An intersectional framework for counterfactual fairness in risk predictionAlong with the increasing availability of data in many sectors has come the
rise of data-driven models to inform decision-making and policy. In the health
care sector, these models have the potential to benefit both patients and
health care providers but can also entrench or exacerbate health inequities.
Existing "algorithmic fairness" methods for measuring and correcting model bias
fall short of what is needed for clinical applications in two key ways. First,
methods typically focus on a single grouping along which discrimination may
occur rather than considering multiple, intersecting groups such as gender and
race. Second, in clinical applications, risk prediction is typically used to
guide treatment, and use of a treatment presents distinct statistical issues
that invalidate most existing fairness measurement techniques. We present novel
unfairness metrics that address both of these challenges. We also develop a
complete framework of estimation and inference tools for our metrics, including
the unfairness value ("u-value"), used to determine the relative extremity of
an unfairness measurement, and standard errors and confidence intervals
employing an alternative to the standard bootstrap.
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