An Algorithmic Approach for Causal Health Equity: A Look at Race Differentials in Intensive Care Unit (ICU) Outcomes

The new era of large-scale data collection and analysis presents an opportunity for diagnosing and understanding the causes of health inequities. In this study, we describe a framework for systematically analyzing health disparities using causal inference. The framework is illustrated by investigating racial and ethnic disparities in intensive care unit (ICU) outcome between majority and minority groups in Australia (Indigenous vs. Non-Indigenous) and the United States (African-American vs. White). We demonstrate that commonly used statistical measures for quantifying inequity are insufficient, and focus on attributing the observed disparity to the causal mechanisms that generate it. We find that minority patients are younger at admission, have worse chronic health, are more likely to be admitted for urgent and non-elective reasons, and have higher illness severity. At the same time, however, we find a protective direct effect of belonging to a minority group, with minority patients showing improved survival compared to their majority counterparts, with all other variables kept equal. We demonstrate that this protective effect is related to the increased probability of being admitted to ICU, with minority patients having an increased risk of ICU admission. We also find that minority patients, while showing improved survival, are more likely to be readmitted to ICU. Thus, due to worse access to primary health care, minority patients are more likely to end up in ICU for preventable conditions, causing a reduction in the mortality rates and creating an effect that appears to be protective. Since the baseline risk of ICU admission may serve as proxy for lack of access to primary care, we developed the Indigenous Intensive Care Equity (IICE) Radar, a monitoring system for tracking the over-utilization of ICU resources by the Indigenous population of Australia across geographical areas.

Testing Causal Models with Hidden Variables in Polynomial Delay via Conditional Independencies

Testing a hypothesized causal model against observational data is a key prerequisite for many causal inference tasks. A natural approach is to test whether the conditional independence relations (CIs) assumed in the model hold in the data. While a model can assume exponentially many CIs (with respect to the number of variables), testing all of them is both impractical and unnecessary. Causal graphs, which encode these CIs in polynomial space, give rise to local Markov properties that enable model testing with a significantly smaller subset of CIs. Model testing based on local properties requires an algorithm to list the relevant CIs. However, existing algorithms for realistic settings with hidden variables and non-parametric distributions can take exponential time to produce even a single CI constraint. In this paper, we introduce the c-component local Markov property (C-LMP) for causal graphs with hidden variables. Since C-LMP can still invoke an exponential number of CIs, we develop a polynomial delay algorithm to list these CIs in poly-time intervals. To our knowledge, this is the first algorithm that enables poly-delay testing of CIs in causal graphs with hidden variables against arbitrary data distributions. Experiments on real-world and synthetic data demonstrate the practicality of our algorithm.

Fairness-Accuracy Trade-Offs: A Causal Perspective

Systems based on machine learning may exhibit discriminatory behavior based on sensitive characteristics such as gender, sex, religion, or race. In light of this, various notions of fairness and methods to quantify discrimination were proposed, leading to the development of numerous approaches for constructing fair predictors. At the same time, imposing fairness constraints may decrease the utility of the decision-maker, highlighting a tension between fairness and utility. This tension is also recognized in legal frameworks, for instance in the disparate impact doctrine of Title VII of the Civil Rights Act of 1964 -- in which specific attention is given to considerations of business necessity -- possibly allowing the usage of proxy variables associated with the sensitive attribute in case a high-enough utility cannot be achieved without them. In this work, we analyze the tension between fairness and accuracy from a causal lens for the first time. We introduce the notion of a path-specific excess loss (PSEL) that captures how much the predictor's loss increases when a causal fairness constraint is enforced. We then show that the total excess loss (TEL), defined as the difference between the loss of predictor fair along all causal pathways vs. an unconstrained predictor, can be decomposed into a sum of more local PSELs. At the same time, enforcing a causal constraint often reduces the disparity between demographic groups. Thus, we introduce a quantity that summarizes the fairness-utility trade-off, called the causal fairness/utility ratio, defined as the ratio of the reduction in discrimination vs. the excess loss from constraining a causal pathway. This quantity is suitable for comparing the fairness-utility trade-off across causal pathways. Finally, as our approach requires causally-constrained fair predictors, we introduce a new neural approach for causally-constrained fair learning.

Mind the Gap: A Causal Perspective on Bias Amplification in Prediction & Decision-Making

Investigating fairness and equity of automated systems has become a critical field of inquiry. Most of the literature in fair machine learning focuses on defining and achieving fairness criteria in the context of prediction, while not explicitly focusing on how these predictions may be used later on in the pipeline. For instance, if commonly used criteria, such as independence or sufficiency, are satisfied for a prediction score $S$ used for binary classification, they need not be satisfied after an application of a simple thresholding operation on $S$ (as commonly used in practice). In this paper, we take an important step to address this issue in numerous statistical and causal notions of fairness. We introduce the notion of a margin complement, which measures how much a prediction score $S$ changes due to a thresholding operation. We then demonstrate that the marginal difference in the optimal 0/1 predictor $\widehat Y$ between groups, written $P(\hat y \mid x_1) - P(\hat y \mid x_0)$, can be causally decomposed into the influences of $X$ on the $L_2$-optimal prediction score $S$ and the influences of $X$ on the margin complement $M$, along different causal pathways (direct, indirect, spurious). We then show that under suitable causal assumptions, the influences of $X$ on the prediction score $S$ are equal to the influences of $X$ on the true outcome $Y$. This yields a new decomposition of the disparity in the predictor $\widehat Y$ that allows us to disentangle causal differences inherited from the true outcome $Y$ that exists in the real world vs. those coming from the optimization procedure itself. This observation highlights the need for more regulatory oversight due to the potential for bias amplification, and to address this issue we introduce new notions of weak and strong business necessity, together with an algorithm for assessing whether these notions are satisfied.

Neural Causal Abstractions

The abilities of humans to understand the world in terms of cause and effect relationships, as well as to compress information into abstract concepts, are two hallmark features of human intelligence. These two topics have been studied in tandem in the literature under the rubric of causal abstractions theory. In practice, it remains an open problem how to best leverage abstraction theory in real-world causal inference tasks, where the true mechanisms are unknown and only limited data is available. In this paper, we develop a new family of causal abstractions by clustering variables and their domains. This approach refines and generalizes previous notions of abstractions to better accommodate individual causal distributions that are spawned by Pearl's causal hierarchy. We show that such abstractions are learnable in practical settings through Neural Causal Models (Xia et al., 2021), enabling the use of the deep learning toolkit to solve various challenging causal inference tasks -- identification, estimation, sampling -- at different levels of granularity. Finally, we integrate these results with representation learning to create more flexible abstractions, moving these results closer to practical applications. Our experiments support the theory and illustrate how to scale causal inferences to high-dimensional settings involving image data.

Reconciling Predictive and Statistical Parity: A Causal Approach

Since the rise of fair machine learning as a critical field of inquiry, many different notions on how to quantify and measure discrimination have been proposed in the literature. Some of these notions, however, were shown to be mutually incompatible. Such findings make it appear that numerous different kinds of fairness exist, thereby making a consensus on the appropriate measure of fairness harder to reach, hindering the applications of these tools in practice. In this paper, we investigate one of these key impossibility results that relates the notions of statistical and predictive parity. Specifically, we derive a new causal decomposition formula for the fairness measures associated with predictive parity, and obtain a novel insight into how this criterion is related to statistical parity through the legal doctrines of disparate treatment, disparate impact, and the notion of business necessity. Our results show that through a more careful causal analysis, the notions of statistical and predictive parity are not really mutually exclusive, but complementary and spanning a spectrum of fairness notions through the concept of business necessity. Finally, we demonstrate the importance of our findings on a real-world example.

A Causal Framework for Decomposing Spurious Variations

One of the fundamental challenges found throughout the data sciences is to explain why things happen in specific ways, or through which mechanisms a certain variable $X$ exerts influences over another variable $Y$. In statistics and machine learning, significant efforts have been put into developing machinery to estimate correlations across variables efficiently. In causal inference, a large body of literature is concerned with the decomposition of causal effects under the rubric of mediation analysis. However, many variations are spurious in nature, including different phenomena throughout the applied sciences. Despite the statistical power to estimate correlations and the identification power to decompose causal effects, there is still little understanding of the properties of spurious associations and how they can be decomposed in terms of the underlying causal mechanisms. In this manuscript, we develop formal tools for decomposing spurious variations in both Markovian and Semi-Markovian models. We prove the first results that allow a non-parametric decomposition of spurious effects and provide sufficient conditions for the identification of such decompositions. The described approach has several applications, ranging from explainable and fair AI to questions in epidemiology and medicine, and we empirically demonstrate its use on a real-world dataset.

Causal Fairness for Outcome Control

As society transitions towards an AI-based decision-making infrastructure, an ever-increasing number of decisions once under control of humans are now delegated to automated systems. Even though such developments make various parts of society more efficient, a large body of evidence suggests that a great deal of care needs to be taken to make such automated decision-making systems fair and equitable, namely, taking into account sensitive attributes such as gender, race, and religion. In this paper, we study a specific decision-making task called outcome control in which an automated system aims to optimize an outcome variable $Y$ while being fair and equitable. The interest in such a setting ranges from interventions related to criminal justice and welfare, all the way to clinical decision-making and public health. In this paper, we first analyze through causal lenses the notion of benefit, which captures how much a specific individual would benefit from a positive decision, counterfactually speaking, when contrasted with an alternative, negative one. We introduce the notion of benefit fairness, which can be seen as the minimal fairness requirement in decision-making, and develop an algorithm for satisfying it. We then note that the benefit itself may be influenced by the protected attribute, and propose causal tools which can be used to analyze this. Finally, if some of the variations of the protected attribute in the benefit are considered as discriminatory, the notion of benefit fairness may need to be strengthened, which leads us to articulating a notion of causal benefit fairness. Using this notion, we develop a new optimization procedure capable of maximizing $Y$ while ascertaining causal fairness in the decision process.

Nonparametric Identifiability of Causal Representations from Unknown Interventions

We study causal representation learning, the task of inferring latent causal variables and their causal relations from high-dimensional functions ("mixtures") of the variables. Prior work relies on weak supervision, in the form of counterfactual pre- and post-intervention views or temporal structure; places restrictive assumptions, such as linearity, on the mixing function or latent causal model; or requires partial knowledge of the generative process, such as the causal graph or the intervention targets. We instead consider the general setting in which both the causal model and the mixing function are nonparametric. The learning signal takes the form of multiple datasets, or environments, arising from unknown interventions in the underlying causal model. Our goal is to identify both the ground truth latents and their causal graph up to a set of ambiguities which we show to be irresolvable from interventional data. We study the fundamental setting of two causal variables and prove that the observational distribution and one perfect intervention per node suffice for identifiability, subject to a genericity condition. This condition rules out spurious solutions that involve fine-tuning of the intervened and observational distributions, mirroring similar conditions for nonlinear cause-effect inference. For an arbitrary number of variables, we show that two distinct paired perfect interventions per node guarantee identifiability. Further, we demonstrate that the strengths of causal influences among the latent variables are preserved by all equivalent solutions, rendering the inferred representation appropriate for drawing causal conclusions from new data. Our study provides the first identifiability results for the general nonparametric setting with unknown interventions, and elucidates what is possible and impossible for causal representation learning without more direct supervision.

Finding and Listing Front-door Adjustment Sets

Identifying the effects of new interventions from data is a significant challenge found across a wide range of the empirical sciences. A well-known strategy for identifying such effects is Pearl's front-door (FD) criterion (Pearl, 1995). The definition of the FD criterion is declarative, only allowing one to decide whether a specific set satisfies the criterion. In this paper, we present algorithms for finding and enumerating possible sets satisfying the FD criterion in a given causal diagram. These results are useful in facilitating the practical applications of the FD criterion for causal effects estimation and helping scientists to select estimands with desired properties, e.g., based on cost, feasibility of measurement, or statistical power.