In the data-driven artificial intelligence paradigm, models heavily rely on large amounts of training data. However, factors like sampling distribution imbalance can lead to issues of bias and unfairness in healthcare data. Sensitive attributes, such as race, gender, age, and medical condition, are characteristics of individuals that are commonly associated with discrimination or bias. In healthcare AI, these attributes can play a significant role in determining the quality of care that individuals receive. For example, minority groups often receive fewer procedures and poorer-quality medical care than white individuals in US. Therefore, detecting and mitigating bias in data is crucial to enhancing health equity. Bias mitigation methods include pre-processing, in-processing, and post-processing. Among them, Reweighting (RW) is a widely used pre-processing method that performs well in balancing machine learning performance and fairness performance. RW adjusts the weights for samples within each (group, label) combination, where these weights are utilized in loss functions. However, RW is limited to considering only a single sensitive attribute when mitigating bias and assumes that each sensitive attribute is equally important. This may result in potential inaccuracies when addressing intersectional bias. To address these limitations, we propose M3Fair, a multi-level and multi-sensitive-attribute reweighting method by extending the RW method to multiple sensitive attributes at multiple levels. Our experiments on real-world datasets show that the approach is effective, straightforward, and generalizable in addressing the healthcare fairness issues.

Locating diseases in chest X-ray images with few careful annotations saves large human effort. Recent works approached this task with innovative weakly-supervised algorithms such as multi-instance learning (MIL) and class activation maps (CAM), however, these methods often yield inaccurate or incomplete regions. One of the reasons is the neglection of the pathological implications hidden in the relationship across anatomical regions within each image and the relationship across images. In this paper, we argue that the cross-region and cross-image relationship, as contextual and compensating information, is vital to obtain more consistent and integral regions. To model the relationship, we propose the Graph Regularized Embedding Network (GREN), which leverages the intra-image and inter-image information to locate diseases on chest X-ray images. GREN uses a pre-trained U-Net to segment the lung lobes, and then models the intra-image relationship between the lung lobes using an intra-image graph to compare different regions. Meanwhile, the relationship between in-batch images is modeled by an inter-image graph to compare multiple images. This process mimics the training and decision-making process of a radiologist: comparing multiple regions and images for diagnosis. In order for the deep embedding layers of the neural network to retain structural information (important in the localization task), we use the Hash coding and Hamming distance to compute the graphs, which are used as regularizers to facilitate training. By means of this, our approach achieves the state-of-the-art result on NIH chest X-ray dataset for weakly-supervised disease localization. Our codes are accessible online.