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We find evidence for potential algorithmic bias in CDI development through various analyses: self-reported participant demographics are skewed\u2014e.g. 73% of participants are White, 55% are male; investigator teams are geographically skewed\u2014e.g. 52% in North America, 31% in Europe; CDIs use predictor variables that may be prone to bias\u2014e.g. 1.9% (13\/690) of CDIs use\n                    <jats:italic>Race and Ethnicity<\/jats:italic>\n                    ; outcome definitions may introduce bias\u2014e.g. 26% (177\/690) of CDIs involve follow-up, which may skew representation based on socioeconomic status. As CDIs become increasingly prominent in medicine, we recommend that these factors are considered during development and clearly conveyed to clinicians.\n                  <\/jats:p>","DOI":"10.1038\/s41746-025-02119-7","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T05:15:38Z","timestamp":1765343738000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Potential for Algorithmic Bias in Clinical Decision Instrument Development"],"prefix":"10.1038","volume":"8","author":[{"given":"Jed Keenan","family":"Obra","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chandan","family":"Singh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenshata","family":"Watkins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean","family":"Feng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ziad","family":"Obermeyer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron","family":"Kornblith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"key":"2119_CR1","doi-asserted-by":"publisher","first-page":"201","DOI":"10.7326\/0003-4819-144-3-200602070-00009","volume":"144","author":"BM Reilly","year":"2006","unstructured":"Reilly, B. 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