紧急入院预测模型中的交叉和边际调整偏差
Elle Lett1,2,3, Shakiba Shahbandegan3,4, Yuval Barak-Corren5
1Center for Anti-Racism and Community Health, University of Washington School of Public Health, Seattle.
JAMA network open
|May 29, 2025
概括
在急诊室 (ED) 入院模型中,交叉分离减少了患者子组之间的性能差异,而不会牺牲整体准确性. 这种方法为临床预测提供了一个比边际微分更公平的解决方案.
科学领域:
- 医疗信息学 医疗信息学
- 临床决策支持 临床决策支持
- 健康 公平 研究 健康 公平 研究
背景情况:
- 公平的临床预测模型对于公平的健康结果至关重要.
- 现有的公平算法经常使用边际微分,简化患者子组.
- 这种简化可能无法充分解决跨界患者群体中的歧视问题.
研究的目的:
- 评估在培训期间简化患者子组对急诊室 (ED) 入院预测模型的交叉子组表现的影响.
- 为了比较交叉减值策略与边际减值策略的有效性.
主要方法:
- 一项使用两个大型ED队列 (MIMIC-IV和BCH) 的回顾性数据进行预后研究.
- 招生预测模型使用公平性优化的变化进行训练 (边际与交叉失误).
- 通过使用诸如接收机操作员特征曲线 (AUROC) 下面的面积,校准误差和由种族,种族和性别定义的子组的假负率等指标来评估性能.
主要成果:
- 与两种队伍的边际失调相比,交叉失调显著降低了子组校准误差和假负率.
- 例如,在MIMIC-IV队列中,截面调试减少了22.3%的校准误差,而边际调试则减少了11.3%.
- 这些公平性改进并没有影响整体模型的准确性,AUROC与基线模型保持一致.
结论:
- 交叉失调比边际失调更有效地缓解ED入院预测的交叉患者群体之间的绩效差异.
- 采用交叉微积分开发的模型可以在不牺牲整体预测准确性的情况下减少特定组的错误.
- 建议将交叉分离纳入临床风险预测模型的开发,以促进健康公平.
相关概念视频
Bias in Epidemiological Studies
709
Biases can arise at various stages of research, from study design and data collection to analysis and interpretation. Recognizing and addressing these biases is essential to ensure the validity and reliability of epidemiological findings.Broadly speaking, biases in epidemiology fall into three main categories: selection bias, information bias, and confounding. A more detailed description of possible biases is:
709
Prediction Intervals
2.4K
The interval estimate of any variable is known as the prediction interval. It helps decide if a point estimate is dependable.
However, the point estimate is most likely not the exact value of the population parameter, but close to it. After calculating point estimates, we construct interval estimates, called confidence intervals or prediction intervals. This prediction interval comprises a range of values unlike the point estimate and is a better predictor of the observed sample value, y.
However, the point estimate is most likely not the exact value of the population parameter, but close to it. After calculating point estimates, we construct interval estimates, called confidence intervals or prediction intervals. This prediction interval comprises a range of values unlike the point estimate and is a better predictor of the observed sample value, y.
2.4K
Clearance Models: Noncompartmental Models
104
Clearance is a pharmacokinetic parameter traditionally defined by compartment models, signifying the rate at which a drug is expelled from the body. However, a noncompartmental model offers an alternative method for assessing clearance, primarily employing empirical data obtained after administering a single drug dose.
The noncompartmental approach capitalizes on extensive sampling data, correlating the volume of distribution to systemic exposure and the administered dosage. This method enables...
The noncompartmental approach capitalizes on extensive sampling data, correlating the volume of distribution to systemic exposure and the administered dosage. This method enables...
104
Motivational Bias
1
Cognitive bias results from limitations in thinking and information processing, leading to systematic errors in judgment. Conversely, motivational bias stems from personal desires or emotions, causing distortions in perception to align with self-interest. Motivational bias influences how individuals perceive and attribute causes to events, often shaped by personal needs, goals, and self-esteem preservation. This bias can distort judgment, leading to inaccurate assessments of success, failure,...
1
Confounding in Epidemiological Studies
278
Confounding in statistical epidemiology represents a pivotal challenge, referring to the distortion in the perceived relationship between an exposure and an outcome due to the presence of a third variable, known as a confounder. This variable is associated with both the exposure and the outcome but is not a direct link in their causal chain. Its presence can lead to erroneous interpretations of the exposure's effect, either exaggerating or underestimating the true association. This...
278
Strategies for Assessing and Addressing Confounding
163
Confounding is a critical issue in epidemiological studies, often leading to misleading conclusions about associations between exposures and outcomes. It occurs when the relationship between the exposure and the outcome is mixed with the effects of other factors that influence the outcome. Given that, addressing confounding is of high importance for drawing accurate inferences in research.
Confounding can be addressed at both the design phase of a study and through analytical methods after data...
Confounding can be addressed at both the design phase of a study and through analytical methods after data...
163


