Individuals who identify as sexual and gender minorities, including lesbian, gay, bisexual, transgender, queer, and others (LGBTQ+) are more likely to experience poorer health than their heterosexual and cisgender counterparts. One primary source that drives these health disparities is minority stress (i.e., chronic and social stressors unique to LGBTQ+ communities' experiences adapting to the dominant culture). This stress is frequently expressed in LGBTQ+ users' posts on social media platforms. However, these expressions are not just straightforward manifestations of minority stress. They involve linguistic complexity (e.g., idiom or lexical diversity), rendering them challenging for many traditional natural language processing methods to detect. In this work, we designed a hybrid model using Graph Neural Networks (GNN) and Bidirectional Encoder Representations from Transformers (BERT), a pre-trained deep language model to improve the classification performance of minority stress detection. We experimented with our model on a benchmark social media dataset for minority stress detection (LGBTQ+ MiSSoM+). The dataset is comprised of 5,789 human-annotated Reddit posts from LGBTQ+ subreddits. Our approach enables the extraction of hidden linguistic nuances through pretraining on a vast amount of raw data, while also engaging in transductive learning to jointly develop representations for both labeled training data and unlabeled test data. The RoBERTa-GCN model achieved an accuracy of 0.86 and an F1 score of 0.86, surpassing the performance of other baseline models in predicting LGBTQ+ minority stress. Improved prediction of minority stress expressions on social media could lead to digital health interventions to improve the wellbeing of LGBTQ+ people-a community with high rates of stress-sensitive health problems.

Primary healthcare is a crucial strategy for achieving universal health coverage. South Asian countries are working to improve their primary healthcare system through their country specific policies designed in line with WHO health system framework using the six thematic pillars: Health Financing, Health Service delivery, Human Resource for Health, Health Information Systems, Governance, Essential Medicines and Technology, and an addition area of Cross-Sectoral Linkages [11]. Measuring the current accessibility of healthcare facilities and workforce availability is essential for improving healthcare standards and achieving universal health coverage in developing countries. Data-driven surveillance approaches are required that can provide rapid, reliable, and geographically scalable solutions to understand a) which communities and areas are most at risk of inequitable access and when, b) what barriers to health access exist, and c) how they can be overcome in ways tailored to the specific challenges faced by individual communities. We propose to harness current breakthroughs in Earth-observation (EO) technology, which provide the ability to generate accurate, up-to-date, publicly accessible, and reliable data, which is necessary for equitable access planning and resource allocation to ensure that vaccines, and other interventions reach everyone, particularly those in greatest need, during normal and crisis times. This requires collaboration among countries to identify evidence based solutions to shape health policy and interventions, and drive innovations and research in the region.

As interest in implementing artificial intelligence (AI) in medical systems grows, discussion continues on how to evaluate the fairness of these systems, or the disparities they may perpetuate. Socioeconomic status (SES) is commonly included in machine learning models to control for health inequities, with the underlying assumption that increased SES is associated with better health. In this work, we considered a large cohort of patients from the Mount Sinai Health System in New York City to investigate the effect of patient SES, race, and sex on schizophrenia (SCZ) diagnosis rates via a logistic regression model. Within an intersectional framework, patient SES, race, and sex were found to have significant interactions. Our findings showed that increased SES is associated with a higher probability of obtaining a SCZ diagnosis in Black Americans ($\beta=4.1\times10^{-8}$, $SE=4.5\times10^{-9}$, $p < 0.001$). Whereas high SES acts as a protective factor for SCZ diagnosis in White Americans ($\beta=-4.1\times10^{-8}$, $SE=6.7\times10^{-9}$, $p < 0.001$). Further investigation is needed to reliably explain and quantify health disparities. Nevertheless, we advocate that building fair AI tools for the health care space requires recognizing the intersectionality of sociodemographic factors.

This study investigates how machine learning (ML) models can predict hospital readmissions for diabetic patients fairly and accurately across different demographics (age, gender, race). We compared models like Deep Learning, Generalized Linear Models, Gradient Boosting Machines (GBM), and Naive Bayes. GBM stood out with an F1-score of 84.3% and accuracy of 82.2%, accurately predicting readmissions across demographics. A fairness analysis was conducted across all the models. GBM minimized disparities in predictions, achieving balanced results across genders and races. It showed low False Discovery Rates (FDR) (6-7%) and False Positive Rates (FPR) (5%) for both genders. Additionally, FDRs remained low for racial groups, such as African Americans (8%) and Asians (7%). Similarly, FPRs were consistent across age groups (4%) for both patients under 40 and those above 40, indicating its precision and ability to reduce bias. These findings emphasize the importance of choosing ML models carefully to ensure both accuracy and fairness for all patients. By showcasing effectiveness of various models with fairness metrics, this study promotes personalized medicine and the need for fair ML algorithms in healthcare. This can ultimately reduce disparities and improve outcomes for diabetic patients of all backgrounds.

Health disparities are differences in health outcomes and access to healthcare between different groups, including racial and ethnic minorities, low-income people, and rural residents. An artificial intelligence (AI) program called large language models (LLMs) can understand and generate human language, improving health communication and reducing health disparities. There are many challenges in using LLMs in human-doctor interaction, including the need for diverse and representative data, privacy concerns, and collaboration between healthcare providers and technology experts. We introduce the comparative investigation of domain-specific large language models such as SciBERT with a multi-purpose LLMs BERT. We used cosine similarity to analyze text queries about health disparities in exam rooms when factors such as race are used alone. Using text queries, SciBERT fails when it doesn't differentiate between queries text: "race" alone and "perpetuates health disparities." We believe clinicians can use generative AI to create a draft response when communicating asynchronously with patients. However, careful attention must be paid to ensure they are developed and implemented ethically and equitably.

The fairness issue of clinical data modeling, especially on Electronic Health Records (EHRs), is of utmost importance due to EHR's complex latent structure and potential selection bias. It is frequently necessary to mitigate health disparity while keeping the model's overall accuracy in practice. However, traditional methods often encounter the trade-off between accuracy and fairness, as they fail to capture the underlying factors beyond observed data. To tackle this challenge, we propose a novel model called Fair Longitudinal Medical Deconfounder (FLMD) that aims to achieve both fairness and accuracy in longitudinal Electronic Health Records (EHR) modeling. Drawing inspiration from the deconfounder theory, FLMD employs a two-stage training process. In the first stage, FLMD captures unobserved confounders for each encounter, which effectively represents underlying medical factors beyond observed EHR, such as patient genotypes and lifestyle habits. This unobserved confounder is crucial for addressing the accuracy/fairness dilemma. In the second stage, FLMD combines the learned latent representation with other relevant features to make predictions. By incorporating appropriate fairness criteria, such as counterfactual fairness, FLMD ensures that it maintains high prediction accuracy while simultaneously minimizing health disparities. We conducted comprehensive experiments on two real-world EHR datasets to demonstrate the effectiveness of FLMD. Apart from the comparison of baseline methods and FLMD variants in terms of fairness and accuracy, we assessed the performance of all models on disturbed/imbalanced and synthetic datasets to showcase the superiority of FLMD across different settings and provide valuable insights into its capabilities.

Currently, the United States healthcare system has a "cruel tendency to delay or deny high-quality care to those who are most in need of it but can least afford its high cost," (Shmerling) resulting in rampant disparities in health outcomes throughout the nation. The news of today is riddled with stories of people receiving poor care due to systematic biases present in the modern healthcare system and the effect of the increasingly unaffordable cost of life-saving medication. In order to better understand the degree to which this inequality exists, we investigated which socioeconomic indicators model health outcomes best.

Background: The use of machine learning (ML) in mental health (MH) research is increasing, especially as new, more complex data types become available to analyze. By systematically examining the published literature, this review aims to uncover potential gaps in the current use of ML to study MH in vulnerable populations of immigrants, refugees, migrants, and racial and ethnic minorities. Methods: In this systematic review, we queried Google Scholar for ML-related terms, MH-related terms, and a population of a focus search term strung together with Boolean operators. Backward reference searching was also conducted. Included peer-reviewed studies reported using a method or application of ML in an MH context and focused on the populations of interest. We did not have date cutoffs. Publications were excluded if they were narrative or did not exclusively focus on a minority population from the respective country. Data including study context, the focus of mental healthcare, sample, data type, type of ML algorithm used, and algorithm performance was extracted from each. Results: Our search strategies resulted in 67,410 listed articles from Google Scholar. Ultimately, 12 were included. All the articles were published within the last 6 years, and half of them studied populations within the US. Most reviewed studies used supervised learning to explain or predict MH outcomes. Some publications used up to 16 models to determine the best predictive power. Almost half of the included publications did not discuss their cross-validation method. Conclusions: The included studies provide proof-of-concept for the potential use of ML algorithms to address MH concerns in these special populations, few as they may be. Our systematic review finds that the clinical application of these models for classifying and predicting MH disorders is still under development.

Machine learning (ML) has become a critical tool in public health, offering the potential to improve population health, diagnosis, treatment selection, and health system efficiency. However, biases in data and model design can result in disparities for certain protected groups and amplify existing inequalities in healthcare. To address this challenge, this study summarizes seminal literature on ML fairness and presents a framework for identifying and mitigating biases in the data and model. The framework provides guidance on incorporating fairness into different stages of the typical ML pipeline, such as data processing, model design, deployment, and evaluation. To illustrate the impact of biases in data on ML models, we present examples that demonstrate how systematic biases can be amplified through model predictions. These case studies suggest how the framework can be used to prevent these biases and highlight the need for fair and equitable ML models in public health. This work aims to inform and guide the use of ML in public health towards a more ethical and equitable outcome for all populations.

Editor's note: Michael Sanky is global industry lead of healthcare and life sciences at Databricks, an enterprise software company. As pervasive health disparities in the U.S. continue to widen, data and artificial intelligence offer the potential to help close that gap. New technologies can analyze large, diverse data sets, informing the work of researchers, decision makers and policymakers across healthcare. If done correctly, AI can ultimately improve care delivery, advance proactive healthcare planning and predictive treatments, reduce clinician burnout and drive better patient outcomes. To this end, we've already seen groundbreaking advancements that move the needle in healthcare.