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Register a new userCounterfactual Reasoning for Fair Clinical Risk Prediction
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Stephen Pfohl
Publication date
2019
fields
Informatics Engineering
and research's language is
English
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The use of machine learning systems to support decision making in healthcare raises questions as to what extent these systems may introduce or exacerbate disparities in care for historically underrepresented and mistreated groups, due to biases implicitly embedded in observational data in electronic health records. To address this problem in the context of clinical risk prediction models, we develop an augmented counterfactual fairness criteria to extend the group fairness criteria of equalized odds to an individual level. We do so by requiring that the same prediction be made for a patient, and a counterfactual patient resulting from changing a sensitive attribute, if the factual and counterfactual outcomes do not differ. We investigate the extent to which the augmented counterfactual fairness criteria may be applied to develop fair models for prolonged inpatient length of stay and mortality with observational electronic health records data. As the fairness criteria is ill-defined without knowledge of the data generating process, we use a variational autoencoder to perform counterfactual inference in the context of an assumed causal graph. While our technique provides a means to trade off maintenance of fairness with reduction in predictive performance in the context of a learned generative model, further work is needed to assess the generality of this approach.
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The use of machine learning to guide clinical decision making has the potential to worsen existing health disparities. Several recent works frame the problem as that of algorithmic fairness, a framework that has attracted considerable attention and criticism. However, the appropriateness of this framework is unclear due to both ethical as well as technical considerations, the latter of which include trade-offs between measures of fairness and model performance that are not well-understood for predictive models of clinical outcomes. To inform the ongoing debate, we conduct an empirical study to characterize the impact of penalizing group fairness violations on an array of measures of model performance and group fairness. We repeat the analyses across multiple observational healthcare databases, clinical outcomes, and sensitive attributes. We find that procedures that penalize differences between the distributions of predictions across groups induce nearly-universal degradation of multiple performance metrics within groups. On examining the secondary impact of these procedures, we observe heterogeneity of the effect of these procedures on measures of fairness in calibration and ranking across experimental conditions. Beyond the reported trade-offs, we emphasize that analyses of algorithmic fairness in healthcare lack the contextual grounding and causal awareness necessary to reason about the mechanisms that lead to health disparities, as well as about the potential of algorithmic fairness methods to counteract those mechanisms. In light of these limitations, we encourage researchers building predictive models for clinical use to step outside the algorithmic fairness frame and engage critically with the broader sociotechnical context surrounding the use of machine learning in healthcare.
Bias mitigation approaches reduce models dependence on sensitive features of data, such as social group tokens (SGTs), resulting in equal predictions across the sensitive features. In hate speech detection, however, equalizing model predictions may ignore important differences among targeted social groups, as hate speech can contain stereotypical language specific to each SGT. Here, to take the specific language about each SGT into account, we rely on counterfactual fairness and equalize predictions among counterfactuals, generated by changing the SGTs. Our method evaluates the similarity in sentence likelihoods (via pre-trained language models) among counterfactuals, to treat SGTs equally only within interchangeable contexts. By applying logit pairing to equalize outcomes on the restricted set of counterfactuals for each instance, we improve fairness metrics while preserving model performance on hate speech detection.
Algorithmic risk assessments are increasingly used to help humans make decisions in high-stakes settings, such as medicine, criminal justice and education. In each of these cases, the purpose of the risk assessment tool is to inform actions, such as medical treatments or release conditions, often with the aim of reducing the likelihood of an adverse event such as hospital readmission or recidivism. Problematically, most tools are trained and evaluated on historical data in which the outcomes observed depend on the historical decision-making policy. These tools thus reflect risk under the historical policy, rather than under the different decision options that the tool is intended to inform. Even when tools are constructed to predict risk under a specific decision, they are often improperly evaluated as predictors of the target outcome. Focusing on the evaluation task, in this paper we define counterfactual analogues of common predictive performance and algorithmic fairness metrics that we argue are better suited for the decision-making context. We introduce a new method for estimating the proposed metrics using doubly robust estimation. We provide theoretical results that show that only under strong conditions can fairness according to the standard metric and the counterfactual metric simultaneously hold. Consequently, fairness-promoting methods that target parity in a standard fairness metric may --- and as we show empirically, do --- induce greater imbalance in the counterfactual analogue. We provide empirical comparisons on both synthetic data and a real world child welfare dataset to demonstrate how the proposed method improves upon standard practice.
Although recent multi-task learning methods have shown to be effective in improving the generalization of deep neural networks, they should be used with caution for safety-critical applications, such as clinical risk prediction. This is because even if they achieve improved task-average performance, they may still yield degraded performance on individual tasks, which may be critical (e.g., prediction of mortality risk). Existing asymmetric multi-task learning methods tackle this negative transfer problem by performing knowledge transfer from tasks with low loss to tasks with high loss. However, using loss as a measure of reliability is risky since it could be a result of overfitting. In the case of time-series prediction tasks, knowledge learned for one task (e.g., predicting the sepsis onset) at a specific timestep may be useful for learning another task (e.g., prediction of mortality) at a later timestep, but lack of loss at each timestep makes it difficult to measure the reliability at each timestep. To capture such dynamically changing asymmetric relationships between tasks in time-series data, we propose a novel temporal asymmetric multi-task learning model that performs knowledge transfer from certain tasks/timesteps to relevant uncertain tasks, based on feature-level uncertainty. We validate our model on multiple clinical risk prediction tasks against various deep learning models for time-series prediction, which our model significantly outperforms, without any sign of negative transfer. Further qualitative analysis of learned knowledge graphs by clinicians shows that they are helpful in analyzing the predictions of the model. Our final code is available at https://github.com/anhtuan5696/TPAMTL.
Fairness concerns about algorithmic decision-making systems have been mainly focused on the outputs (e.g., the accuracy of a classifier across individuals or groups). However, one may additionally be concerned with fairness in the inputs. In this paper, we propose and formulate two properties regarding the inputs of (features used by) a classifier. In particular, we claim that fair privacy (whether individuals are all asked to reveal the same information) and need-to-know (whether users are only asked for the minimal information required for the task at hand) are desirable properties of a decision system. We explore the interaction between these properties and fairness in the outputs (fair prediction accuracy). We show that for an optimal classifier these three properties are in general incompatible, and we explain what common properties of data make them incompatible. Finally we provide an algorithm to verify if the trade-off between the three properties exists in a given dataset, and use the algorithm to show that this trade-off is common in real data.
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