-- Fairness remains a critical concern in healthcare, where unequal access to services and treatment outcomes can adversely affect patient health. While Federated Learning (FL) presents a collaborative and privacy-preserving approach to model training, ensuring fairness is challenging due to heterogeneous data across institutions, and current research primarily addresses non-medical applications. To fill this gap, we establish the first experimental benchmark for fairness in medical FL, evaluating six representative FL methods across diverse demographic attributes and imaging modalities. We introduce FairFedMed, the first medical FL dataset specifically designed to study group fairness (i.e., demographics). It comprises two parts: FairFedMed-Oph, featuring 2D fundus and 3D OCT ophthalmology samples with six demographic attributes; and FairFedMed-Chest, which simulates real cross-institutional FL using subsets of CheXpert and MIMIC-CXR. Together, they support both simulated and real-world FL across diverse medical modalities and demographic groups. Existing FL models often underperform on medical images and overlook fairness across demographic groups. To address this, we propose FairLoRA, a fairness-aware FL framework based on SVD-based low-rank approximation. Experimental results on the FairFedMed dataset demonstrate that FairLoRA not only achieves state-of-the-art performance in medical image classification but also significantly improves fairness across diverse populations. Our code and dataset can be accessible via the link: https: //wang.hms.harvard.edu/fairfedmed/. Minghan Li, Y an Luo, and Mengyu Wang are with Harvard AI and Robotics Lab and Harvard Ophthalmology AI lab, Harvard University, Boston, Massachusetts, USA (e-mail: mili4@meei.harvard.edu;

Recent advances in parameter-efficient fine-tuning methods, such as Low Rank Adaptation (LoRA), have gained significant attention for their ability to efficiently adapt large foundational models to various downstream tasks. These methods are appreciated for achieving performance comparable to full fine-tuning on aggregate-level metrics, while significantly reducing computational costs. To systematically address fairness in LLMs previous studies fine-tune on fairness specific data using a larger LoRA rank than typically used. In this paper, we introduce FairLoRA, a novel fairness-specific regularizer for LoRA aimed at reducing performance disparities across data subgroups by minimizing per-class variance in loss. To the best of our knowledge, we are the first to introduce a fairness based finetuning through LoRA. Our results demonstrate that the need for higher ranks to mitigate bias is not universal; it depends on factors such as the pre-trained model, dataset, and task. More importantly, we systematically evaluate FairLoRA across various vision models, including ViT, DiNO, and CLIP, in scenarios involving distribution shifts. We further emphasize the necessity of using multiple fairness metrics to obtain a holistic assessment of fairness, rather than relying solely on the metric optimized during training.