Annals of Internal MedicineThe Impact of Health Care Algorithms on Racial and Ethnic Disparities: A Systematic Review

Algorithms at the Intersection of Technology and Equity in Healthcare

The systematic review examines the nuanced effects of health care algorithms on racial and ethnic disparities, offering insights into their potential to mitigate, exacerbate, or have no significant impact on these disparities. It underscores the importance of intentional design and implementation strategies in algorithm development to address equity concerns in healthcare outcomes.

Study Design:

• Timeframe: Studies published from January 1, 2011, to September 30, 2023.
• Data Extraction: Utilized ROBINS-I and adapted CARE-CPM tools.
• Study Inclusion: 63 studies, including 51 modeling, 4 retrospective, 2 prospective, 5 prepost studies, and 1 RCT.
• Focus: Effects of algorithms on disparities and strategies to mitigate bias.

Key Findings:

• Varied Impact: Algorithms showed diverse effects—some reduced disparities, others perpetuated or worsened them, and some had no significant effect.
• Mitigation Strategies: Identified strategies include altering variables, adjusting population composition in model development, and modifying analytic techniques.
• Context-specific: The impact of algorithms is highly context-dependent, with evidence mostly from modeling studies.

According to a study published in Science, an algorithm widely used in US hospitals was found to significantly underestimate the health needs of black patients compared to white patients.

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