BACKGROUND: The CDC’s Social Vulnerability Index (SVI) scores census tracts based on socioeconomic status, household composition & disability, minority status & language, and housing type & transportation. In 2020, a national retail pharmacy chain used an Artificial Intelligence (AI) powered program to target in-person, telephonic, SMS and email interventions to patients with the goal of improving the population’s adherence rate to Diabetes, Hypertension, and Statin medications. The AI program did not explicitly attempt to provide more or less support to patients based on their SVI score. To assure health equity, it is prudent to evaluate AI programs for unintended bias.

OBJECTIVES: The objective was to determine whether patients classified as socially vulnerable, were more or less likely to be targeted by AI for adherence improving interventions.

METHODS: This retrospective study used the SVI dataset and prescription, intervention, and AI targeting data between 1/1/2020 and 12/24/2020 from Walgreens pharmacy and AllazoHealth, a healthcare AI company. Patients who qualified for CMS specified hypertension, diabetes, or statin adherence measures were included in the study. Patients living in the 20% of Census Tracts ranked most vulnerable on the SVI were classified as Highly Vulnerable; the remaining patients were classified as Less Vulnerable. Two-proportion z-tests were performed comparing the proportion of Highly Vulnerable patients to the proportion of Less Vulnerable patients targeted for medication adherence interventions.

RESULTS: Highly Vulnerable patients were 11.1% more likely than Less Vulnerable patients to be targeted by the AI for interventions for Diabetes (P< .00001), 15.6% more likely for Hypertension (P< .00001) and 17.7% more likely for Statins (P< .00001). Sample sizes were 349,514 (Diabetes), 1,044,568 (Hypertension), and 1,174,871 (Statins).

CONCLUSIONS: Highly Vulnerable patients were more likely to be targeted by the AI for interventions than Less Vulnerable patients, thus assuring advanced pharmacy services were offered to vulnerable populations.