Representation Disentanglement for Fair Chest X-Ray Diagnosis

Deep learning has advanced chest X-ray (CXR) diagnosis, yet demographic biases in learned representations may contribute to performance disparities across intersectional groups. We propose a single-encoder framework combining dual-level decorrelation with prototype-guided cross-group contrastive learning to reduce demographic dependence while accounting for within-class variation. We further propose Demographic Representation Alignment Reduction (DRAR), a new metric that quantifies the reduction in demographic structure within disease representations. The framework is evaluated on four classification tasks using 34,809 CheXpert test images across eight intersectional groups, defined by age, sex and ethnicity. Compared with empirical risk minimization (ERM), our method reduces the mean equalized-odds gap from 15.41% to 10.86% and the AUC gap from 5.95% to 5.01%. Our method achieves a DRAR of 59.04% relative to ERM, with only a slight decrease in mean AUC. These results demonstrate that representation disentanglement can reduce demographic bias and improve intersectional fairness. Code is available at urlhttps://github.com/06Yujie/Fair-Medical-Imaging.