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Jul 9

Gender-Dependent Diagnostic Substitution in LLM Medical Triage: Same Symptoms, Unequal Urgency

We investigate whether large language models produce different medical triage recommendations for identical neurological symptoms when only the patient's stated gender and age vary. Using three model families--Gemini 3.5 Flash, Claude Sonnet 4.6, and GPT-5.4-mini--we present a standardized symptom profile (persistent headache, blurred vision, morning nausea, visual disturbances) across seven demographic conditions: three age groups (25, 38, 65) x two genders (male, female), plus a gender-unspecified baseline (n = 30 per condition per model, 630 total trials). We find a stark, systemic gender-dependent triage disparity: young women receive significantly lower emergency room (ER) referral rates than age-matched men (Gemini: 0% vs. 23.3%; Claude: 6.7% vs. 96.7%; GPT: 6.7% vs. 66.7%, all p < 0.001). The disparity disappears at age 65 for all models. The primary mechanism is diagnostic substitution: the models anchor on a gender-associated diagnosis, preferentially classifying young women with Idiopathic Intracranial Hypertension (IIH)--a condition epidemiologically linked to women of childbearing age--while diagnosing men with generic increased intracranial pressure with space-occupying lesions in the differential. This diagnostic closure routes female patients to lower-urgency care (outpatient doctor appointments) despite comparable severity ratings (7-9/10). Our findings demonstrate that clinical LLMs replicate documented human clinical biases by using epidemiological priors to suppress triage urgency, suggesting that AI triage engines must decouple urgency assessment from probabilistic diagnostic priors. We release all code, prompts, and raw results.

  • 1 authors
·
Jun 1

FACET: Fairness in Computer Vision Evaluation Benchmark

Computer vision models have known performance disparities across attributes such as gender and skin tone. This means during tasks such as classification and detection, model performance differs for certain classes based on the demographics of the people in the image. These disparities have been shown to exist, but until now there has not been a unified approach to measure these differences for common use-cases of computer vision models. We present a new benchmark named FACET (FAirness in Computer Vision EvaluaTion), a large, publicly available evaluation set of 32k images for some of the most common vision tasks - image classification, object detection and segmentation. For every image in FACET, we hired expert reviewers to manually annotate person-related attributes such as perceived skin tone and hair type, manually draw bounding boxes and label fine-grained person-related classes such as disk jockey or guitarist. In addition, we use FACET to benchmark state-of-the-art vision models and present a deeper understanding of potential performance disparities and challenges across sensitive demographic attributes. With the exhaustive annotations collected, we probe models using single demographics attributes as well as multiple attributes using an intersectional approach (e.g. hair color and perceived skin tone). Our results show that classification, detection, segmentation, and visual grounding models exhibit performance disparities across demographic attributes and intersections of attributes. These harms suggest that not all people represented in datasets receive fair and equitable treatment in these vision tasks. We hope current and future results using our benchmark will contribute to fairer, more robust vision models. FACET is available publicly at https://facet.metademolab.com/

  • 8 authors
·
Aug 31, 2023 2

Machine Learning with Multitype Protected Attributes: Intersectional Fairness through Regularisation

Ensuring equitable treatment (fairness) across protected attributes (such as gender or ethnicity) is a critical issue in machine learning. Most existing literature focuses on binary classification, but achieving fairness in regression tasks-such as insurance pricing or hiring score assessments-is equally important. Moreover, anti-discrimination laws also apply to continuous attributes, such as age, for which many existing methods are not applicable. In practice, multiple protected attributes can exist simultaneously; however, methods targeting fairness across several attributes often overlook so-called "fairness gerrymandering", thereby ignoring disparities among intersectional subgroups (e.g., African-American women or Hispanic men). In this paper, we propose a distance covariance regularisation framework that mitigates the association between model predictions and protected attributes, in line with the fairness definition of demographic parity, and that captures both linear and nonlinear dependencies. To enhance applicability in the presence of multiple protected attributes, we extend our framework by incorporating two multivariate dependence measures based on distance covariance: the previously proposed joint distance covariance (JdCov) and our novel concatenated distance covariance (CCdCov), which effectively address fairness gerrymandering in both regression and classification tasks involving protected attributes of various types. We discuss and illustrate how to calibrate regularisation strength, including a method based on Jensen-Shannon divergence, which quantifies dissimilarities in prediction distributions across groups. We apply our framework to the COMPAS recidivism dataset and a large motor insurance claims dataset.

  • 5 authors
·
Sep 9, 2025

Learning from Two Decades of Blood Pressure Data: Demography-Specific Patterns Across 75 Million Patient Encounters

Hypertension remains a global health concern with a rising prevalence, necessitating effective monitoring and understanding of blood pressure (BP) dynamics. This study delves into the wealth of information derived from BP measurement, a crucial approach in informing our understanding of hypertensive trends. Numerous studies have reported on the relationship between BP variation and various factors. In this research, we leveraged an extensive dataset comprising 75 million records spanning two decades, offering a unique opportunity to explore and analyze BP variations across demographic features such as age, race, and gender. Our findings revealed that gender-based BP variation was not statistically significant, challenging conventional assumptions. Interestingly, systolic blood pressure (SBP) consistently increased with age, while diastolic blood pressure (DBP) displayed a distinctive peak in the forties age group. Moreover, our analysis uncovered intriguing similarities in the distribution of BP among some of the racial groups. This comprehensive investigation contributes to the ongoing discourse on hypertension and underscores the importance of considering diverse demographic factors in understanding BP variations. Our results provide valuable insights that may inform personalized healthcare approaches tailored to specific demographic profiles.

  • 4 authors
·
Feb 2, 2024

Adaptive Sampling Strategies to Construct Equitable Training Datasets

In domains ranging from computer vision to natural language processing, machine learning models have been shown to exhibit stark disparities, often performing worse for members of traditionally underserved groups. One factor contributing to these performance gaps is a lack of representation in the data the models are trained on. It is often unclear, however, how to operationalize representativeness in specific applications. Here we formalize the problem of creating equitable training datasets, and propose a statistical framework for addressing this problem. We consider a setting where a model builder must decide how to allocate a fixed data collection budget to gather training data from different subgroups. We then frame dataset creation as a constrained optimization problem, in which one maximizes a function of group-specific performance metrics based on (estimated) group-specific learning rates and costs per sample. This flexible approach incorporates preferences of model-builders and other stakeholders, as well as the statistical properties of the learning task. When data collection decisions are made sequentially, we show that under certain conditions this optimization problem can be efficiently solved even without prior knowledge of the learning rates. To illustrate our approach, we conduct a simulation study of polygenic risk scores on synthetic genomic data -- an application domain that often suffers from non-representative data collection. We find that our adaptive sampling strategy outperforms several common data collection heuristics, including equal and proportional sampling, demonstrating the value of strategic dataset design for building equitable models.

  • 7 authors
·
Jan 31, 2022

Eye Fairness: A Large-Scale 3D Imaging Dataset for Equitable Eye Diseases Screening and Fair Identity Scaling

Fairness or equity in machine learning is profoundly important for societal well-being, but limited public datasets hinder its progress, especially in the area of medicine. It is undeniable that fairness in medicine is one of the most important areas for fairness learning's applications. Currently, no large-scale public medical datasets with 3D imaging data for fairness learning are available, while 3D imaging data in modern clinics are standard tests for disease diagnosis. In addition, existing medical fairness datasets are actually repurposed datasets, and therefore they typically have limited demographic identity attributes with at most three identity attributes of age, gender, and race for fairness modeling. To address this gap, we introduce our Eye Fairness dataset with 30,000 subjects (Harvard-EF) covering three major eye diseases including age-related macular degeneration, diabetic retinopathy, and glaucoma affecting 380 million patients globally. Our Harvard-EF dataset includes both 2D fundus photos and 3D optical coherence tomography scans with six demographic identity attributes including age, gender, race, ethnicity, preferred language, and marital status. We also propose a fair identity scaling (FIS) approach combining group and individual scaling together to improve model fairness. Our FIS approach is compared with various state-of-the-art fairness learning methods with superior performance in the racial, gender, and ethnicity fairness tasks with 2D and 3D imaging data, which demonstrate the utilities of our Harvard-EF dataset for fairness learning. To facilitate fairness comparisons between different models, we propose performance-scaled disparity measures, which can be used to compare model fairness accounting for overall performance levels. The dataset and code are publicly accessible via https://ophai.hms.harvard.edu/datasets/harvard-ef30k.

  • 5 authors
·
Oct 3, 2023

Demographic Probing of Large Language Models Lacks Construct Validity

Demographic probing is widely used to study how large language models (LLMs) adapt their behavior to signaled demographic attributes. This approach typically uses a single demographic cue in isolation (e.g., a name or dialect) as a signal for group membership, implicitly assuming strong construct validity: that such cues are interchangeable operationalizations of the same underlying, demographically conditioned behavior. We test this assumption in realistic advice-seeking interactions, focusing on race and gender in a U.S. context. We find that cues intended to represent the same demographic group induce only partially overlapping changes in model behavior, while differentiation between groups within a given cue is weak and uneven. Consequently, estimated disparities are unstable, with both magnitude and direction varying across cues. We further show that these inconsistencies partly arise from variation in how strongly cues encode demographic attributes and from linguistic confounders that independently shape model behavior. Together, our findings suggest that demographic probing lacks construct validity: it does not yield a single, stable characterization of how LLMs condition on demographic information, which may reflect a misspecified or fragmented construct. We conclude by recommending the use of multiple, ecologically valid cues and explicit control of confounders to support more defensible claims about demographic effects in LLMs.

  • 8 authors
·
Jan 26

AgentFairBench: Do LLM Agents Discriminate When They Act?

Large language model (LLM) agents increasingly take actions (screening applicants, recommending credit, triaging patients), yet fairness for LLMs is still measured by grading answers. We introduce AgentFairBench, a cheap, reproducible, multi-domain benchmark for demographic disparity in the actions of LLM agents. Grounded in a companion framework, the Bias Conduction Framework (BCF, restated here), it spans three regulator-anchored domains: hiring, lending, and medical triage. Synthetic, demographic-neutral profiles are evaluated in counterfactual matched sets that vary only a name-coded race x gender signal (in the Bertrand Mullainathan tradition), under four agent scaffolds of increasing agency (direct, chain-of-thought, multi-agent deliberation, tool-augmented). A NumPy-only harness computes counterfactual flip rate, mean absolute score difference (MASD), action-rate disparity, and tool-invocation disparity, with bootstrap confidence intervals, paired tests, and false-discovery-rate control, for single-digit dollars per model. A live leaderboard with a held-out private split and a contamination canary admits external models by submission. Our pilot (864 decisions plus a test-retest replication) carries a methodological lesson: comparing a six-group score spread against a two-run noise difference overstates disparity by ~ 2.4X through statistic arity alone. Against an arity matched noise floor and an omnibus group test, claude haiku 4 5 shows no demographic effect above sampling noise (0 of 120 pairwise and 0 of 9 omnibus contrasts survive correction); a planted-bias test confirms the instrument detects disparity when present. The contribution is a sound, sensitive, adoption-ready instrument, the arity matched null methodology, and open artifacts to scale it. Code, data, and harness are released under open licenses, with an anonymized review artifact.

  • 4 authors
·
Jun 14

Understanding Disparities in Post Hoc Machine Learning Explanation

Previous work has highlighted that existing post-hoc explanation methods exhibit disparities in explanation fidelity (across 'race' and 'gender' as sensitive attributes), and while a large body of work focuses on mitigating these issues at the explanation metric level, the role of the data generating process and black box model in relation to explanation disparities remains largely unexplored. Accordingly, through both simulations as well as experiments on a real-world dataset, we specifically assess challenges to explanation disparities that originate from properties of the data: limited sample size, covariate shift, concept shift, omitted variable bias, and challenges based on model properties: inclusion of the sensitive attribute and appropriate functional form. Through controlled simulation analyses, our study demonstrates that increased covariate shift, concept shift, and omission of covariates increase explanation disparities, with the effect pronounced higher for neural network models that are better able to capture the underlying functional form in comparison to linear models. We also observe consistent findings regarding the effect of concept shift and omitted variable bias on explanation disparities in the Adult income dataset. Overall, results indicate that disparities in model explanations can also depend on data and model properties. Based on this systematic investigation, we provide recommendations for the design of explanation methods that mitigate undesirable disparities.

  • 4 authors
·
Jan 25, 2024

DVMap: Fine-Grained Pluralistic Value Alignment via High-Consensus Demographic-Value Mapping

Current Large Language Models (LLMs) typically rely on coarse-grained national labels for pluralistic value alignment. However, such macro-level supervision often obscures intra-country value heterogeneity, yielding a loose alignment. We argue that resolving this limitation requires shifting from national labels to multi-dimensional demographic constraints, which can identify groups with predictable, high-consensus value preference. To this end, we propose DVMap (High-Consensus Demographic-Value Mapping), a framework for fine-grained pluralistic value alignment. In this framework, we first present a demographic archetype extraction strategy to construct a high-quality value alignment corpus of 56,152 samples from the World Values Survey (WVS) by strictly retaining respondents with consistent value preferences under identical demographics. Over this corpus, we introduce a Structured Chain-of-Thought (CoT) mechanism that explicitly guides LLMs to reason about demographic-value correlations. Subsequently, we employ Group Relative Policy Optimization (GRPO) to achieve adaptive anchoring of value distributions. To rigorously evaluate generalization, we further establish a triple-generalization benchmark (spanning cross-demographic, cross-country, and cross-value) comprising 21,553 samples. Experimental results demonstrate that DVMap effectively learns the manifold mapping from demographics to values, exhibiting strong generalization and robustness. On cross-demographic tests, Qwen3-8B-DVMap achieves 48.6% accuracy, surpassing the advanced open-source LLM DeepSeek-v3.2 (45.1%). The source code and dataset are available at https://github.com/EnlightenedAI/DVMap.

  • 5 authors
·
May 13