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.

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References
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.
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.
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.
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.
NIH Data Book - Report 226: NIH Budget Mechanism Detail [Available from: https://report.nih.gov/nihdatabook/category/1.
Research gets funding boost for FY 2023. Cancer Discov. 202313(3):520.https://doi.org/10.1158/2159-8290.Cd-nb2023-0004
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Takshi S. Unexpected inequality: disparate-impact from artificial intelligence in healthcare decisions. J Law Health. 2021;34(2):215–51.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Sorin V, Klang E. Artificial intelligence and health care disparities in radiology. Radiology. 2021;301(3):E443. https://doi.org/10.1148/radiol.2021210566.
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.
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.
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.
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.
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.
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.
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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.
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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.
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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
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DOI: https://doi.org/10.1007/s40615-024-02057-2