# Representation Disentanglement for Fair Chest X-Ray Diagnosis

arXiv: https://arxiv.org/abs/2610.06041 · HTML: https://mlsanity.com/paper/2610.06041/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 14 of its 19 references that are in the map.
- First posted on arXiv 5 Oct 2026.

## Builds on (most cited first, 14 of 14)

- [Densely Connected Convolutional Networks](https://mlsanity.com/paper/1608.06993/) (2016)
- [Domain-Adversarial Training of Neural Networks](https://mlsanity.com/paper/1505.07818/) (2015)
- [Equality of Opportunity in Supervised Learning](https://mlsanity.com/paper/1610.02413/) (2016)
- [Similarity of Neural Network Representations Revisited](https://mlsanity.com/paper/1905.00414/) (2019)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [Distributionally Robust Neural Networks for Group Shifts: On the Importance of Regularization for Worst-Case Generalization](https://mlsanity.com/paper/1911.08731/) (2019)
- [Simple data balancing achieves competitive worst-group-accuracy](https://mlsanity.com/paper/2110.14503/) (2021)
- [Addressing Fairness Issues in Deep Learning-Based Medical Image Analysis: A Systematic Review](https://mlsanity.com/paper/2209.13177/) (2022)
- [Risk of Bias in Chest Radiography Deep Learning Foundation Models](https://mlsanity.com/paper/2209.02965/) (2022)
- [EVA-X: A Foundation Model for General Chest X-ray Analysis with Self-supervised Learning](https://mlsanity.com/paper/2405.05237/) (2024)
- [FairAdaBN: Mitigating unfairness with adaptive batch normalization and its application to dermatological disease classification](https://mlsanity.com/paper/2303.08325/) (2023)
- [MeDi: Metadata-Guided Diffusion Models for Mitigating Biases in Tumor Classification](https://mlsanity.com/paper/2506.17140/) (2025)
- [FairREAD: Re-fusing Demographic Attributes after Disentanglement for Fair Medical Image Classification](https://mlsanity.com/paper/2412.16373/) (2024)
- [AdFair-CLIP: Adversarial Fair Contrastive Language-Image Pre-training for Chest X-rays](https://mlsanity.com/paper/2506.23467/) (2025)

## Abstract (arXiv)

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.