S.G. Joshi

Donna Tjandra, Trenton Chang, Sonali Parbhoo et al.

Objective: The growing availability of large-scale observational clinical datasets and challenges in conducting randomized controlled trials have spurred enthusiasm in using causal machine learning (ML) for causal inference in observational data. We present a roadmap for applying causal ML to observational data. Materials and methods: We outline the importance of assessing validity assumptions within available data and applying causal ML responsibly for clinical experts using causal ML and ML practitioners with limited clinical expertise. Observations: Despite advances in causal ML, its limitations remain largely under-appreciated across disciplines. This gap in shared knowledge may impact the validity of findings. Discussion: Causal assumptions must be satisfied and modeling choices justified. Otherwise, these approaches risk producing biased or misleading results, with consequences for clinical research and patient care. Conclusion: Causal ML can be a powerful tool for generating causal hypotheses. We provide a template to strengthen the rigor and interpretability of causal analyses.

Kevin Zhang, Yonghan Jung, Divyat Mahajan et al.

Identifying and measuring biases associated with sensitive attributes is a crucial consideration in healthcare to prevent treatment disparities. One prominent issue is inaccurate pulse oximeter readings, which tend to overestimate oxygen saturation for dark-skinned patients and misrepresent supplemental oxygen needs. Most existing research has revealed statistical disparities linking device measurement errors to patient outcomes in intensive care units (ICUs) without causal formalization. This study causally investigates how racial discrepancies in oximetry measurements affect invasive ventilation in ICU settings. We employ a causal inference-based approach using path-specific effects to isolate the impact of bias by race on clinical decision-making. To estimate these effects, we leverage a doubly robust estimator, propose its self-normalized variant for improved sample efficiency, and provide novel finite-sample guarantees. Our methodology is validated on semi-synthetic data and applied to two large real-world health datasets: MIMIC-IV and eICU. Contrary to prior work, our analysis reveals minimal impact of racial discrepancies on invasive ventilation rates. However, path-specific effects mediated by oxygen saturation disparity are more pronounced on ventilation duration, and the severity differs by dataset. Our work provides a novel pipeline for investigating potential disparities in clinical decision-making and, more importantly, highlights the necessity of causal methods to robustly assess fairness in healthcare.