Fairness at Every Intersection: Uncovering and Mitigating Intersectional Biases in Multimodal Clinical Predictions

Abstract: Biases in automated clinical decision-making using Electronic Healthcare Records (EHR) impose significant disparities in patient care and treatment outcomes. Conventional approaches have primarily focused on bias mitigation strategies stemming from single attributes, overlooking intersectional subgroups -- groups formed across various demographic intersections (such as race, gender, ethnicity, etc.). Rendering single-attribute mitigation strategies to intersectional subgroups becomes statistically irrelevant due to the varying distribution and bias patterns across these subgroups. The multimodal nature of EHR -- data from various sources such as combinations of text, time series, tabular, events, and images -- adds another layer of complexity as the influence on minority groups may fluctuate across modalities. In this paper, we take the initial steps to uncover potential intersectional biases in predictions by sourcing extensive multimodal datasets, MIMIC-Eye1 and MIMIC-IV ED, and propose mitigation at the intersectional subgroup level. We perform and benchmark downstream tasks and bias evaluation on the datasets by learning a unified text representation from multimodal sources, harnessing the enormous capabilities of the pre-trained clinical LLMs (LM), MedBERT, Clinical BERT, and Clinical BioBERT. Our findings indicate that the proposed sub-group-specific bias mitigation is robust across different datasets, subgroups, and embeddings, demonstrating effectiveness in addressing intersectional biases in multimodal settings.