decisions ought to be made. In contrast, here, we descriptively survey users for how they perceive and reason about fairness in algorithmic decision making. A key contribution of this work is the framework we propose to understand why people perceive certain features as fair or u…
Improving Fairness of Large Language Model-Based ICU Mortality Prediction via Case-Based Prompting
School of Computer Science and Engineering, Tianjin University of Technology, Tianjin, China（天津理工大学计算机科学与工程学院）；Institute for Artificial Intelligence, Peking University, Beijing, China（北京大学人工智能研究院）；DCST, BNRist, RIIT, Institute of Internet Industry, Tsinghua University, Beijing, China（清华大学信息产业研究院）；National Institute of Health Data Science, Peking University, Beijing, China（北京大学健康数据科学国家研究院）
Google Research（谷歌研究院）；University of Pittsburgh（匹兹堡大学）
Machine learning systems show significant promise for forecasting patient adverse events via risk scores. However, these risk scores implicitly encode assumptions about future interventions that the patient is likely to receive, based on the intervention policy present in the training data. Without this important context, predictions from such systems are less interpretable for clinicians. We propose a joint model of intervention policy and adverse event risk as a means to explicitly communicate the model's assumptions about future interventions. We develop such an intervention policy model on…
In domains such as criminal justice, medicine, and social welfare, decision makers increasingly have access to algorithmic Risk Assessment Instruments (RAIs). RAIs estimate the risk of an adverse outcome such as recidivism or child neglect, potentially informing high-stakes decisions such as whether to release a defendant on bail or initiate a child welfare investigation. It is important to ensure that RAIs are fair, so that the benefits and harms of such decisions are equitably distributed. The most widely used algorithmic fairness criteria are formulated with respect to observable outcomes, …
Stanford Center for Biomedical Informatics Research（斯坦福生物医学信息学研究中心）；Stanford University（斯坦福大学）
The use of machine learning systems to support decision making in healthcare raises questions as to what extent these systems may introduce or exacerbate disparities in care for historically underrepresented and mistreated groups, due to biases implicitly embedded in observational data in electronic health records. To address this problem in the context of clinical risk prediction models, we develop an augmented counterfactual fairness criteria to extend the group fairness criteria of equalized odds to an individual level. We do so by requiring that the same prediction be made for a patient, a…
Much work aims to explain a model's prediction on a static input. We consider explanations in a temporal setting where a stateful dynamical model produces a sequence of risk estimates given an input at each time step. When the estimated risk increases, the goal of the explanation is to attribute the increase to a few relevant inputs from the past. While our formal setup and techniques are general, we carry out an in-depth case study in a clinical setting. The goal here is to alert a clinician when a patient's risk of deterioration rises. The clinician then has to decide whether to intervene an…
Istituto Italiano di Tecnologia（意大利理工学院）；University of Genova（热那亚大学）；University of Waterloo（滑铁卢大学）；University College London（伦敦大学学院）
We address the problem of algorithmic fairness: ensuring that sensitive variables do not unfairly influence the outcome of a classifier. We present an approach based on empirical risk minimization, which incorporates a fairness constraint into the learning problem. It encourages the conditional risk of the learned classifier to be approximately constant with respect to the sensitive variable. We derive both risk and fairness bounds that support the statistical consistency of our approach. We specify our approach to kernel methods and observe that the fairness requirement implies an orthogonali…
Recent discussion in the public sphere about algorithmic classification has involved tension between competing notions of what it means for a probabilistic classification to be fair to different groups. We formalize three fairness conditions that lie at the heart of these debates, and we prove that except in highly constrained special cases, there is no method that can satisfy these three conditions simultaneously. Moreover, even satisfying all three conditions approximately requires that the data lie in an approximate version of one of the constrained special cases identified by our theorem. …
Australian National University（澳大利亚国立大学）；Google（谷歌公司）
Ensuring that classifiers are non-discriminatory or fair with respect to a sensitive feature (e.g., race or gender) is a topical problem. Progress in this task requires fixing a definition of fairness, and there have been several proposals in this regard over the past few years. Several of these, however, assume either binary sensitive features (thus precluding categorical or real-valued sensitive groups), or result in non-convex objectives (thus adversely affecting the optimisation landscape). In this paper, we propose a new definition of fairness that generalises some existing proposals, whi…
University of Genova（热那亚大学）；Amazon Web Services（亚马逊云科技）；Istituto Italiano di Tecnologia（意大利理工学院）；University College London（伦敦大学学院）
We tackle the problem of algorithmic fairness, where the goal is to avoid the unfairly influence of sensitive information, in the general context of regression with possible continuous sensitive attributes. We extend the framework of fair empirical risk minimization to this general scenario, covering in this way the whole standard supervised learning setting. Our generalized fairness measure reduces to well known notions of fairness available in literature. We derive learning guarantees for our method, that imply in particular its statistical consistency, both in terms of the risk and the fair…
Stanford University（斯坦福大学）；Université de Lorraine（洛林大学）；CNRS（法国国家科学研究中心）；Inria（法国国家信息与自动化研究所）
Guidelines for the management of atherosclerotic cardiovascular disease (ASCVD) recommend the use of risk stratification models to identify patients most likely to benefit from cholesterol-lowering and other therapies. These models have differential performance across race and gender groups with inconsistent behavior across studies, potentially resulting in an inequitable distribution of beneficial therapy. In this work, we leverage adversarial learning and a large observational cohort extracted from electronic health records (EHRs) to develop a "fair" ASCVD risk prediction model with reduced …
Where machine-learned predictive risk scores inform high-stakes decisions, such as bail and sentencing in criminal justice, fairness has been a serious concern. Recent work has characterized the disparate impact that such risk scores can have when used for a binary classification task. This may not account, however, for the more diverse downstream uses of risk scores and their non-binary nature. To better account for this, in this paper, we investigate the fairness of predictive risk scores from the point of view of a bipartite ranking task, where one seeks to rank positive examples higher tha…
Sorbonne Université（索邦大学）；CNRS（法国国家科学研究中心）；AXA Group（安盛集团）；Université du Québec à Montréal（魁北克大学蒙特利尔分校）
At the core of insurance business lies classification between risky and non-risky insureds, actuarial fairness meaning that risky insureds should contribute more and pay a higher premium than non-risky or less-risky ones. Actuaries, therefore, use econometric or machine learning techniques to classify, but the distinction between a fair actuarial classification and "discrimination" is subtle. For this reason, there is a growing interest about fairness and discrimination in the actuarial community Lindholm, Richman, Tsanakas, and Wuthrich (2022). Presumably, non-sensitive characteristics can se…
Copula Based Fusion of Clinical and Genomic Machine Learning Risk Scores for Breast Cancer Risk Stratification
Department of Mathematics, University of Louisiana at Lafayette（路易斯安那州立大学拉斐特分校数学系）；Department of Physical Sciences & Mathematics, West Liberty University（韦斯特里布利大学物理科学与数学系）；Department of Mathematics and Statistics, Minnesota State University（明尼苏达州立大学数学与统计学系）
Risk assessment algorithms have been correctly criticized for potential unfairness, and there is an active cottage industry trying to make repairs. In this paper, we adopt a framework from conformal prediction sets to remove unfairness from risk algorithms themselves and the covariates used for forecasting. From a sample of 300,000 offenders at their arraignments, we construct a confusion table and its derived measures of fairness that are effectively free any meaningful differences between Black and White offenders. We also produce fair forecasts for individual offenders coupled with valid pr…
The distribution of health care payments to insurance plans has substantial consequences for social policy. Risk adjustment formulas predict spending in health insurance markets in order to provide fair benefits and health care coverage for all enrollees, regardless of their health status. Unfortunately, current risk adjustment formulas are known to underpredict spending for specific groups of enrollees leading to undercompensated payments to health insurers. This incentivizes insurers to design their plans such that individuals in undercompensated groups will be less likely to enroll, impacti…
PAC-Bayesian Generalization Guarantees for Fairness on Stochastic and Deterministic Classifiers
CNRS（法国国家科学研究中心）；Institut d Optique Graduate School（高等光学学院）；Inria（法国国家信息与自动化研究所）；Institut Universitaire de France（法国大学研究院）；Universite Claude Bernard Lyon 1（里昂第一大学）；Univ Rennes（雷恩大学）
Carnegie Mellon University（卡内基梅隆大学）；Highmark Health（高马克健康）；Allegheny Health Network（阿勒格尼健康网络）
With COVID-19 now pervasive, identification of high-risk individuals is crucial. Using data from a major healthcare provider in Southwestern Pennsylvania, we develop survival models predicting severe COVID-19 progression. In this endeavor, we face a tradeoff between more accurate models relying on many features and less accurate models relying on a few features aligned with clinician intuition. Complicating matters, many EHR features tend to be under-coded, degrading the accuracy of smaller models. In this study, we develop two sets of high-performance risk scores: (i) an unconstrained model b…
Cornell University（康奈尔大学）；Michigan State University（密歇根州立大学）；University of Michigan（密歇根大学）；Oregon Health & Science University（俄勒冈健康与科学大学）
In recent years, increasingly augmentation of health data, such as patient Electronic Health Records (EHR), are becoming readily available. This provides an unprecedented opportunity for knowledge discovery and data mining algorithms to dig insights from them, which can, later on, be helpful to the improvement of the quality of care delivery. Predictive modeling of clinical risk, including in-hospital mortality, hospital readmission, chronic disease onset, condition exacerbation, etc., from patient EHR, is one of the health data analytic problems that attract most of the interests. The reason …
Imperial College London（帝国理工学院）；MRC London Institute of Medical Sciences（MRC伦敦医学科学研究所）
In this work, a novel approach is proposed for joint analysis of high dimensional time-resolved cardiac motion features obtained from segmented cardiac MRI and low dimensional clinical risk factors to improve survival prediction in heart failure. Different methods are evaluated to find the optimal way to insert conventional covariates into deep prediction networks. Correlation analysis between autoencoder latent codes and covariate features is used to examine how these predictors interact. We believe that similar approaches could also be used to introduce knowledge of genetic variants to such …
In this work we formulate and formally characterize group fairness as a multi-objective optimization problem, where each sensitive group risk is a separate objective. We propose a fairness criterion where a classifier achieves minimax risk and is Pareto-efficient w.r.t. all groups, avoiding unnecessary harm, and can lead to the best zero-gap model if policy dictates so. We provide a simple optimization algorithm compatible with deep neural networks to satisfy these constraints. Since our method does not require test-time access to sensitive attributes, it can be applied to reduce worst-case cl…
We consider a variation on the classical finance problem of optimal portfolio design. In our setting, a large population of consumers is drawn from some distribution over risk tolerances, and each consumer must be assigned to a portfolio of lower risk than her tolerance. The consumers may also belong to underlying groups (for instance, of demographic properties or wealth), and the goal is to design a small number of portfolios that are fair across groups in a particular and natural technical sense. Our main results are algorithms for optimal and near-optimal portfolio design for both social we…
