arXiv:2508.05435cs.LG2025-08被引 2

忽略竞争风险会高估风险,加剧算法不公平,尤其影响高危人群。

Competing Risks: Impact on Risk Estimation and Algorithmic Fairness

  • 将竞争风险误作删失会引入系统性偏差,导致生存估计偏高。
  • 实证分析显示,忽略竞争风险会使高危群体风险被严重低估。
  • 研究揭示了医疗预测模型中公平性问题,提醒建模需考虑竞争风险。

准确的时间到事件预测对医疗指南、招聘决策和资源分配至关重要。生存分析是建模时间到事件数据的量化框架,能处理未观察到事件的受试者(即删失患者)。然而,许多患者会经历阻止观察目标事件发生的其他事件,这些称为竞争风险。当前常将竞争风险视为删失,这一做法因对其后果理解不足而被忽视。本文从理论上证明,将竞争风险当作删失会引入显著偏差,导致风险估计系统性偏高,并可能放大不平等。我们构建框架量化该误差,揭示其对预测性能和算法公平性的影响。进一步分析发现,不同人口群体的风险特征差异会导致群体特异性误差,加剧现有不公。基于心血管管理的真实数据分析表明,忽略竞争风险会不成比例地影响最易患病人群,可能加剧不平等。本研究强调,在构建生存模型时必须考虑竞争风险,以提升准确性、减少评估差异,更好支持后续决策。

原文摘要 · Abstract (English)

Accurate time-to-event prediction is integral to decision-making, informing medical guidelines, hiring decisions, and resource allocation. Survival analysis, the quantitative framework used to model time-to-event data, accounts for patients who do not experience the event of interest during the study period, known as censored patients. However, many patients experience events that prevent the observation of the outcome of interest. These competing risks are often treated as censoring, a practice frequently overlooked due to a limited understanding of its consequences. Our work theoretically demonstrates why treating competing risks as censoring introduces substantial bias in survival estimates, leading to systematic overestimation of risk and, critically, amplifying disparities. First, we formalize the problem of misclassifying competing risks as censoring and quantify the resulting error in survival estimates. Specifically, we develop a framework to estimate this error and demonstrate the associated implications for predictive performance and algorithmic fairness. Furthermore, we examine how differing risk profiles across demographic groups lead to group-specific errors, potentially exacerbating existing disparities. Our findings, supported by an empirical analysis of cardiovascular management, demonstrate that ignoring competing risks disproportionately impacts the individuals most at risk of these events, potentially accentuating inequity. By quantifying the error and highlighting the fairness implications of the common practice of considering competing risks as censoring, our work provides a critical insight into the development of survival models: practitioners must account for competing risks to improve accuracy, reduce disparities in risk assessment, and better inform downstream decisions.

生存分析算法公平竞争风险医疗预测

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