Algorithms Trained on Normal Chest X-rays Can Predict Health Insurance Types

Artificial intelligence is revealing what medicine never intended to encode. Deep vision models, trained on chest X-rays, can now detect not only disease but also invisible traces of social inequality. In this study, we show that state-of-the-art architectures (DenseNet121, SwinV2-B, MedMamba) can predict a patient's health insurance type, a strong proxy for socioeconomic status, from normal chest X-rays with significant accuracy (AUC around 0.67 on MIMIC-CXR-JPG, 0.68 on CheXpert). The signal persists even when age, race, and sex are controlled for, and remains detectable when the model is trained exclusively on a single racial group. Patch-based occlusion reveals that the signal is diffuse rather than localized, embedded in the upper and mid-thoracic regions. This suggests that deep networks may be internalizing subtle traces of clinical environments, equipment differences, or care pathways; learning socioeconomic segregation itself. These findings challenge the assumption that medical images are neutral biological data. By uncovering how models perceive and exploit these hidden social signatures, this work reframes fairness in medical AI: the goal is no longer only to balance datasets or adjust thresholds, but to interrogate and disentangle the social fingerprints embedded in clinical data itself.

LTCXNet: Advancing Chest X-Ray Analysis with Solutions for Long-Tailed Multi-Label Classification and Fairness Challenges

Chest X-rays (CXRs) often display various diseases with disparate class frequencies, leading to a long-tailed, multi-label data distribution. In response to this challenge, we explore the Pruned MIMIC-CXR-LT dataset, a curated collection derived from the MIMIC-CXR dataset, specifically designed to represent a long-tailed and multi-label data scenario. We introduce LTCXNet, a novel framework that integrates the ConvNeXt model, ML-Decoder, and strategic data augmentation, further enhanced by an ensemble approach. We demonstrate that LTCXNet improves the performance of CXR interpretation across all classes, especially enhancing detection in rarer classes like `Pneumoperitoneum' and `Pneumomediastinum' by 79\% and 48\%, respectively. Beyond performance metrics, our research extends into evaluating fairness, highlighting that some methods, while improving model accuracy, could inadvertently affect fairness across different demographic groups negatively. This work contributes to advancing the understanding and management of long-tailed, multi-label data distributions in medical imaging, paving the way for more equitable and effective diagnostic tools.