Medical decision systems increasingly rely on data from multiple sources to ensure reliable and unbiased diagnosis. However, existing multimodal learning models fail to achieve this goal because they often overlook two critical challenges. First, various data modalities may learn unevenly, thereby converging to a model biased towards certain modalities. Second, the model may emphasize learning on certain demographic groups causing unfair performances. The two aspects can influence each other, as different data modalities may favor respective groups during optimization, leading to both imbalanced and unfair multimodal learning. This paper proposes a novel approach called MultiFair for multimodal medical classification, which addresses these challenges with a dual-level gradient modulation process. MultiFair dynamically modulates training gradients regarding the optimization direction and magnitude at both data modality and group levels. We evaluate MultiFair on three real-world medical classification datasets with diverse demographic attributes,including multiclass classification and missing-modality settings. Experimental results demonstrate its effectiveness.
Diagnostic performance in medical AI varies systematically across demographic groups, yet subgroup AUC can mask clinically important disparities. At a fixed inference-time operating point, some groups may exhibit over-diagnostic behaviour, characterized by elevated true and false positive rates, while others show under-diagnostic patterns with reduced true and false positive rates. These opposing tendencies can cancel in aggregate AUCs while producing meaningful inequities in clinical decision-making. Motivated by the need to assess and mitigate such disparities at the operating point and across multiple demographic attributes simultaneously, we propose a worst-group equalized-odds margin regularizer. The proposed regularizer explicitly targets subgroup-level deviations on both the true positive and false positive sides at inference. At each update, the method identifies subgroups defined by explicit demographic attributes (e.g., age, sex, and race) that exhibit the most extreme margin deviations and applies a unified penalty, enabling fairness optimization across multiple demographic axes without requiring explicit intersectional constraints. Across two medical imaging datasets in realistic multi-label settings, our method consistently reduces disparities in Equalized Odds and Equalized Opportunity with minimal impact on AUC, preserving diagnostic performance while improving fairness.
Nikhil Cherian Kurian, Victor Caquilpan Parra, Abin Shoby +6
Ensuring fair and equitable treatment across diverse groups, particularly in multi-class classification tasks, poses a significant challenge due to the persistent biases inherent in machine learning models. Most existing bias mitigation techniques are tailored to binary settings, and the presence of multi-dimensional outputs and complex fairness mechanisms makes their extension to multi-class scenarios neither straightforward nor effective. In this paper, we investigate two fundamental, unresolved challenges in fair classification: (i) characterizing the optimal accuracy-fairness frontier in multi-class settings, and (ii) designing practical algorithms that attain this optimum in different training phases. To tackle these challenges, we first specify an analytically tractable probabilistic formulation of the optimal classifier under fairness constraints. Building upon this, we propose two attribute-blind algorithms to enforce fairness requirements in practice: an in-processing approach for fairness intervention during training via the reduction approach, and a post-processing approach for fine-tuning output probabilities with plug-in estimation. Theoretical analysis reveals that both methods converge to the optimal accuracy-fairness Pareto frontier. Experiments conducted on multiple datasets demonstrate the superior performance of our methods in balancing accuracy and fairness.
Multimodal learning often suffers from modality imbalance, where modalities that converge faster dominate optimization while others remain undertrained. Existing approaches typically mitigate this issue by strengthening the weak modality or adjusting optimization gradients. However, such strategies mainly compensate for optimization rate discrepancies, often at the expense of the strong modality's optimization capacity, without analyzing how these discrepancies arise at the modality level. Based on theoretical insights and empirical observations, we argue that the discrepancy of learning pace arises from differences in the mapping difficulty between modality-specific feature space and the shared label space. To address this issue, we propose Balanced Multimodal Label Reshaping (BMLR), the first method that promotes multimodal balance from the label-side design. BMLR reshapes the cross-modal label space to equalize mapping difficulty across modalities, thereby facilitating modality interaction and injecting richer inter-class information into each modality. Extensive experiments across multiple architectures demonstrate that BMLR consistently improves multimodal performance and exhibits strong compatibility with diverse model designs. The source code will be released soon.