01 Clinical AI · Fairness · Uganda
Hypertension risk research in a real, incomplete clinical cohort
A study of whether a screening model can remain useful, understandable, and fair when the health records contain serious missing data.
The research question
Can a hypertension risk model trained on community health records be trusted when almost half of the age entries are missing—and does it work equally well for different patient groups?
What I did
- Compared simple missing-value filling with MICE and a MissForest-style method that learn from relationships between fields.
- Kept imputation inside the training pipeline so test patients could not leak information into the model.
- Audited performance separately by sex and age instead of trusting one overall score.
- Used SHAP to study which features and feature pairs influenced predictions.
The result, in everyday language
An AUROC of 0.649 means the model found some real signal, but it was only moderately better than chance. More importantly, the fairness audit found that it identified just 14% of hypertensive men, compared with 36.2% of hypertensive women, and missed every hypertensive patient under 30 in that test group. That is not a result to hide—it is the strongest reason this model should not yet be used on its own.
Limitations
- The data comes from people who reached one hospital-linked screening programme, not a representative sample of rural Uganda.
- The study is a single snapshot in time and lacks several useful biomarkers and long-term follow-up.
- Age-group findings use only records with observed age, because grouping people by an imputed age would introduce another uncertainty.
- The fairness audit currently covers sex and age, but not geography or other access-related groups.
Research opportunities
- Collect prospective data across more hospitals and community settings.
- Recalibrate the decision threshold and test whether group-aware rules improve sensitivity without creating new harms.
- Add geographic access, stronger clinical measures, and repeated patient visits.
- Explore retinal imaging only after paired image-and-record data is collected, followed by a new fairness audit.