arXiv:2510.20629cs.LGcs.AI2025-10被引 2

提出FASM方法,让生存模型在预测时更公平地对待不同群体。

Equitable Survival Prediction: A Fairness-Aware Survival Modeling (FASM) Approach

  • 引入公平性感知的生存建模框架,兼顾组内与组间风险排序公平。
  • 在SEER乳腺癌数据上,10年随访中公平性显著提升,中期效果最佳。
  • 适合关注医疗算法公平性的临床研究者与模型开发者使用。

随着机器学习在医疗中的广泛应用,临床数据中的结构性不平等和社会偏见可能被数据驱动模型延续甚至放大。生存分析中,删失和时间动态进一步增加了公平建模的复杂性。现有算法公平性方法常忽略跨群体排名差异,例如高风险黑人患者可能被排在未发生死亡事件的低风险白人患者之下,这种错误排序可能强化生物本质主义,损害公平诊疗。本文提出公平性感知生存建模(FASM),旨在缓解模型在时间维度上的组内与组间风险排序偏差。以乳腺癌预后为例,在应用FASM于SEER乳腺癌数据集时,模型显著改善了公平性,同时保持与无公平性意识模型相当的判别性能。分层时间评估显示,FASM在长达10年的随访期内维持稳定公平性,中段随访期改善最为明显。该方法推动生存模型在临床决策中兼顾准确性与公平性,将公平性作为临床护理的核心原则。

原文摘要 · Abstract (English)

As machine learning models become increasingly integrated into healthcare, structural inequities and social biases embedded in clinical data can be perpetuated or even amplified by data-driven models. In survival analysis, censoring and time dynamics can further add complexity to fair model development. Additionally, algorithmic fairness approaches often overlook disparities in cross-group rankings, e.g., high-risk Black patients may be ranked below lower-risk White patients who do not experience the event of mortality. Such misranking can reinforce biological essentialism and undermine equitable care. We propose a Fairness-Aware Survival Modeling (FASM), designed to mitigate algorithmic bias regarding both intra-group and cross-group risk rankings over time. Using breast cancer prognosis as a representative case and applying FASM to SEER breast cancer data, we show that FASM substantially improves fairness while preserving discrimination performance comparable to fairness-unaware survival models. Time-stratified evaluations show that FASM maintains stable fairness over a 10-year horizon, with the greatest improvements observed during the mid-term of follow-up. Our approach enables the development of survival models that prioritize both accuracy and equity in clinical decision-making, advancing fairness as a core principle in clinical care.

生存分析算法公平医疗AI乳腺癌

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