Disparate privacy risks from medical AI

Abstract Medical artificial intelligence (AI) models hold the promise to improve global access to high-quality diagnostics 1 . However, the training data underlying these models often contain sensitive patient information that may be exposed through privacy attacks 2–7 . Previous research has primarily quantified the success of these attacks in aggregate, across all records in a dataset. Thus, the privacy risk faced by individual patients, who often contribute multiple similar records to a training dataset, is poorly understood. Here we present one of the first patient-level privacy audits of AI models for medical diagnostic applications. We focus on membership inference attacks 2–4 (MIAs), which seek to determine whether the data of a given individual were used to train a model. Across a diverse range of medical datasets, we show that MIAs can achieve near-perfect success rates for individual patients, even when the aggregate performance does not substantially deviate from random guessing. We further find that the number of patients with high attack success increases substantially with model capacity, and that underrepresented groups—stratified by disease status, self-reported race, insurance, sex or imaging protocol—face disproportionately high attack success. Together, our findings show that aggregate privacy metrics can severely underestimate individual privacy risk. Whether the disparate risk profiles we observe extend to attacks beyond MIAs remains an open question, motivating the further development of risk assessment and mitigation techniques that cater to all data-contributing patients.