Background: Health disparities research increasingly relies on complex survey data to understand survival differences between population subgroups. While Peters–Belson decomposition provides a principled framework for distinguishing disparities explained by measured covariates from unexplained residual differences, traditional approaches face challenges with complex data patterns and model validation for counterfactual estimation.
Objective: To develop validated Peters–Belson decomposition methods for survival analysis that integrate ensemble machine learning with transfer learning while ensuring logical validity of counterfactual estimates through comprehensive model validation.
Methods: We extend the traditional Peters–Belson framework through ensemble machine learning that combines Cox proportional hazards models, cross-validated random survival forests, and regularized gradient boosting approaches. Our framework incorporates a transfer learning component via principal component analysis (PCA) to discover shared latent factors between majority and minority groups. We note that this “transfer learning” differs from the standard machine learning definition (pre-trained models or domain adaptation); here, we use the term in its statistical sense to describe the transfer of covariate structure information from the pooled population to identify group-level latent factors. We develop a comprehensive validation framework that ensures Peters–Belson logical bounds compliance, preventing mathematical violations in counterfactual estimates. The approach is evaluated through simulation studies across five realistic health disparity scenarios using stratified complex survey designs.
Results: Simulation studies demonstrate that validated ensemble methods achieve superior performance compared to individual models (proportion explained: 0.352 vs. 0.310 for individual Cox, 0.325 for individual random forests), with validation framework reducing logical violations from 34.7% to 2.1% of cases. Transfer learning provides additional 16.1% average improvement in explanation of unexplained disparity when significant unmeasured confounding exists, with 90.1% overall validation success rate. The validation framework ensures explanation proportions remain within realistic bounds while maintaining computational efficiency with 31% overhead for validation procedures.
Conclusions: Validated ensemble machine learning provides substantial advantages for Peters–Belson decomposition when combined with proper model validation. Transfer learning offers conditional benefits for capturing unmeasured group-level factors while preventing mathematical violations common in standard approaches. The framework demonstrates that realistic health disparity patterns show 25–35% of differences explained by measured factors, providing actionable targets for reducing health inequities.
