Cited by 83Machine Learning in HealthcareEthics and Social Impacts of AIArtificial Intelligence in Healthcare and Education

Assessing Socioeconomic Bias in Machine Learning Algorithms in Health Care: A Case Study of the HOUSES Index

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Juhn, Young J, Ryu, Euijung, Wi, Chung-Il, King, Katherine S, Malik, Momin, Romero-Brufau, Santiago, Weng, Chunhua, Sohn, Sunghwan +2 more·2022·Journal of the American Medical Informatics Association

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Abstract

Objective: Artificial intelligence (AI) models may propagate harmful biases in performance and hence negatively affect the underserved. We aimed to assess the degree to which data quality of electronic health records (EHRs) affected by inequities related to low socioeconomic status (SES), results in differential performance of AI models across SES. Materials and Methods: This study utilized existing machine learning models for predicting asthma exacerbation in children with asthma. We compared balanced error rate (BER) against different SES levels measured by HOUsing-based SocioEconomic Status measure (HOUSES) index. As a possible mechanism for differential performance, we also compared incompleteness of EHR information relevant to asthma care by SES. Results: Asthmatic children with lower SES had larger BER than those with higher SES (eg, ratio = 1.35 for HOUSES Q1 vs Q2–Q4) and had a higher proportion of missing information relevant to asthma care (eg, 41% vs 24% for missing asthma severity and 12% vs 9.8% for undiagnosed asthma despite meeting asthma criteria). Discussion: Our study suggests that lower SES is associated with worse predictive model performance. It also highlights the potential role of incomplete EHR data in this differential performance and suggests a way to mitigate this bias. Conclusion: The HOUSES index allows AI researchers to assess bias in predictive model performance by SES. Although our case study was based on a small sample size and a single-site study, the study results highlight a potential strategy for identifying bias by using an innovative SES measure.

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Research works printed but not linked: 3

  1. Warnecke RB, Oh A, Breen N, et al. Approaching health disparities from a population perspective: the National Institutes of Health Centers for Population Health and Health Disparities. Am J Public Health. 2008;98(9):1608-1615.
  2. Narayanan A. Translation tutorial: 21 fairness definitions and their politics. Paper presented at: Proc. Conf. Fairness Accountability Transp., New York, USA2018.
  3. Hammer R, Capili C, Wi C-I, Ryu E, Rand-Weaver J, Juhn YJ. A new socioeconomic status measure for vaccine research in children using individual housing data: a population-based case-control study. BMC Public Health. 2016;16(1):1-9.

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Authors
Juhn, Y. J., Ryu, E., Wi, C.-I., King, K. S., Malik, M., Romero-Brufau, S., Weng, C., Sohn, S., Sharp, R. R., & Halamka, J. D.
Affiliations
  • Mayo Clinic (US)
  • Department of Internal Medicine, Mayo Clinic , Rochester, Minnesota, USA
  • Columbia University (US)
Corresponding author
Juhn, Young J
Venue
Journal of the American Medical Informatics Association
Published
2022-04-09
Volume
29
Issue
7
Pages
1142-1151
ISSN
  • 1067-5027 (ISSN-L)
  • 1527-974X
OpenAlex
W4223468055
Cited by
83
References
82
Citations by year
2026: 21 · 2025: 36 · 2024: 16 · 2023: 8 · 2022: 2
FWCI
5.10
Type
journal article
Language
en
Open access
Locations
  • Journal of the American Medical Informatics Association (publishedVersion)
  • medRxiv (acceptedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Health (NIH)-funded (R01 grant (R01 HL126667), R21 grant (R21AG65639), R21 grant (R21AI142702))
Topics
  • Physical Sciences › Computer Science › Artificial Intelligence › Machine Learning in Healthcare
  • Social Sciences › Safety Research › Ethics and Social Impacts of AI
  • Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
Keywords
socioeconomic bias, algorithmic bias, socioeconomic status, electronic health records, data quality, missing data, asthma exacerbation prediction, childhood asthma, health care inequities, prediction model performance
MeSH terms
Machine Learning, Artificial Intelligence, Asthma, Child, Delivery of Health Care, Humans, Social Class, Bias

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