In the United States, schizophrenia (SCZ) carries a race and sex disparity that may be explained by clinician bias - a belief held by a clinician about a patient that prevents impartial clinical decision making. The emergency department (ED) is marked by higher rates of stress that lead to clinicians relying more on implicit biases during decision making. In this work, we considered a large cohort of psychiatric patients in the ED from the Mount Sinai Health System (MSHS) in New York City to investigate the effects of clinician bias on SCZ diagnosis while controlling for known risk factors and patient sociodemographic information. Clinician bias was quantified as the ratio of negative to total sentences within a patient's first ED note. We utilized a logistic regression to predict SCZ diagnosis given patient race, sex, age, history of trauma or substance use disorder, and the ratio of negative sentences. Our findings showed that an increased ratio of negative sentences is associated with higher odds of obtaining a SCZ diagnosis [OR (95% CI)=1.408 (1.361-1.456)]. Identifying as male [OR (95% CI)=1.112 (1.055-1.173)] or Black [OR (95% CI)=1.081(1.031-1.133)] increased one's odds of being diagnosed with SCZ. However, from an intersectional lens, Black female patients with high SES have the highest odds of obtaining a SCZ diagnosis [OR (95% CI)=1.629 (1.535-1.729)]. Results such as these suggest that SES does not act as a protective buffer against SCZ diagnosis in all patients, demanding more attention to the quantification of health disparities. Lastly, we demonstrated that clinician bias is operational with real world data and related to increased odds of obtaining a stigmatizing diagnosis such as SCZ.

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.