A Computational Audit of Demographic Association Encoding in ClinicalBERT Language Predictions

Abstract

Transformer-based clinical language models are increasingly integrated into high-stakes clinical decision support pipelines, yet the computational mechanisms through which demographic associations encoded in medical documentation propagate into model probability distributions remain empirically underspecified. We present a systematic computational audit of representational bias in ClinicalBERT (Alsentzer et al., 2019), a BERT-based model pretrained on MIMIC-III discharge summaries, employing two complementary probing methodologies: Log Probability Bias Analysis (LPBA), which quantifies demographic descriptor-induced shifts in masked token probability distributions across behavioral and evaluative semantic categories, and Masked Language Model-based analysis (MLM), which probes internal representational structure for demographic agency attribution encoding across 98 real clinical sentence templates and eight intersectional race-gender combinations. Corpus frequency analysis operationalizes the distinction between statistical disparity and bias amplification by benchmarking model outputs against empirical term frequencies in the MIMIC-III training corpus. Of 32 statistically significant findings, 65.6% contradict observed corpus distributions, rising to 80% for Black patients and 87.5% for agency attribution under MLM probing, providing direct empirical evidence that representational bias in ClinicalBERT operates predominantly through model-internal amplification rather than training data inheritance. Keywords: natural language processing, clinical documentation, algorithmic auditing, representational bias, health equity 1