equimed-dss 1.9.4

A comprehensive Python library for clinical AI fairness assessment with 37 metrics across five domains

EquiMed_DSS

A Comprehensive Python Library for Clinical AI Fairness Assessment

Evaluate reliability, equity, governance, and intersectionality in clinical AI systems using 37 metrics across five domains

---

Overview

EquiMed_DSS (Equitable Medical Decision Support System) provides a systematic framework for evaluating clinical AI systems across multiple dimensions of fairness, reliability, and governance. The library implements 37 metrics across five domains specifically designed for healthcare applications where equity and safety are paramount.

Key Features

Feature	Description
37 Metrics	Five domains (reliability, equity, governance, representation/robustness, technical-supplement fairness) plus geographic and advanced-appendix metrics
Clinical AI Focus	Designed specifically for healthcare applications
Statistical Analyses	HLM, Mediation Analysis, Network Statistics
Publication-Ready Visualizations	6 manuscript-quality figure generators
Multi-Format Data Support	MySQL, CSV, TSV, JSON with automatic standardization
Intersectional Analysis	Detect bias across demographic combinations
Geographic Equity	BEMI and GCC measure evidence-burden mismatch and regional concentration
Tidy Reporting Tables	export_table renders metric results as markdown, LaTeX, or HTML

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Table of Contents

• Installation
• Quick Start
• Data Format
• Metrics Overview
  • Domain 1: Reliability & Calibration
  • Domain 2: Fairness, Equity & Ethics
  • Domain 3: Governance & Transparency
  • Domain 4: Representation & Robustness
  • Domain 5: Technical-supplement Fairness
  • Appendix: Advanced Metrics
  • Full formulas, clinical meaning, and runnable examples: see docs/VIGNETTE.md
• Statistical Analyses
• Visualizations
• Examples
• Vignette
• API Reference
• Contributing
• Citation
• License

---

Installation

Prerequisites

• Python 3.8 or higher
• pip package manager

Install from Source

# Clone the repository
git clone https://github.com/johnmuteba/EquiMed_DSS.git
cd EquiMed_DSS

# Create virtual environment (recommended)
python -m venv venv
source venv/bin/activate  # On Windows: venv\Scripts\activate

# Install the package with dependencies
pip install -e .

Install via pip

pip install equimed_dss

Installing inside Jupyter or conda (read this if you hit ModuleNotFoundError)

The most common installation problem is installing into a different Python than the one your notebook or environment actually runs. You see Successfully installed equimed_dss in a terminal, then ModuleNotFoundError: No module named 'equimed_dss' in Jupyter. This is an environment mismatch, not a package problem. Install into the running interpreter:

In a Jupyter notebook cell (installs into the active kernel, then restart the kernel):

%pip install equimed_dss

From a terminal, target a specific interpreter explicitly:

python -m pip install equimed_dss          # uses THIS python
# conda example:
conda activate myenv && python -m pip install equimed_dss

Confirm the install is visible to your interpreter:

import sys; print(sys.executable)          # which python is running
import equimed_dss; print(equimed_dss.__version__)

Dependencies

numpy>=1.20.0
pandas>=1.3.0
scipy>=1.7.0
scikit-learn>=1.0.0
matplotlib>=3.5.0
seaborn>=0.11.0
networkx>=2.6.0
statsmodels>=0.13.0

---

Quick Start

Generate Sample Data

from equimed_dss.utils import SampleDataGenerator

# Generate synthetic clinical AI evaluation data
generator = SampleDataGenerator(random_state=42)
data = generator.generate_fairness_data(n_samples=1000)

print(f"Generated {len(data)} samples with columns: {list(data.columns)}")
# Output: Generated 1000 samples with columns: ['id', 'race', 'gender', 'age_group', 'prediction', 'actual', 'confidence']

Calculate Fairness Metrics

import numpy as np
from equimed_dss.domain2 import HierarchicalEquityRatio, HarmAdjustedFairnessGap

# Example: Calculate Hierarchical Equity Ratio across racial groups
her_metric = HierarchicalEquityRatio()
group_performance = {
    'White': 0.85,
    'Black': 0.78,
    'Hispanic': 0.80,
    'Asian': 0.87
}

her_scores = her_metric.calculate_her(group_performance)
gini = her_metric.calculate_bias_gini(list(group_performance.values()))

print(f"Equity Ratios: {her_scores}")
print(f"Bias-Gini Index: {gini:.4f}")
# Interpretation: Gini < 0.2 indicates low dispersion (good)

Analyze Distributional Fairness

from equimed_dss.appendix import JensenShannonDivergence, WassersteinDistance

# Compare prediction distributions between groups
group_a_predictions = np.array([0.9, 0.85, 0.78, 0.92, 0.88])
group_b_predictions = np.array([0.75, 0.70, 0.68, 0.72, 0.65])

# Jensen-Shannon Divergence (between two aggregate distributions: no underlying
# per-observation sample, so it prints "CI unavailable")
jsd = JensenShannonDivergence()
jsd_result = jsd.calculate_jsd(group_a_predictions, group_b_predictions)
print(jsd_result)                   # JSD = ... :: 95% CI unavailable

# Wasserstein Distance (the two inputs are treated as samples -> bootstrap CI)
wd = WassersteinDistance()
wd_result = wd.calculate_wd(group_a_predictions, group_b_predictions)
print(wd_result)                    # WD = ... :: 95% CI [...] (bootstrap)

---

Data Format

Required Data Structure

EquiMed_DSS expects data in a standardized format. Use the built-in utilities to convert your data:

from equimed_dss.utils import CorpusLoader, DemographicProcessor

# Load and standardize your data
loader = CorpusLoader()

# From CSV
df = loader.load_from_csv('your_data.csv', text_column='clinical_notes')

# Validate format
validation = loader.validate_format(df)
print(validation)

Expected Columns

Column	Type	Required	Description
id	string	Yes	Unique identifier
content	string	For text analysis	Clinical text/notes
prediction	float	For fairness metrics	Model prediction (0-1)
actual	int	For fairness metrics	Ground truth (0 or 1)
race	string	For demographic analysis	Racial/ethnic group
gender	string	For demographic analysis	Gender identity
age_group	string	For demographic analysis	Age category

Sample Data Schema

{
  "id": "patient_001",
  "content": "Patient presents with chest pain...",
  "prediction": 0.85,
  "actual": 1,
  "race": "Black",
  "gender": "Female",
  "age_group": "Middle Age"
}

---

Metrics Overview

Domain 1: Reliability & Calibration

Metric	Abbreviation	Range	Ideal	Description
Decision Flip Rate	DFR	[0, 1]	close to 0	Decision instability under counterfactual inputs
Embedding Consistency Score	ECS	[0, 1]	higher	Embedding stability under perturbation
Inter-Rater Reliability (ICC 2,1)	ICC	[0, 1]	> 0.75	Agreement across judges

Every metric result carries a 95% confidence interval and prints it. Just print(result) and the value is shown alongside its CI (the result is still a plain dict, so result['flip_rate'] etc. keep working):

import numpy as np
from equimed_dss.domain1 import DecisionFlipRate, EmbeddingConsistencyScore, InterRaterReliability

# Decision Flip Rate (DFR): how often decisions flip under counterfactual inputs
dfr = DecisionFlipRate()
print(dfr.calculate_dfr(
    original_decisions=['ACS', 'ACS', 'non-cardiac', 'ACS'],
    counterfactual_decisions=['ACS', 'non-cardiac', 'non-cardiac', 'ACS'],
))
# DFR = 0.250 :: 95% CI [0.046; 0.699] (Wilson score)

# Embedding Consistency Score (ECS): stability of embeddings under perturbation
ecs = EmbeddingConsistencyScore()
original = np.random.RandomState(0).rand(10, 8)
perturbed = original + np.random.RandomState(1).normal(0, 0.05, (10, 8))
print(ecs.calculate_ecs(original, perturbed))
# ECS = 0.003 :: 95% CI [0.002; 0.005] (bootstrap)

# Inter-Rater Reliability (ICC 2,1): agreement across judges (subjects x raters)
icc = InterRaterReliability()
print(icc.calculate_icc_2_1(np.array([[3, 4, 3], [5, 5, 4], [2, 3, 2], [4, 4, 5]])))
# ICC(2,1) = 0.750 :: 95% CI [-0.500; 0.816] (bootstrap (over items))

Domain 2: Fairness, Equity & Ethics

Metric	Abbreviation	Range	Ideal	Description
Hierarchical Equity Ratio	HER	[0, ∞)	0.8-1.25	Group equity (4/5ths rule)
Bias-Gini Index	BGI	[0, 1]	< 0.2	Performance dispersion
Harm-Adjusted Fairness Gap	HAFG	[0, ∞)	< 0.1	Clinical harm-weighted disparity
Ethical Risk Index	ERI	[0, ∞)	< 0.05	Aggregated ethical violations
Intersectional Bias Score	IBS	varies	low	Subgroup outlier detection

from equimed_dss.domain2 import HierarchicalEquityRatio, HarmAdjustedFairnessGap, EthicalRiskIndex

# Harm-Adjusted Fairness Gap. Pass per-case error labels (group*_cases) to get a
# bootstrap CI; with only aggregate counts the result prints "CI unavailable".
hafg = HarmAdjustedFairnessGap()
result = hafg.calculate_hafg(
    group1_errors={'fn': 5, 'fp': 10},
    group2_errors={'fn': 2, 'fp': 5},
    group1_cases=['fn'] * 5 + ['fp'] * 10 + ['tn'] * 85,
    group2_cases=['fn'] * 2 + ['fp'] * 5 + ['tn'] * 93,
)
print(result)
# HAFG = 0.562 :: 95% CI [...] (bootstrap)

# Ethical Risk Index (CHR-style: value + Wilson SVR + bootstrap ERI CI)
eri = EthicalRiskIndex()
result = eri.calculate_eri(
    violations=[{'severity': 2.5}, {'severity': 1.0}, {'severity': 5.0}],
    n_total_outputs=100
)
print(result)
# ERI = 0.085 :: 95% CI [...] (bootstrap)

Domain 3: Governance & Transparency

Metric	Abbreviation	Range	Ideal	Description
Temporal Fairness Drift	TFD	varies	stable	Fairness degradation over time
Audit Traceability Score	ATS	[0, 1]	> 0.9	Audit trail completeness
Governance Compliance Index	GCI	[0, 1]	1.0	Regulatory compliance

from equimed_dss.domain3 import TemporalFairnessDrift, AuditTraceabilityScore, GovernanceComplianceIndex

# Temporal Fairness Drift
tfd = TemporalFairnessDrift()
result = tfd.calculate_drift([0.85, 0.84, 0.86, 0.83, 0.75, 0.84])
print(result)                       # TFD = mean PDI :: 95% CI [...] (bootstrap)
print("Drift detected:", result['drift_detected'])

# Audit Traceability Score: fraction of audit records that are fully traceable
ats = AuditTraceabilityScore()
result = ats.calculate_ats(n_traceable=8, n_total=10)
print(result)                       # ATS = 0.800 :: 95% CI [...] (Wilson score)

Domain 4: Representation & Robustness

Metric	Abbreviation	Range	Ideal	Description
Semantic Parity Gap	SPG	[0, ∞)	close to 0	Embedding-centroid distance between identical cases differing only by a protected attribute
Clinical Hallucination Rate	CHR	[0, 1]	close to 0	Fraction of response claims unsupported by the retrieved context (NLI entailment)
Instructional Vulnerability Index	IVI	[0, 1]	close to 0	Proportion of decisions that flip under a biased/leading instruction
Geographic Representation Index	GRI	[0, 1]	higher	Set-based non-Western variety of represented locations

import numpy as np
from equimed_dss.domain4 import (
    SemanticParityGap, ClinicalHallucinationRate,
    InstructionalVulnerabilityIndex, GeographicRepresentationIndex,
)

# Clinical Hallucination Rate (CHR): unsupported claims at entailment threshold tau
chr_ = ClinicalHallucinationRate()
result = chr_.calculate_chr(support_scores=[0.9, 0.2, 0.4, 0.8, 0.1], tau=0.5)
print(result)                       # CHR = 0.600 :: 95% CI [...] (Wilson score)

# Instructional Vulnerability Index (IVI): decision flips under a biased prompt
ivi = InstructionalVulnerabilityIndex()
result = ivi.calculate_ivi(neutral_outputs=['acs', 'non_cardiac', 'acs', 'other'],
                           biased_outputs=['acs', 'acs', 'acs', 'other'])
print(result)                       # IVI = 0.250 :: 95% CI [...] (Wilson score)

# Semantic Parity Gap (SPG): centroid distance between two demographic embedding clusters
spg = SemanticParityGap()
rng = np.random.RandomState(0)
result = spg.calculate_spg(privileged_embeddings=rng.rand(20, 16),
                           marginalized_embeddings=rng.rand(20, 16) + 0.1)
print(result)                       # SPG = ... :: 95% CI [...] (bootstrap)

Domain 5: Technical-supplement Fairness

Metric	Abbreviation	Range	Ideal	Description
Intersectional Calibration Error	ICE	[0, 1]	close to 0	Population-weighted calibration error across intersectional groups; dICE = max gap
Weighted Clinical Harm-Adjusted Fairness Gap	wHAFG	[0, 1]	close to 0	Severity-weighted harm gap across groups
Lexical Diversity Disparity Index	LDDI	[0, ∞)	close to 0	Root type-token-ratio gap across groups
Recommendation Entropy Gap	REG	[0, ∞) bits	close to 0	Max-min recommendation-distribution entropy across groups
Counterfactual Parity Score	CPS	[0, 1]	1.0	Mean response similarity under a demographic swap (CFU = 1 − CPS)
Clinical Information Density Ratio	CIDR	[0, 1]	1.0	Group concept-density relative to the richest group
Diagnostic Completeness Index	DCI	[0, 1]	higher	Coverage of a reference differential set; dDCI = max gap
Uncertainty Quantification Gap	UQG	[0, ∞)	close to 0	Hedging-density disparity across groups
Geographic Representation Bias Index	GRBI	[0, ∞) nats	close to 0	KL divergence of corpus geography from disease burden
Healthcare System Stratified Fairness	HSSF	[0, 1]	close to 0	Population-weighted within-system demographic gap
Intersectional Shapley Fairness Value	ISFV	varies	low	Shapley attribution of disparity to each attribute + interactions
Semantic Robustness Parity Index	SRPI	[0, 1]	1.0	Min/max paraphrase robustness across groups

from equimed_dss.domain5 import (
    CounterfactualParityScore, GeographicRepresentationBiasIndex,
    IntersectionalShapleyFairnessValue,
)

# Counterfactual Parity Score (CPS) and counterfactual unfairness (CFU)
cps = CounterfactualParityScore()
result = cps.calculate_cps([0.95, 0.88, 0.91, 0.86])
print(result)                       # CPS = 0.900 :: 95% CI [...] (bootstrap)

# Geographic Representation Bias Index (GRBI): KL of corpus geography from burden.
# Pass corpus_records (one region label per evidence record) for a bootstrap CI;
# with only aggregate counts the result prints "CI unavailable".
grbi = GeographicRepresentationBiasIndex()
result = grbi.calculate_grbi(
    corpus_counts={'AMRO': 78, 'EURO': 11, 'WPRO': 8, 'EMRO': 3, 'AFRO': 0, 'SEARO': 0},
    burden_shares={'AMRO': 0.11, 'EURO': 0.19, 'WPRO': 0.10, 'EMRO': 0.23, 'AFRO': 0.15, 'SEARO': 0.21},
    corpus_records=(['AMRO'] * 78 + ['EURO'] * 11 + ['WPRO'] * 8 + ['EMRO'] * 3),
)
print(result)                       # GRBI = ... :: 95% CI [...] (bootstrap)

# Intersectional Shapley Fairness Value (ISFV): attribute attribution of disparity
isfv = IntersectionalShapleyFairnessValue()
result = isfv.calculate_isfv(
    attributes={'race': ['A', 'A', 'B', 'B'], 'sex': ['M', 'F', 'M', 'F']},
    outcomes=[0.8, 0.7, 0.5, 0.6],
)
print(result)                       # ISFV = total disparity :: 95% CI [...] (bootstrap)
print("By attribute:", result['shapley_by_attribute'])

Appendix: Advanced Metrics

These 9 additional metrics provide deeper statistical analysis:

Metric	Class	Range	Threshold	Description
Bootstrap Confidence Intervals	BootstrapConfidenceIntervals	varies	CI width < 0.05	Robust uncertainty estimation
Statistical Power Analysis	StatisticalPowerAnalysis	[0, 1]	≥ 0.8	Sample size adequacy
Bias Concentration Index	BiasConcentrationIndex	[0, 1]	> 0.7	Bias distribution across groups
Mutual Information Content	MutualInformationContent	[0, ∞)	< 0.1	Demographic information leakage
Jensen-Shannon Divergence	JensenShannonDivergence	[0, 1]	< 0.1	Distributional similarity
Wasserstein Distance	WassersteinDistance	[0, ∞)	< 0.1	Optimal transport distance
Network Modularity	NetworkModularity	[-1, 1]	> 0.3	Metric clustering structure
Transparency Score	TransparencyScore	[0, 1]	> 0.7	Explanation quality
Robustness Certification	RobustnessCertificationScore	[0, 1]	> 0.8	Perturbation stability

from equimed_dss.appendix import (
    BootstrapConfidenceIntervals,
    StatisticalPowerAnalysis,
    BiasConcentrationIndex,
    MutualInformationContent,
    JensenShannonDivergence,
    WassersteinDistance,
    NetworkModularity,
    TransparencyScore,
    RobustnessCertificationScore
)
import numpy as np

# Bootstrap Confidence Intervals
bci = BootstrapConfidenceIntervals(n_bootstrap=1000, random_state=42)
data = np.random.normal(0.85, 0.05, 100)
result = bci.calculate_bci(data)
print(result)                       # BCI = observed stat :: 95% CI [...] (bootstrap)

# Statistical Power Analysis (an analytic design quantity: prints "CI unavailable")
spa = StatisticalPowerAnalysis()
result = spa.calculate_sample_size(effect_size=0.5, power=0.8)
print(result)                       # SampleSize = N per group :: 95% CI unavailable

# Bias Concentration Index
bci_metric = BiasConcentrationIndex()
result = bci_metric.calculate_bci([0.3, 0.25, 0.25, 0.2])  # Bias proportions
print(result)                       # BiasConcentration = ... :: 95% CI [...] (bootstrap)

# Mutual Information Content
mic = MutualInformationContent()
demographics = np.array([0, 0, 1, 1, 2, 2, 0, 1])  # Encoded demographics
outcomes = np.array([1, 1, 0, 0, 1, 0, 1, 0])      # Model outcomes
result = mic.calculate_mic(demographics, outcomes)
print(result)                       # MIC = ... :: 95% CI [...] (bootstrap)

# Network Modularity
nm = NetworkModularity()
adjacency = np.array([[0, 0.8, 0.3], [0.8, 0, 0.4], [0.3, 0.4, 0]])
result = nm.calculate_modularity(adjacency)
print(result)                       # NM = ... :: 95% CI [...] (bootstrap)

# Transparency Score
ts = TransparencyScore()
explanations = [
    {'explanation_quality': 0.8, 'feature_importance': 0.75, 'interpretability': 0.9},
    {'explanation_quality': 0.7, 'feature_importance': 0.8, 'interpretability': 0.85}
]
result = ts.calculate_ts(explanations)
print(result)                       # TS = ... :: 95% CI [...] (bootstrap)

# Robustness Certification Score
rcs = RobustnessCertificationScore()
original = np.array([1, 1, 0, 1, 0])
perturbed = [np.array([1, 1, 0, 1, 0]), np.array([1, 0, 0, 1, 0])]
result = rcs.calculate_rcs(original, perturbed)
print(result)                       # RCS = ... :: 95% CI [...] (bootstrap)

Geographic Equity (v1.1.0)

equimed_dss.geographic quantifies how well the evidence base reflects the global disease burden:

• BurdenEvidenceMismatch (BEMI): total-variation distance between the regional evidence distribution and the regional disease-burden distribution. Range [0, 1]; 0 means evidence tracks burden exactly, 1 means the two distributions are completely disjoint.
• GeographicConcentration (GCC): sample-corrected Gini coefficient (G*) and normalized Shannon entropy (H_norm) for the regional distribution of included studies. G* = 0 and H_norm = 1 both indicate even coverage; G* = 1 and H_norm = 0 indicate single-region concentration. Note that Gini and entropy run in opposite directions.
• WHO_REGION_IHD_BURDEN: bundled reference constant of normalized IHD DALY shares from Roth GA et al., 2020 (GBD). AFRO and SEARO together carry about 36% of global IHD burden.

from equimed_dss.geographic import BurdenEvidenceMismatch, GeographicConcentration, WHO_REGION_IHD_BURDEN

evidence = {"AFRO": 5, "AMRO": 40, "EURO": 30, "SEARO": 3, "WPRO": 10, "EMRO": 2}

# Pass per-study region labels (evidence_records / region_records) for a bootstrap
# CI; with only aggregate counts the result prints "CI unavailable".
records = [r for r, n in evidence.items() for _ in range(n)]

bemi = BurdenEvidenceMismatch()
bemi_result = bemi.calculate_bemi(
    evidence_counts=evidence,
    burden_shares=WHO_REGION_IHD_BURDEN,
    evidence_records=records,
)
print(bemi_result)                  # BEMI = ... :: 95% CI [...] (bootstrap)

gcc = GeographicConcentration()
gcc_result = gcc.calculate_gcc(evidence, region_records=records)
print(gcc_result)                   # GCC = G* :: 95% CI [...] (bootstrap)
print("H_norm:", gcc_result['entropy_normalized'])

Reporting Tables (v1.1.0)

equimed_dss.reporting converts metric results into tidy DataFrames and exports them:

from equimed_dss.geographic import (
    BurdenEvidenceMismatch, GeographicConcentration, WHO_REGION_IHD_BURDEN,
)
from equimed_dss.reporting import geographic_table, export_table

evidence = {"AFRO": 5, "AMRO": 40, "EURO": 30, "SEARO": 3, "WPRO": 10, "EMRO": 2}
bemi_result = BurdenEvidenceMismatch().calculate_bemi(
    evidence_counts=evidence, burden_shares=WHO_REGION_IHD_BURDEN)
gcc_result = GeographicConcentration().calculate_gcc(evidence)

df = geographic_table(bemi_result, gcc_result)
print(df)                                    # show the table in the console
print(export_table(df, fmt="markdown"))      # render it as markdown to the screen

# To also save to files, pass a path (returns None, so do not wrap these in print):
export_table(df, fmt="markdown", path="results/geographic.md")
export_table(df, fmt="latex",    path="results/geographic.tex")
export_table(df, fmt="html",     path="results/geographic.html")

Output:

                       metric  value
0                        BEMI   0.48
1                  Gini* (G*)  0.613
2                      H_norm  0.742
3  concentration (1 - H_norm)  0.258
4     most_underserved_region   EMRO
5                   n_regions      6

---

Visualizations

All plot helpers in equimed_dss.utils return a Matplotlib figure (they do not call plt.show()), and write to save_path when given, so they compose cleanly in scripts, notebooks, and report pipelines.

Equity radar — one normalized score per domain for an at-a-glance audit:

from equimed_dss.utils import plot_equity_radar

fig = plot_equity_radar(
    {"Reliability": 0.16, "Fairness": 0.95, "Governance": 0.80,
     "Representation": 0.33, "Robustness": 0.73},
    reference=0.8,                      # optional acceptability-target ring
    save_path="equity_radar.png",
)

Geographic dumbbell — disease burden vs evidence share per region (reads the burden-evidence mismatch, BEMI, far more clearly than a bubble plot):

from equimed_dss.utils import plot_geographic_dumbbell

fig = plot_geographic_dumbbell(
    burden_shares={"AMRO": 0.114, "SEARO": 0.211, "AFRO": 0.150,
                   "EMRO": 0.230, "EURO": 0.195, "WPRO": 0.100},
    evidence_shares={"AMRO": 0.780, "SEARO": 0.0, "AFRO": 0.002,
                     "EMRO": 0.037, "EURO": 0.105, "WPRO": 0.077},
    save_path="geographic_dumbbell.png",
)

Other helpers: plot_bland_altman, plot_control_chart, plot_correlation_matrix, plot_her_heatmap, plot_metric_distribution, plot_network_graph, and the six manuscript figures plot_figure2…7.

---

Statistical Analyses

EquiMed_DSS includes advanced statistical methods:

Hierarchical Linear Modeling (HLM)

from equimed_dss.statistics import HierarchicalLinearModeling

hlm = HierarchicalLinearModeling()
# Decompose outcome variance into between-group (e.g. hospital) vs within-group
# components; the ICC reports the between-group share.

Mediation Analysis

from equimed_dss.statistics import MediationAnalysis

mediation = MediationAnalysis(n_bootstrap=1000)
# Decompose a total effect into direct and indirect (mediated) pathways with a
# bootstrap CI for the indirect effect.

Network Statistics

from equimed_dss.statistics import NetworkStatistics

network = NetworkStatistics()
# Calculate centrality measures, clustering coefficients

Reliability Analysis

from equimed_dss.statistics import ReliabilityAnalysis

reliability = ReliabilityAnalysis()
# Cronbach's Alpha, Bland-Altman analysis

---

Visualizations

Generate publication-ready figures (Figures 2-7 from manuscript):

Each plot_figure* function takes a structured dict of inputs (the exact keys are documented in each function's docstring). Use generate_figure_data() for ready-to-run sample inputs, then swap in your own data using the same keys:

from equimed_dss.utils import (
    generate_figure_data,
    plot_figure2_reliability_dashboard,
    plot_figure3_corpus_comparison,
    plot_figure4_temporal_robustness,
    plot_figure5_ethics_governance,
    plot_figure6_metric_networks,
    plot_figure7_intersectional_heatmap,
)

figs = generate_figure_data()  # sample inputs for every figure

plot_figure2_reliability_dashboard(figs["fig2"], save_path="figures/fig2.png")
plot_figure3_corpus_comparison(figs["fig3"], save_path="figures/fig3.png")
plot_figure4_temporal_robustness(figs["fig4"], save_path="figures/fig4.png")
plot_figure5_ethics_governance(figs["fig5"], save_path="figures/fig5.png")
plot_figure6_metric_networks(figs["fig6"], save_path="figures/fig6.png")
plot_figure7_intersectional_heatmap(figs["fig7"], save_path="figures/fig7.png")

---

Examples

The examples/ directory contains comprehensive usage examples:

# Domain examples
python examples/example_domain1.py  # Reliability metrics
python examples/example_domain2.py  # Fairness & Ethics metrics
python examples/example_domain3.py  # Governance metrics
python examples/example_appendix.py # Advanced metrics

# Advanced examples
python examples/example_advanced_metrics.py  # All 9 new metrics
python examples/example_dataset.py           # Sample data generation
python examples/example_advanced_network.py  # Network analysis

For an end-to-end tutorial with data loading, metric calculations, statistical analyses, and visualization examples, see the EquiMed-DSS vignette.

---

Project Structure

EquiMed_DSS/
├── equimed_dss/
│   ├── domain1/              # Reliability & Calibration (3 metrics)
│   │   ├── dfr.py            # Decision Flip Rate (DFR)
│   │   ├── ecs.py            # Embedding Consistency Score (ECS)
│   │   └── icc.py            # Inter-Rater Reliability (ICC)
│   ├── domain2/              # Fairness, Equity & Ethics (4 metrics)
│   │   ├── her.py            # Hierarchical Equity Ratio + Bias-Gini
│   │   ├── hafg.py           # Harm-Adjusted Fairness Gap
│   │   ├── eri.py            # Ethical Risk Index
│   │   └── ibs.py            # Intersectional Bias Score
│   ├── domain3/              # Governance & Transparency (3 metrics)
│   │   ├── tfd.py            # Temporal Fairness Drift
│   │   ├── ats.py            # Audit Traceability Score
│   │   └── gci.py            # Governance Compliance Index
│   ├── domain4/              # Representation & Robustness (4 metrics)
│   │   ├── spg.py            # Semantic Parity Gap (SPG)
│   │   ├── chr.py            # Clinical Hallucination Rate (CHR)
│   │   ├── ivi.py            # Instructional Vulnerability Index (IVI)
│   │   └── gri.py            # Geographic Representation Index (GRI)
│   ├── domain5/              # Technical-supplement fairness (12 metrics)
│   │   ├── calibration.py    # Intersectional Calibration Error (ICE)
│   │   ├── harm.py           # Weighted Clinical Harm-Adjusted Fairness Gap (wHAFG)
│   │   ├── text.py           # LDDI, REG, CIDR, DCI, UQG
│   │   ├── counterfactual.py # Counterfactual Parity Score (CPS), SRPI
│   │   ├── geographic_bias.py# Geographic Representation Bias Index (GRBI)
│   │   ├── system.py         # Healthcare System Stratified Fairness (HSSF)
│   │   └── shapley.py        # Intersectional Shapley Fairness Value (ISFV)
│   ├── geographic/           # Geographic equity (2 metrics + reference)
│   │   ├── burden_evidence.py# Burden-Evidence Mismatch (BEMI)
│   │   ├── concentration.py  # Geographic Concentration of Coverage (GCC)
│   │   └── reference_data.py # WHO_REGION_IHD_BURDEN reference shares
│   ├── appendix/             # Advanced Metrics (9 metrics)
│   │   └── advanced_metrics.py
│   ├── reporting/            # Tidy result tables + export
│   │   ├── tables.py         # hierarchical/mediation/network/geographic tables
│   │   └── export.py         # export_table (markdown/LaTeX/HTML)
│   ├── statistics/           # Statistical Analyses
│   │   ├── hierarchical.py   # Hierarchical Linear Modeling
│   │   ├── mediation.py      # Mediation Analysis
│   │   ├── network_stats.py  # Network Statistics
│   │   └── reliability_stats.py
│   └── utils/                # Utilities
│       ├── data_formatters.py # Data loading & conversion
│       ├── visualization.py   # Publication-ready figures
│       └── sample_data.py     # Sample data generation
├── examples/                 # Usage examples
├── tests/                    # Test suite (124 tests)
├── docs/                     # Documentation (incl. VIGNETTE.md)
└── pyproject.toml

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API Reference

Core Classes

Class	Module	Description
DecisionFlipRate	domain1	Decision instability under counterfactual inputs
EmbeddingConsistencyScore	domain1	Representation stability under perturbation
InterRaterReliability	domain1	Inter-rater reliability (ICC(2,1))
HierarchicalEquityRatio	domain2	Group equity ratios + Bias-Gini
HarmAdjustedFairnessGap	domain2	Clinical harm gaps
EthicalRiskIndex	domain2	Ethical violations
IntersectionalBiasScore	domain2	Subgroup bias detection
TemporalFairnessDrift	domain3	Fairness over time
AuditTraceabilityScore	domain3	Audit completeness
GovernanceComplianceIndex	domain3	Regulatory compliance
SemanticParityGap	domain4	Latent demographic sensitivity (SPG)
ClinicalHallucinationRate	domain4	Unsupported-claim rate (CHR)
InstructionalVulnerabilityIndex	domain4	Susceptibility to bias-priming (IVI)
GeographicRepresentationIndex	domain4	Non-Western location share (GRI)
IntersectionalCalibrationError	domain5	Intersectional calibration gap (ICE)
WeightedClinicalHarmAdjustedFairnessGap	domain5	Severity-weighted harm gap (wHAFG)
LexicalDiversityDisparityIndex	domain5	Vocabulary-richness disparity (LDDI)
RecommendationEntropyGap	domain5	Recommendation-entropy gap (REG)
CounterfactualParityScore	domain5	Counterfactual response parity (CPS)
ClinicalInformationDensityRatio	domain5	Clinical-concept density ratio (CIDR)
DiagnosticCompletenessIndex	domain5	Guideline-differential coverage (DCI)
UncertaintyQuantificationGap	domain5	Hedging-density gap (UQG)
GeographicRepresentationBiasIndex	domain5	KL geography-vs-burden divergence (GRBI)
HealthcareSystemStratifiedFairness	domain5	System-stratified fairness (HSSF)
IntersectionalShapleyFairnessValue	domain5	Shapley disparity attribution (ISFV)
SemanticRobustnessParityIndex	domain5	Cross-group paraphrase robustness (SRPI)
BootstrapConfidenceIntervals	appendix	Uncertainty quantification
StatisticalPowerAnalysis	appendix	Sample size planning
BiasConcentrationIndex	appendix	Bias distribution
MutualInformationContent	appendix	Information leakage
JensenShannonDivergence	appendix	Distribution divergence
WassersteinDistance	appendix	Optimal transport
NetworkModularity	appendix	Community structure
TransparencyScore	appendix	Explanation quality
RobustnessCertificationScore	appendix	Perturbation stability
BurdenEvidenceMismatch	geographic	Evidence-burden mismatch (BEMI)
GeographicConcentration	geographic	Regional concentration (GCC)
WHO_REGION_IHD_BURDEN	geographic	IHD DALY burden reference shares
hierarchical_coefficients_table	reporting	HLM results as tidy DataFrame
mediation_effects_table	reporting	Mediation results as tidy DataFrame
network_centrality_table	reporting	Network centrality as tidy DataFrame
geographic_table	reporting	BEMI/GCC results as tidy DataFrame
export_table	reporting	Render DataFrame to markdown/LaTeX/HTML

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Contributing

We welcome contributions! Please see CONTRIBUTING.md for guidelines.

Development Setup

# Clone and install in development mode
git clone https://github.com/johnmuteba/EquiMed_DSS.git
cd EquiMed_DSS
pip install -e ".[dev]"

# Run tests
pytest tests/ -v --cov=equimed_dss

# Code quality
black equimed_dss tests examples
isort equimed_dss tests examples
mypy equimed_dss

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Citation

If you use EquiMed_DSS in your research, please cite:

@software{muteba_equimed_dss_2025,
  title={EquiMed_DSS: A Comprehensive Library for Clinical AI Fairness Assessment},
  author={Muteba Mwamba, John},
  year={2025},
  url={https://github.com/johnmuteba/EquiMed_DSS},
  note={37 metrics for reliability, equity, governance, representation, and robustness in clinical AI}
}

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License

This project is licensed under the MIT License - see the LICENSE file for details.

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Acknowledgments

• Developed for advancing equity in clinical AI systems
• Built with support from the research community
• Statistical methods based on peer-reviewed literature

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Documentation | Examples | Issues | Discussions