Skip to main content

Advertisement

Log in

Bridging Health Disparities in the Data-Driven World of Artificial Intelligence: A Narrative Review

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Background

Artificial intelligence (AI) holds exciting potential to revolutionize healthcare delivery in the United States. However, there are concerns about its potential to perpetuate disparities among historically marginalized populations.

Objective

Following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we conducted a narrative review of current literature on AI and health disparities in the United States. We aimed to answer the question, Does AI have the potential to reduce or eliminate health disparities, or will its use further exacerbate these disparities?

Methods

We searched the Ovid MEDLINE electronic database to identify and retrieve publications discussing AI and its impact on racial/ethnic health disparities. Articles were included if they discussed AI as a tool to mitigate racial health disparities with or without bias in developing and using AI.

Results

This review included 65 articles. We identified six themes of limitations in AI that impact health equity: (1) biases in AI can perpetuate and exacerbate racial and ethnic inequities; (2) equity in algorithms should be a priority; (3) lack of diversity in the field of AI is concerning; (4) the need for regulation and testing algorithms for accuracy; (5) ethical standards for AI in health care are needed; and (6) the importance of promoting transparency and accountability.

Conclusions

While AI promises to enhance healthcare outcomes and address equity concerns, risks and challenges are associated with its implementation. To maximize the use of AI, it must be approached with an equity lens during all phases of development.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

Explore related subjects

Discover the latest articles, news and stories from top researchers in related subjects.

Data Availability

The authors confirm that the data supporting the findings of this study are available within the article.

Code Availability

Not applicable.

References

  1. Wang JX, Somani S, Chen JH, Murray S, Sarkar U. Health equity in artificial intelligence and primary care research: protocol for a scoping review. JMIR Res Protoc. 2021;10(9):e27799. https://doi.org/10.2196/27799.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Obermeyer Z, Powers B, Vogeli C, Mullainathan S. Dissecting racial bias in an algorithm used to manage the health of populations. Science. 2019;366(6464):447–53. https://doi.org/10.1126/science.aax2342.

    Article  CAS  PubMed  Google Scholar 

  3. Corti C, Cobanaj M, Dee EC, Criscitiello C, Tolaney SM, Celi LA, et al. Artificial intelligence in cancer research and precision medicine: applications, limitations and priorities to drive transformation in the delivery of equitable and unbiased care. Cancer Treat Rev. 2023;112:102498. https://doi.org/10.1016/j.ctrv.2022.102498.

    Article  PubMed  Google Scholar 

  4. Dankwa-Mullan I, Weeraratne D. Artificial intelligence and machine learning technologies in cancer care: addressing disparities, bias, and data diversity. Cancer Discovery. 2022;12(6):1423–7. https://doi.org/10.1158/2159-8290.CD-22-0373.

    Article  PubMed  PubMed Central  Google Scholar 

  5. NIH Data Book - Report 226: NIH Budget Mechanism Detail [Available from: https://report.nih.gov/nihdatabook/category/1.

  6. Research gets funding boost for FY 2023. Cancer Discov. 202313(3):520.https://doi.org/10.1158/2159-8290.Cd-nb2023-0004

  7. Chowdhury-Paulino IM, Ericsson C, Vince R Jr, Spratt DE, George DJ, Mucci LA. Racial disparities in prostate cancer among black men: epidemiology and outcomes. Prostate Cancer Prostatic Dis. 2022;25(3):397–402. https://doi.org/10.1038/s41391-021-00451-z.

    Article  PubMed  Google Scholar 

  8. Spratt DE, Chan T, Waldron L, Speers C, Feng FY, Ogunwobi OO, et al. Racial/ethnic disparities in genomic sequencing. JAMA Oncol. 2016;2(8):1070–4. https://doi.org/10.1001/jamaoncol.2016.1854.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372:n160. https://doi.org/10.1136/bmj.n160.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Parikh RB, Teeple S, Navathe AS. Addressing bias in artificial intelligence in health care. JAMA. 2019;322(24):2377–8. https://doi.org/10.1001/jama.2019.18058.

    Article  PubMed  Google Scholar 

  11. Topol EJ. High-performance medicine: the convergence of human and artificial intelligence. Nat Med. 2019;25(1):44–56. https://doi.org/10.1038/s41591-018-0300-7.

    Article  CAS  PubMed  Google Scholar 

  12. Rajkomar A, Dean J, Kohane I. Machine learning in medicine. N Engl J Med. 2019;380(14):1347–58. https://doi.org/10.1056/NEJMra1814259.

    Article  PubMed  Google Scholar 

  13. Hinton G. Deep learning-a technology with the potential to transform health care. JAMA. 2018;320(11):1101–2. https://doi.org/10.1001/jama.2018.11100.

    Article  PubMed  Google Scholar 

  14. Hague DC. Benefits, pitfalls, and potential bias in health care AI. N C Med J. 2019;80(4):219–23. https://doi.org/10.18043/ncm.80.4.219.

    Article  PubMed  Google Scholar 

  15. Matheny ME, Whicher D, ThadaneyIsrani S. Artificial intelligence in health care: a report from the National Academy of Medicine. JAMA. 2020;323(6):509–10. https://doi.org/10.1001/jama.2019.21579.

    Article  PubMed  Google Scholar 

  16. Panch T, Mattie H, Atun R. Artificial intelligence and algorithmic bias: implications for health systems. J Glob Health. 2019;9(2):010318. https://doi.org/10.7189/jogh.09.020318.

    Article  PubMed  Google Scholar 

  17. Rajkomar A, Hardt M, Howell MD, Corrado G, Chin MH. Ensuring fairness in machine learning to advance health equity. Ann Intern Med. 2018;169(12):866–72. https://doi.org/10.7326/M18-1990.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Solomonides AE, Koski E, Atabaki SM, Weinberg S, McGreevey JD, Kannry JL, et al. Defining AMIA’s artificial intelligence principles. J Am Med Inform. 2022;29(4):585–91. https://doi.org/10.1093/jamia/ocac006.

    Article  Google Scholar 

  19. Thomasian NM, Eickhoff C, Adashi EY. Advancing health equity with artificial intelligence. J Public Health Policy. 2021;42(4):602–11. https://doi.org/10.1057/s41271-021-00319-5.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Timmons AC, Duong JB, Simo Fiallo N, Lee T, Vo HPQ, Ahle MW, Comer JS, Brewer LC, Frazier SL, Chaspari T. A call to action on assessing and mitigating bias in artificial intelligence applications for mental health. Perspect Psychol Sci. 2023;18(5):1062–96. https://doi.org/10.1177/17456916221134490

  21. Makhni S, Chin MH, Fahrenbach J, Rojas JC. Equity challenges for artificial intelligence algorithms in health care. Chest. 2022;161(5):1343–6. https://doi.org/10.1016/j.chest.2022.01.009.

    Article  PubMed  Google Scholar 

  22. Adamson AS, Smith A. Machine learning and health care disparities in dermatology. JAMA Dermatol. 2018;154(11):1247–8. https://doi.org/10.1001/jamadermatol.2018.2348.

    Article  PubMed  Google Scholar 

  23. McCradden MD, Joshi S, Anderson JA, Mazwi M, Goldenberg A, Zlotnik SR. Patient safety and quality improvement: ethical principles for a regulatory approach to bias in healthcare machine learning. J Am Med Inform Assoc. 2020;27(12):2024–7. https://doi.org/10.1093/jamia/ocaa085.

    Article  PubMed  PubMed Central  Google Scholar 

  24. O’Connor S, Booth RG. Algorithmic bias in health care: opportunities for nurses to improve equality in the age of artificial intelligence. Nurs Outlook. 2022;70(6):780–2. https://doi.org/10.1016/j.outlook.2022.09.003.

    Article  PubMed  Google Scholar 

  25. Gianfrancesco MA, Tamang S, Yazdany J, Schmajuk G. Potential biases in machine learning algorithms using electronic health record data. JAMA Intern Med. 2018;178(11):1544–7. https://doi.org/10.1001/jamainternmed.2018.3763.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Nordling L. A fairer way forward for AI in health care. Nature. 2019;573(7775):S103–5. https://doi.org/10.1038/d41586-019-02872-2.

    Article  CAS  PubMed  Google Scholar 

  27. Johnson SLJ. AI, machine learning, and ethics in health care. J Leg Med. 2019;39(4):427–41. https://doi.org/10.1080/01947648.2019.1690604.

    Article  PubMed  Google Scholar 

  28. Dixon BE, Holmes JH. Special section on inclusive digital health: notable papers on addressing bias, equity, and literacy to strengthen health systems. Yearb Med Inform. 2022;31(1):100–4. https://doi.org/10.1055/s-0042-1742536.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Plana D, Shung DL, Grimshaw AA, Saraf A, Sung JJY, Kann BH. Randomized clinical trials of machine learning interventions in health care: a systematic review. JAMA Netw Open. 2022;5(9):e2233946. https://doi.org/10.1001/jamanetworkopen.2022.33946.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Brault N, Saxena M. For a critical appraisal of artificial intelligence in healthcare: the problem of bias in mHealth. J Eval Clin Pract. 2021;27(3):513–9. https://doi.org/10.1111/jep.13528.

    Article  PubMed  Google Scholar 

  31. Pham Q, Gamble A, Hearn J, Cafazzo JA. The need for ethnoracial equity in artificial intelligence for diabetes management: review and recommendations. J Med Internet Res. 2021;23(2):e22320. https://doi.org/10.2196/22320.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Char DS, Shah NH, Magnus D. Implementing machine learning in health care - addressing ethical challenges. N Engl J Med. 2018;378(11):981–3. https://doi.org/10.1056/NEJMp1714229.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Crigger E, Reinbold K, Hanson C, Kao A, Blake K, Irons M. Trustworthy augmented intelligence in health care. J Med Syst. 2022;46(2):12. https://doi.org/10.1007/s10916-021-01790-z.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Takshi S. Unexpected inequality: disparate-impact from artificial intelligence in healthcare decisions. J Law Health. 2021;34(2):215–51.

    PubMed  Google Scholar 

  35. Khoury P, Srinivasan R, Kakumanu S, Ochoa S, Keswani A, Sparks R, et al. A framework for augmented intelligence in allergy and immunology practice and research-a work group report of the AAAAI Health Informatics, Technology, and Education Committee. J Allergy Clin Immunol Pract. 2022;10(5):1178–88. https://doi.org/10.1016/j.jaip.2022.01.047.

    Article  PubMed  Google Scholar 

  36. Uche-Anya E, Anyane-Yeboa A, Berzin TM, Ghassemi M, May FP. Artificial intelligence in gastroenterology and hepatology: how to advance clinical practice while ensuring health equity. Gut. 2022;71(9):1909–15. https://doi.org/10.1136/gutjnl-2021-326271.

    Article  PubMed  Google Scholar 

  37. Xiang Y, Du J, Fujimoto K, Li F, Schneider J, Tao C. Application of artificial intelligence and machine learning for HIV prevention interventions. The Lancet HIV. 2022;9(1):e54–62. https://doi.org/10.1016/S2352-3018(21)00247-2.

    Article  CAS  PubMed  Google Scholar 

  38. Cho MK. Rising to the challenge of bias in health care AI. Nat Med. 2021;27(12):2079–81. https://doi.org/10.1038/s41591-021-01577-2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Seyyed-Kalantari L, Zhang H, McDermott MBA, Chen IY, Ghassemi M. Underdiagnosis bias of artificial intelligence algorithms applied to chest radiographs in under-served patient populations. Nat Med. 2021;27(12):2176–82. https://doi.org/10.1038/s41591-021-01595-0.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Noseworthy PA, Attia ZI, Brewer LC, Hayes SN, Yao X, Kapa S, et al. Assessing and mitigating bias in medical artificial intelligence: the effects of race and ethnicity on a deep learning model for ECG analysis. Circ. 2020;13(3):e007988. https://doi.org/10.1161/CIRCEP.119.007988.

    Article  Google Scholar 

  41. Wiens J, Price WN 2nd, Sjoding MW. Diagnosing bias in data-driven algorithms for healthcare. Nat Med. 2020;26(1):25–6. https://doi.org/10.1038/s41591-019-0726-6.

    Article  CAS  PubMed  Google Scholar 

  42. Sood A, Sangari A, Chen JY, Stoff BK. The ethics of using biased artificial intelligence programs in the clinic. J Am Acad Dermatol. 2022;87(4):935–6. https://doi.org/10.1016/j.jaad.2021.11.031.

    Article  PubMed  Google Scholar 

  43. Kocher MR, Lee CI. Preventing artificial intelligence in medical imaging from perpetuating health care biases and disparities. J Am College Radiol. 2022;19(12):1345–6. https://doi.org/10.1016/j.jacr.2022.07.021.

    Article  Google Scholar 

  44. Rojas JC, Fahrenbach J, Makhni S, Cook SC, Williams JS, Umscheid CA, et al. Framework for integrating equity into machine learning models: a case study. Chest. 2022;161(6):1621–7. https://doi.org/10.1016/j.chest.2022.02.001.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Zaidi D, Miller T. Implicit bias and machine learning in health care. South Med J. 2023;116(1):62–4. https://doi.org/10.14423/SMJ.0000000000001489.

    Article  PubMed  Google Scholar 

  46. Starke G, De Clercq E, Elger BS. Towards a pragmatist dealing with algorithmic bias in medical machine learning. Med Health Care Philos. 2021;24(3):341–9. https://doi.org/10.1007/s11019-021-10008-5.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Chen IY, Szolovits P, Ghassemi M. Can AI help reduce disparities in general medical and mental health care? AMA J Ethics. 2019;21(2):E167-79. https://doi.org/10.1001/amajethics.2019.167.

    Article  PubMed  Google Scholar 

  48. Byrne MD. Reducing bias in healthcare artificial intelligence. J Perianesth Nurs. 2021;36(3):313–6. https://doi.org/10.1016/j.jopan.2021.03.009.

    Article  PubMed  Google Scholar 

  49. Sorin V, Klang E. Artificial intelligence and health care disparities in radiology. Radiology. 2021;301(3):E443. https://doi.org/10.1148/radiol.2021210566.

    Article  PubMed  Google Scholar 

  50. Seker E, Talburt JR, Greer ML. Preprocessing to address bias in healthcare data. Stud Health Technol Inform. 2022;294:327–31. https://doi.org/10.3233/SHTI220468.

    Article  PubMed  Google Scholar 

  51. Sikstrom L, Maslej MM, Hui K, Findlay Z, Buchman DZ, Hill SL. Conceptualising fairness: three pillars for medical algorithms and health equity. BMJ Health Care Inform. 2022;29:1. https://doi.org/10.1136/bmjhci-2021-100459.

    Article  Google Scholar 

  52. Administration FaD. Artificial intelligence and machine learning (AI/ML) for drug development 2023 [Available from: https://www.fda.gov/science-research/science-and-research-special-topics/artificial-intelligence-and-machine-learning-aiml-drug-development.

  53. Gervasi SS, Chen IY, Smith-McLallen A, Sontag D, Obermeyer Z, Vennera M, et al. The potential for bias in machine learning and opportunities for health insurers to address it. Health Aff (Millwood). 2022;41(2):212–8. https://doi.org/10.1377/hlthaff.2021.01287.

    Article  PubMed  Google Scholar 

  54. McCradden MD, Joshi S, Mazwi M, Anderson JA. Ethical limitations of algorithmic fairness solutions in health care machine learning. Lancet Digit Health. 2020;2(5):e221–3. https://doi.org/10.1016/S2589-7500(20)30065-0.

    Article  PubMed  Google Scholar 

  55. Yousefi Nooraie R, Lyons PG, Baumann AA, Saboury B. Equitable implementation of artificial intelligence in medical imaging: what can be learned from implementation science? PET Clin. 2021;16(4):643–53. https://doi.org/10.1016/j.cpet.2021.07.002.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Editorial assistance was provided by Moffitt Cancer Center’s Office of Scientific Publishing by Daley Drucker and Gerard Hebert; no compensation was given beyond their regular salaries.

Author information

Authors and Affiliations

Authors

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [Blinded Authors]. The first draft of the manuscript was written by [Blinded Authors] and all authors commented on previous versions of the manuscript. [Blinded Authors] critically revised the manuscript and all authors read and approved the final manuscript.

Corresponding author

Correspondence to Anastasia Murphy.

Ethics declarations

Ethics Approval

This is a narrative review; therefore, no ethical approval is required.

Consent to Participate

This narrative review did not require requesting or obtaining consent.

Consent for Publication

All authors give consent to publish.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 20 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Murphy, A., Bowen, K., Naqa, I.M.E. et al. Bridging Health Disparities in the Data-Driven World of Artificial Intelligence: A Narrative Review. J. Racial and Ethnic Health Disparities (2024). https://doi.org/10.1007/s40615-024-02057-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s40615-024-02057-2

Keywords