Racial Bias in Clinical and Population Health Algorithms: A Critical Review of Current Debates.

Among health care researchers, there is increasing debate over how best to assess and ensure the fairness of algorithms used for clinical decision support and population health, particularly concerning potential racial bias. Here we first distill concerns over the fairness of health care algorithms into four broad categories: () the explicit inclusion (or, conversely, the exclusion) of race and ethnicity in algorithms, () unequal algorithm decision rates across groups, () unequal error rates across groups, and () potential bias in the target variable used in prediction. With this taxonomy, we critically examine seven prominent and controversial health care algorithms.

A Framework for Considering the Value of Race and Ethnicity in Estimating Disease Risk.

Background: Accounting for race and ethnicity in estimating disease risk may improve the accuracy of predictions but may also encourage a racialized view of medicine.

Objective: To present a decision analytic framework for considering the potential benefits of race-aware over race-unaware risk predictions, using cardiovascular disease, breast cancer, and lung cancer as case studies.

Design: Cross-sectional study.

Designing equitable algorithms.

Predictive algorithms are now commonly used to distribute society's resources and sanctions. But these algorithms can entrench and exacerbate inequities. To guard against this possibility, many have suggested that algorithms be subject to formal fairness constraints.

Basketball clinic educates asthmatic children.

Healthy Hoops Kentucky is a new and innovative health program in Jefferson County, Kentucky that teaches asthmatic children (9-13 years) and their families how to manage the disease through the appropriate use of medications, proper nutrition, monitored exercise, and recreational activities. The Healthy Hoops Kentucky program includes asthma screenings at selected YMCA after-school care facilities and community health fairs, asthma awareness seminars for sports and school coaches, and a half-day basketball event held once a year, featuring local university coaches and current and former college basketball players.

Protein S deficiency and skin necrosis associated with continuous ambulatory peritoneal dialysis.

Skin necrosis associated with protein C deficiency has recently been reported to occur in hemodialysis patients. The clinical presentation and course of this syndrome appears indistinguishable from skin necrosis (purpura fulminans) seen in other settings with inherited or acquired deficiency of the naturally occurring anticoagulant proteins, protein C and S. Patients on maintenance hemodialysis may have low levels of these factors.