Disparities in Social Determinants among Performances of Mortality Prediction with Machine Learning for Sepsis Patients

TL;DR

This study investigates how social determinants like race, gender, and language affect the accuracy of machine learning models in predicting mortality among sepsis patients, revealing significant disparities that impact model performance.

Contribution

It highlights the existence of social determinant disparities in sepsis identification and mortality prediction, emphasizing the need for more equitable diagnostic systems.

Findings

Significant social disparities in sepsis identification methods.

Performance decreases in mortality prediction for Asian and Hispanic patients.

Discrepancies in prediction accuracy between different racial and language groups.

Abstract

Background Sepsis is one of the most life-threatening circumstances for critically ill patients in the US, while a standardized criteria for sepsis identification is still under development. Disparities in social determinants of sepsis patients can interfere with the risk prediction performances using machine learning. Methods Disparities in social determinants, including race, gender, marital status, insurance types and languages, among patients identified by six available sepsis criteria were revealed by forest plots. Sixteen machine learning classifiers were trained to predict in-hospital mortality for sepsis patients. The performance of the trained model was tested on the entire randomly conducted test set and each sub-population built based on each of the following social determinants: race, gender, marital status, insurance type, and language. Results We analyzed a total of 11,791 critical care patients from the MIMIC-III database. Within the population identified by each sepsis identification method, significant differences were observed among sub-populations regarding race, marital status, insurance type, and language. On the 5,783 sepsis patients identified by the Sepsis-3 criteria statistically significant performance decreases for mortality prediction were observed when applying the trained machine learning model on Asian and Hispanic patients. With pairwise comparison, we detected performance discrepancies in mortality prediction between Asian and White patients, Asians and patients of other races, as well as English-speaking and Spanish-speaking patients. Conclusions Disparities in proportions of patients identified by various sepsis criteria were detected among the different social determinant groups. To achieve accurate diagnosis, a versatile diagnostic system for sepsis is needed to overcome the social determinant disparities of patients.