Unmasking Bias and Inequities: A Systematic Review of Bias Detection and Mitigation in Healthcare Artificial Intelligence Using Electronic Health Records

Objectives: Artificial intelligence (AI) applications utilizing electronic health records (EHRs) have gained popularity, but they also introduce various types of bias. This study aims to systematically review the literature that address bias in AI research utilizing EHR data. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. We retrieved articles published between January 1, 2010, and October 31, 2022, from PubMed, Web of Science, and the Institute of Electrical and Electronics Engineers. We defined six major types of bias and summarized the existing approaches in bias handling. Results: Out of the 252 retrieved articles, 20 met the inclusion criteria for the final review. Five out of six bias were covered in this review: eight studies analyzed selection bias; six on implicit bias; five on confounding bias; four on measurement bias; two on algorithmic bias. For bias handling approaches, ten studies identified bias during model development, while seventeen presented methods to mitigate the bias. Discussion: Bias may infiltrate the AI application development process at various stages. Although this review discusses methods for addressing bias at different development stages, there is room for implementing additional effective approaches. Conclusion: Despite growing attention to bias in healthcare AI, research using EHR data on this topic is still limited. Detecting and mitigating AI bias with EHR data continues to pose challenges. Further research is needed to raise a standardized method that is generalizable and interpretable to detect, mitigate and evaluate bias in medical AI.

Counterpart Fairness -- Addressing Systematic between-group Differences in Fairness Evaluation

When using machine learning (ML) to aid decision-making, it is critical to ensure that an algorithmic decision is fair, i.e., it does not discriminate against specific individuals/groups, particularly those from underprivileged populations. Existing group fairness methods require equal group-wise measures, which however fails to consider systematic between-group differences. The confounding factors, which are non-sensitive variables but manifest systematic differences, can significantly affect fairness evaluation. To mitigate this problem, we believe that a fairness measurement should be based on the comparison between counterparts (i.e., individuals who are similar to each other with respect to the task of interest) from different groups, whose group identities cannot be distinguished algorithmically by exploring confounding factors. We have developed a propensity-score-based method for identifying counterparts, which prevents fairness evaluation from comparing "oranges" with "apples". In addition, we propose a counterpart-based statistical fairness index, termed Counterpart-Fairness (CFair), to assess fairness of ML models. Empirical studies on the Medical Information Mart for Intensive Care (MIMIC)-IV database were conducted to validate the effectiveness of CFair. We publish our code at \url{https://github.com/zhengyjo/CFair}.