Concordancia, eficiencia y aplicación regional de metodologías epidemiológicas frente al ensayo aleatorizado: revisión sistemática y meta-análisis meta-epidemiológico
DOI:
https://doi.org/10.71068/hs000106Palabras clave:
epidemiología, metodología de la investigación, meta-epidemiología, emulación de ensayo diana, evidencia de mundo real, razón de razones, equidad en saludResumen
Introducción: la elección del diseño condiciona la validez, la oportunidad y la utilidad de la evidencia epidemiológica. Estimamos la concordancia de los diseños no aleatorizados y emergentes con el ensayo controlado aleatorizado (ECA) y describimos su eficiencia y aplicación regional.Método: revisión sistemática y meta-análisis meta-epidemiológico según PRISMA 2020. Consultamos MEDLINE, Embase, Scopus, Web of Science y Cochrane (enero de 2020 a mayo de 2026). Se priorizó la comparación de cinco estimadores no aleatorizados frente a ECA; el agrupamiento heterogéneo de seis se mantuvo como exploratorio. Se aplicaron efectos aleatorios, REML, Hartung-Knapp-Sidik-Jonkman y exclusión conjunta de posibles fuentes solapadas. Se evaluaron riesgo de sesgo, certeza GRADE adaptada y matrices ordinales de distribución regional y eficiencia.Resultados: se incluyeron 24 estudios. Los cinco contrastes entre diseños no aleatorizados y ECA produjeron una RoR de 1.00 (IC 95 % 0.92–1.10); el agrupamiento exploratorio de seis estimadores fue 0.98 (0.89–1.06; I² = 77.9 %). Al excluir conjuntamente Toews y Kimachi, los tres estimadores no aleatorizados restantes dieron aproximadamente 0.95 (0.88–1.02), reconstruido desde valores publicados redondeados. Las RoR por familias fueron 1.05 para observacionales y 0.91 para emulación/evidencia de mundo real, con certeza baja y muy baja, respectivamente. Dieciséis de 28 puntuaciones regionales máximas se basaron en evidencia indirecta.Conclusiones: una RoR próxima a 1 no demuestra equivalencia con los ECA. Los contrastes entre diseños y las puntuaciones regionales requieren interpretación prudente y por familias; la combinación de métodos sigue siendo una hipótesis que debe evaluarse.
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Derechos de autor 2026 Marco Antonio Ramos Espinal
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