The Boundaries of Fair AI in Medical Image Prognosis: A Causal Perspective

Thai-Hoang Pham, Jiayuan Chen, Seungyeon Lee, Yuanlong Wang, Sayoko E. Moroi, Xueru Zhang, Ping Zhang

Keywords: fairness, time-to-event, survival analysis, bias, distribution shift, causal

TL;DR: FairTTE is the first comprehensive framework for analyzing fairness in time-to-event prediction using medical imaging, revealing widespread bias across modalities and the limitations of existing fairness methods, especially under distribution shifts.

Abstract: As machine learning (ML) algorithms are increasingly used in medical image analysis, concerns have emerged about their potential biases against certain social groups. Although many approaches have been proposed to ensure the fairness of ML models, most existing works focus only on medical image diagnosis tasks, such as image classification and segmentation, and overlooked prognosis scenarios, which involve predicting the likely outcome or progression of a medical condition over time. To address this gap, we introduce FairTTE, the first comprehensive framework for assessing fairness in time-to-event (TTE) prediction in medical imaging. FairTTE encompasses a diverse range of imaging modalities and TTE outcomes, integrating cutting-edge TTE prediction and fairness algorithms to enable systematic and fine-grained analysis of fairness in medical image prognosis. Leveraging causal analysis techniques, FairTTE uncovers and quantifies distinct sources of bias embedded within medical imaging datasets. Our large-scale evaluation reveals that bias is pervasive across different imaging modalities and that current fairness methods offer limited mitigation. We further demonstrate a strong association between underlying bias sources and model disparities, emphasizing the need for holistic approaches that target all forms of bias. Notably, we find that fairness becomes increasingly difficult to maintain under distribution shifts, underscoring the limitations of existing solutions and the pressing need for more robust, equitable prognostic models.

Primary Area: Social and economic aspects of machine learning (e.g., fairness, interpretability, human-AI interaction, privacy, safety, strategic behavior)

Submission Number: 17685