AdaPCLA: Adaptive Prior-Calibrated Logit Adjustment for Long-Tailed Longitudinal EHR Generation

Generative modeling of longitudinal Electronic Health Records is increasingly important for privacy-preserving research, yet standard autoregressive models tend to underrepresent the co-occurrence structure of tail events (i.e., diseases, symptoms), reducing the fidelity and faithfulness of generated data for rare subpopulations. To this end, we propose AdaPCLA framework, which enables generative models to adaptively fit and generate EHR data through a data distribution-aware training strategy; this is achieved by internalizing data knowledge parameters by simulated annealing training. It also supports training-free adaptation to a diverse clinical population for generation through zero-shot distribution control. Moreover, our theoretical analysis characterizes rare-code logit updates through the label-wise empirical NTK and derives a prior-internalization bound for how annealing speed and NTK conditioning affect retained prior signals. Experiments on real-world data show that AdaPCLA achieves consistent gains in tail plausibility, downstream utility, and zero-shot control; in particular, it improves TailPairSeen over HALO by 114.2% on MIMIC-III and 65.1% on MIMIC-IV, outperforms GPT-style generation by 3.5% F1 for zero-shot cross-population adaptation.