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Evaluación de la integridad del Índice de Fragilidad: Perspectivas de un estudio de red internacional

Robert Cavanaugh, Chelsea Wong, Louisa H Smith

medRxiv : the preprint server for health sciences

|February 6, 2026

Resumen

Los Índices de Fragilidad (FI) de acumulación de déficits muestran resultados variables entre países. Los Índices de Fragilidad (FI) desarrollados en un contexto pueden no ser externamente válidos cuando se aplican en otro debido a diferencias en los datos y las prácticas de codificación.

Área de la Ciencia:

Gerontología
Informática de la Salud
Epidemiología

Sus antecedentes:

Los Índices de Fragilidad (FI) de acumulación de déficits se utilizan ampliamente para evaluar la reserva fisiológica en poblaciones que envejecen.
Los Modelos Comunes de Datos (CDM) facilitan la aplicación internacional de los FI, pero su validez en diferentes sistemas de atención médica es incierta.

Objetivo del estudio:

Comparar la validez y las estimaciones de dos Índices de Fragilidad (FI) basados en registros de salud electrónicos (EHR): el FI basado en EE. UU. de Asuntos de Veteranos (VAFI) y el FI electrónico (eFI) del Reino Unido.
Evaluar la validez externa de los FI cuando se aplican en diferentes bases de datos internacionales y contextos de atención médica.

Principales métodos:

Un estudio de red internacional comparó las estimaciones de VAFI y eFI en cinco grandes bases de datos de EHR en los EE. UU. y el Reino Unido.
Los datos incluyeron las bases de datos *All of Us* e IQVIA Pharmetrics+ (EE. UU.), y las bases de datos IMRD-THIN, IMRD-EMIS y UK BioBank (Reino Unido).
Los análisis incluyeron variaciones en los períodos de retrospectiva y la construcción del FI.

Principales resultados:

Se observaron discrepancias significativas en la prevalencia de fragilidad entre VAFI y eFI en las bases de datos de EE. UU. y el Reino Unido.
En las bases de datos de EE. UU., VAFI identificó mayores proporciones de fragilidad (por ejemplo, 10,3 % frente al 2,5 % en *All of Us*).
En las bases de datos del Reino Unido, eFI identificó mayores proporciones de fragilidad (por ejemplo, 0,08 % frente a <0,003 % en IMRD-THIN).

Conclusiones:

Las estimaciones del Índice de Fragilidad (FI) dependen del contexto, influenciadas por los comportamientos de codificación locales y los incentivos del sistema de atención médica.
La validez externa de los FI es limitada, incluso cuando se utilizan Modelos Comunes de Datos (CDM).
Se recomienda precaución al aplicar los FI fuera de su contexto de desarrollo original; se recomienda un mayor desarrollo del instrumento.

Palabras clave:

Fragilidad Índice de Fragilidad Salud Electrónica Validez Externa Estudios Comparativos Gerontología Informática de la Salud Epidemiología

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