Neuron Incidence Redistribution for Fairness in Medical Image Classification

Abstract: Deep learning models for medical image classification are susceptible to subgroup performance disparities across demographic attributes such as age, gender, and race. We identify a latent representational mechanism underlying these disparities: in transfer-learned models, the dominant penultimate-layer activation channel under positive predictions is co-activated by both disease-positive samples and privileged demographic groups (male, older patients), producing over-diagnosis; conversely, the dominant channel under negative predictions is co-activated by disadvantaged groups (female, younger patients), producing systematic under-diagnosis. To address this, we propose Neuron Incidence Redistribution (NIR), a lightweight regularization method that penalizes the variance of predicted-probability-weighted mean activations across penultimate-layer neurons, requiring no demographic labels at training time. On HAM10000, TPR disparity drops from 10.81% to 0.93% across age groups and from 12.04% to 0.74% across gender, with a marginal AUC improvement of 0.51 points. On Harvard OCT-RNFL, NIR reduces FPR disparity for race (from 15.68% to 10.66%) and age (from 12.69% to 1.80%), demonstrating that distributing latent disease evidence across the full penultimate layer is a principled and effective strategy for improving demographic fairness in medical AI.