# Worst-Group Equalized Odds Regularization for Multi-Attribute Fair Medical Image Classification

arXiv: https://arxiv.org/abs/2605.19214 · HTML: https://mlsanity.com/paper/2605.19214/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 16 of its 23 references that are in the map.
- First posted on arXiv 19 May 2026.

## Builds on (most cited first, 16 of 16)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Densely Connected Convolutional Networks](https://mlsanity.com/paper/1608.06993/) (2016)
- [Equality of Opportunity in Supervised Learning](https://mlsanity.com/paper/1610.02413/) (2016)
- [A Survey on Bias and Fairness in Machine Learning](https://mlsanity.com/paper/1908.09635/) (2019)
- [Just Train Twice: Improving Group Robustness without Training Group Information](https://mlsanity.com/paper/2107.09044/) (2021)
- [Preventing Fairness Gerrymandering: Auditing and Learning for Subgroup Fairness](https://mlsanity.com/paper/1711.05144/) (2017)
- [Hidden Stratification Causes Clinically Meaningful Failures in Machine Learning for Medical Imaging](https://mlsanity.com/paper/1909.12475/) (2019)
- [CheXclusion: Fairness gaps in deep chest X-ray classifiers](https://mlsanity.com/paper/2003.00827/) (2020)
- [FairBatch: Batch Selection for Model Fairness](https://mlsanity.com/paper/2012.01696/) (2020)
- [Achieving Fairness through Adversarial Learning: an Application to Recidivism Prediction](https://mlsanity.com/paper/1807.00199/) (2018)
- [Harvard Glaucoma Fairness: A Retinal Nerve Disease Dataset for Fairness Learning and Fair Identity Normalization](https://mlsanity.com/paper/2306.09264/) (2023)
- [Addressing Fairness Issues in Deep Learning-Based Medical Image Analysis: A Systematic Review](https://mlsanity.com/paper/2209.13177/) (2022)
- [FairDisCo: Fairer AI in Dermatology via Disentanglement Contrastive Learning](https://mlsanity.com/paper/2208.10013/) (2022)
- [On Fairness of Medical Image Classification with Multiple Sensitive Attributes via Learning Orthogonal Representations](https://mlsanity.com/paper/2301.01481/) (2023)
- [Incorporating Rather Than Eliminating: Achieving Fairness for Skin Disease Diagnosis Through Group-Specific Expert](https://mlsanity.com/paper/2506.17787/) (2025)
- [FairREAD: Re-fusing Demographic Attributes after Disentanglement for Fair Medical Image Classification](https://mlsanity.com/paper/2412.16373/) (2024)

## Abstract (arXiv)

Diagnostic performance in medical AI varies systematically across demographic groups, yet subgroup AUC can mask clinically important disparities. At a fixed inference-time operating point, some groups may exhibit over-diagnostic behaviour, characterized by elevated true and false positive rates, while others show under-diagnostic patterns with reduced true and false positive rates. These opposing tendencies can cancel in aggregate AUCs while producing meaningful inequities in clinical decision-making. Motivated by the need to assess and mitigate such disparities at the operating point and across multiple demographic attributes simultaneously, we propose a worst-group equalized-odds margin regularizer. The proposed regularizer explicitly targets subgroup-level deviations on both the true positive and false positive sides at inference. At each update, the method identifies subgroups defined by explicit demographic attributes (e.g., age, sex, and race) that exhibit the most extreme margin deviations and applies a unified penalty, enabling fairness optimization across multiple demographic axes without requiring explicit intersectional constraints. Across two medical imaging datasets in realistic multi-label settings, our method consistently reduces disparities in Equalized Odds and Equalized Opportunity with minimal impact on AUC, preserving diagnostic performance while improving fairness.