Beyond Metadata: CAPRA for Hidden Subgroup Analysis under Missing Metadata in Medical Imaging

Medical imaging models are often deployed without the demographic, acquisition, and quality metadata needed for subgroup auditing. Once those metadata disappear, clinically critical failure modes can be masked by strong aggregate performance, and many robust-learning methods lose the group structure they rely on. We present CAPRA, a calibrated proxy-axis framework for hidden subgroup analysis under missing metadata. CAPRA predicts image-derived semantic axes, calibrates axis posteriors on a small metadata-labeled split via patient-level cross-fitting, and organizes those posteriors into a calibrated subgroup interface that supports both deployment-time failure analysis and downstream robust learning without requiring subgroup labels at deployment. Across fundus, dermoscopy, and chest radiography, CAPRA reveals disparity patterns missed by metadata-only slicing, remains informative under dataset shift, and produces subgroup partitions that align more closely with explicit failure axes than image-only or latent-slice baselines. The same interface can also be reused by downstream robust learners, although those gains are domain-dependent. Overall, CAPRA turns hidden subgroup analysis under missing metadata into a calibrated, interpretable, and reusable subgroup interface for deployment-time analysis and robust transfer.