{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T05:28:04Z","timestamp":1777440484055,"version":"3.51.4"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T00:00:00Z","timestamp":1710374400000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["DP1NS122038"],"award-info":[{"award-number":["DP1NS122038"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01NS125137"],"award-info":[{"award-number":["R01NS125137"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100017021","name":"Mirowski Family Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100017021","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Science Foundation Research","award":["DGE-1845298"],"award-info":[{"award-number":["DGE-1845298"]}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["T32NS091006"],"award-info":[{"award-number":["T32NS091006"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23NS121520"],"award-info":[{"award-number":["K23NS121520"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"American Academy of Neurology Susan S. Spencer Clinical Research Training Scholarship"},{"DOI":"10.13039\/100017021","name":"Mirowski Family Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100017021","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000006","name":"Office of Naval Research","doi-asserted-by":"publisher","award":["N00014-19-1-2620"],"award-info":[{"award-number":["N00014-19-1-2620"]}],"id":[{"id":"10.13039\/100000006","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Large-language models (LLMs) can potentially revolutionize health care delivery and research, but risk propagating existing biases or introducing new ones. In epilepsy, social determinants of health are associated with disparities in care access, but their impact on seizure outcomes among those with access remains unclear. Here we (1) evaluated our validated, epilepsy-specific LLM for intrinsic bias, and (2) used LLM-extracted seizure outcomes to determine if different demographic groups have different seizure outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We tested our LLM for differences and equivalences in prediction accuracy and confidence across demographic groups defined by race, ethnicity, sex, income, and health insurance, using manually annotated notes. Next, we used LLM-classified seizure freedom at each office visit to test for demographic outcome disparities, using univariable and multivariable analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We analyzed 84\u00a0675 clinic visits from 25\u00a0612 unique patients seen at our epilepsy center. We found little evidence of bias in the prediction accuracy or confidence of outcome classifications across demographic groups. Multivariable analysis indicated worse seizure outcomes for female patients (OR 1.33, P \u2264 .001), those with public insurance (OR 1.53, P \u2264 .001), and those from lower-income zip codes (OR \u22651.22, P \u2009\u2264\u2009.007). Black patients had worse outcomes than White patients in univariable but not multivariable analysis (OR 1.03, P\u2009=\u2009.66).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We found little evidence that our LLM was intrinsically biased against any demographic group. Seizure freedom extracted by LLM revealed disparities in seizure outcomes across several demographic groups. These findings quantify the critical need to reduce disparities in the care of people with epilepsy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jamia\/ocae047","type":"journal-article","created":{"date-parts":[[2024,2,23]],"date-time":"2024-02-23T17:14:53Z","timestamp":1708708493000},"page":"1348-1355","source":"Crossref","is-referenced-by-count":14,"title":["Disparities in seizure outcomes revealed by large language models"],"prefix":"10.1093","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1849-2085","authenticated-orcid":false,"given":"Kevin","family":"Xie","sequence":"first","affiliation":[{"name":"Department of Bioengineering, University of Pennsylvania , Philadelphia, PA 19104,","place":["United States"]},{"name":"Center for Neuroengineering and Therapeutics, University of Pennsylvania , Philadelphia, PA 19104,","place":["United States"]}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5166-536X","authenticated-orcid":false,"given":"William K S","family":"Ojemann","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, University of Pennsylvania , Philadelphia, PA 19104,","place":["United States"]},{"name":"Center for Neuroengineering and Therapeutics, University of Pennsylvania , Philadelphia, PA 19104,","place":["United States"]}]},{"given":"Ryan S","family":"Gallagher","sequence":"additional","affiliation":[{"name":"Center for Neuroengineering and Therapeutics, University of Pennsylvania , Philadelphia, PA 19104,","place":["United States"]},{"name":"Department of Neurology, University of Pennsylvania , Philadelphia, PA 19104,","place":["United States"]}]},{"given":"Russell T","family":"Shinohara","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania , Philadelphia, PA 19104,","place":["United States"]}]},{"given":"Alfredo","family":"Lucas","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, University of Pennsylvania , Philadelphia, PA 19104,","place":["United States"]},{"name":"Center for Neuroengineering and Therapeutics, University of Pennsylvania , Philadelphia, PA 19104,","place":["United States"]},{"name":"Department of Neurology, University of Pennsylvania , Philadelphia, PA 19104,","place":["United States"]}]},{"given":"Chlo\u00e9 E","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Michigan , Ann Arbor, MI 48109,","place":["United States"]}]},{"given":"Roy H","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Pennsylvania , Philadelphia, PA 19104,","place":["United States"]}]},{"given":"Kevin B","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, University of Pennsylvania , Philadelphia, PA 19104,","place":["United States"]},{"name":"Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania , Philadelphia, PA 19104,","place":["United States"]},{"name":"Department of Computer and Information Science, University of Pennsylvania , Philadelphia, PA 19104,","place":["United States"]},{"name":"Department of Pediatrics, University of Pennsylvania , Philadelphia, PA 19104,","place":["United States"]}]},{"given":"Dan","family":"Roth","sequence":"additional","affiliation":[{"name":"Department of Computer and Information Science, University of Pennsylvania , Philadelphia, PA 19104,","place":["United States"]}]},{"given":"Brian","family":"Litt","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, University of Pennsylvania , Philadelphia, PA 19104,","place":["United States"]},{"name":"Center for Neuroengineering and Therapeutics, University of Pennsylvania , Philadelphia, PA 19104,","place":["United States"]},{"name":"Department of Neurology, University of Pennsylvania , Philadelphia, PA 19104,","place":["United States"]}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2152-8106","authenticated-orcid":false,"given":"Colin A","family":"Ellis","sequence":"additional","affiliation":[{"name":"Center for Neuroengineering and Therapeutics, University of Pennsylvania , Philadelphia, PA 19104,","place":["United States"]},{"name":"Department of Neurology, University of Pennsylvania , Philadelphia, PA 19104,","place":["United States"]}]}],"member":"286","published-online":{"date-parts":[[2024,3,13]]},"reference":[{"issue":"10077","key":"2025031300024564300_ocae047-B1","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1016\/S0140-6736(17)30398-7","article-title":"Inequality and the health-care system in the USA","volume":"389","author":"Dickman","year":"2017","journal-title":"Lancet"},{"issue":"3","key":"2025031300024564300_ocae047-B2","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1212\/WNL.0000000000200830","article-title":"Black patients matter in neurology: race, racism, and race-based 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