Assessing Social Determinants-Related Performance Bias of Machine Learning Models: A case of Hyperchloremia Prediction in ICU Population

Machine learning in medicine leverages the wealth of healthcare data to extract knowledge, facilitate clinical decision-making, and ultimately improve care delivery. However, ML models trained on datasets that lack demographic diversity could yield suboptimal performance when applied to the underrepresented populations (e.g. ethnic minorities, lower social-economic status), thus perpetuating health disparity. In this study, we evaluated four classifiers built to predict Hyperchloremia - a condition that often results from aggressive fluids administration in the ICU population - and compared their performance in racial, gender, and insurance subgroups. We observed that adding social determinants features in addition to the lab-based ones improved model performance on all patients. The subgroup testing yielded significantly different AUC scores in 40 out of the 44 model-subgroup, suggesting disparities when applying ML models to social determinants subgroups. We urge future researchers to design models that proactively adjust for potential biases and include subgroup reporting in their studies.