针对医疗影像多属性公平性,提出最差群体等效几率正则化方法。
Worst-Group Equalized Odds Regularization for Multi-Attribute Fair Medical Image Classification

- 通过识别表现最差的群体,统一惩罚其真假阳性偏差。
- 在两个真实多标签数据集上显著降低公平性差距,仅轻微影响AUC。
- 无需交集约束,可同时优化多个社会属性的公平性。
医疗AI的诊断性能在不同人口群体间存在系统性差异,但总体AUC可能掩盖临床重要不平等。在固定推理阈值下,某些群体表现出过度诊断(真阳、假阳率高),另一些则出现诊断不足(真阳、假阳率低)。这些相反趋势在整体AUC中相互抵消,却导致临床决策中的实质性不公平。为在操作点和多个社会属性上同时评估与缓解此类差异,本文提出最差群体等效几率边缘正则化器。该方法在每轮更新中识别由年龄、性别、种族等显式属性定义的边际偏差最大的子群体,并施加统一惩罚,实现多属性公平优化,无需显式交集约束。在两个真实医学影像数据集的多标签设置下,本方法持续降低等效几率与等效机会的差异,对AUC影响极小,既保持诊断性能又提升公平性。
原文摘要 · Abstract (English)
Diagnostic performance in medical AI varies systematically across demographic groups, yet subgroup AUC can mask clinically important disparities. At a fixed inference-time operating point, some groups may exhibit over-diagnostic behaviour, characterized by elevated true and false positive rates, while others show under-diagnostic patterns with reduced true and false positive rates. These opposing tendencies can cancel in aggregate AUCs while producing meaningful inequities in clinical decision-making. Motivated by the need to assess and mitigate such disparities at the operating point and across multiple demographic attributes simultaneously, we propose a worst-group equalized-odds margin regularizer. The proposed regularizer explicitly targets subgroup-level deviations on both the true positive and false positive sides at inference. At each update, the method identifies subgroups defined by explicit demographic attributes (e.g., age, sex, and race) that exhibit the most extreme margin deviations and applies a unified penalty, enabling fairness optimization across multiple demographic axes without requiring explicit intersectional constraints. Across two medical imaging datasets in realistic multi-label settings, our method consistently reduces disparities in Equalized Odds and Equalized Opportunity with minimal impact on AUC, preserving diagnostic performance while improving fairness.
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