Mind the data gap: Missingness Still Shapes Large Language Model Prognoses

Data collection often reflects human decisions. In healthcare, for instance, a referral for a diagnostic test is influenced by the patient's health, their preferences, available resources, and the practitioner's recommendations. Despite the extensive literature on the informativeness of missingness, its implications on the performance of Large Language Models (LLMs) have not been studied. Through a series of experiments on data from Columbia University Medical Center, a large urban academic medical center, and MIMIC-IV, we demonstrate that patterns of missingness significantly impact zero-shot predictive performance. Notably, the explicit inclusion of missingness indicators at prompting benefits some while hurting other LLMs' zero-shot predictive performance and calibration, suggesting an inconsistent impact. The proposed aggregated analysis and theoretical insights suggest that larger models benefit from these interventions, while smaller models can be negatively impacted. The LLM paradigm risks obscuring the impact of missingness, often neglected even in conventional ML, even further. We conclude that there is a need for more transparent accounting and systematic evaluation of the impact of representing (informative) missingness on downstream performance.