Fairness constitutes a concern within machine learning (ML) applications. Currently, there is no study on how disparities in classification complexity between privileged and unprivileged groups could influence the fairness of solutions, which serves as a preliminary indicator of potential unfairness. In this work, we investigate this gap, specifically, we focus on synthetic datasets designed to capture a variety of biases ranging from historical bias to measurement and representational bias to evaluate how various complexity metrics differences correlate with group fairness metrics. We then apply association rule mining to identify patterns that link disproportionate complexity differences between groups with fairness-related outcomes, offering data-centric indicators to guide bias mitigation. Our findings are also validated by their application in real-world problems, providing evidence that quantifying group-wise classification complexity can uncover early indicators of potential fairness challenges. This investigation helps practitioners to proactively address bias in classification tasks.

Artificial intelligence (AI) models trained using medical images for clinical tasks often exhibit bias in the form of disparities in performance between subgroups. Since not all sources of biases in real-world medical imaging data are easily identifiable, it is challenging to comprehensively assess how those biases are encoded in models, and how capable bias mitigation methods are at ameliorating performance disparities. In this article, we introduce a novel analysis framework for systematically and objectively investigating the impact of biases in medical images on AI models. We developed and tested this framework for conducting controlled in silico trials to assess bias in medical imaging AI using a tool for generating synthetic magnetic resonance images with known disease effects and sources of bias. The feasibility is showcased by using three counterfactual bias scenarios to measure the impact of simulated bias effects on a convolutional neural network (CNN) classifier and the efficacy of three bias mitigation strategies. The analysis revealed that the simulated biases resulted in expected subgroup performance disparities when the CNN was trained on the synthetic datasets. Moreover, reweighing was identified as the most successful bias mitigation strategy for this setup, and we demonstrated how explainable AI methods can aid in investigating the manifestation of bias in the model using this framework. Developing fair AI models is a considerable challenge given that many and often unknown sources of biases can be present in medical imaging datasets. In this work, we present a novel methodology to objectively study the impact of biases and mitigation strategies on deep learning pipelines, which can support the development of clinical AI that is robust and responsible.