Mediation analysis in epidemiology: methods, interpretation and bias
- PMID: 24019424
- DOI: 10.1093/ije/dyt127
Mediation analysis in epidemiology: methods, interpretation and bias
Abstract
In epidemiological studies it is often necessary to disentangle the pathways that link an exposure to an outcome. Typically the aim is to identify the total effect of the exposure on the outcome, the effect of the exposure that acts through a given set of mediators of interest (indirect effect) and the effect of the exposure unexplained by those same mediators (direct effect). The traditional approach to mediation analysis is based on adjusting for the mediator in standard regression models to estimate the direct effect. However, several methodological papers have shown that under a number of circumstances this traditional approach may produce flawed conclusions. Through a better understanding of the causal structure of the variables involved in the analysis, with a formal definition of direct and indirect effects in a counterfactual framework, alternative analytical methods have been introduced to improve the validity and interpretation of mediation analysis. In this paper, we review and discuss the impact of the three main sources of potential bias in the traditional approach to mediation analyses: (i) mediator-outcome confounding;(ii) exposure-mediator interaction and (iii) mediator-outcome confounding affected by the exposure. We provide examples and discuss the impact these sources have in terms of bias.
Keywords: Mediation analysis; direct effects; indirect effects.
Similar articles
-
Misclassification of the mediator matters when estimating indirect effects.J Epidemiol Community Health. 2013 May;67(5):458-66. doi: 10.1136/jech-2012-201813. Epub 2013 Mar 16. J Epidemiol Community Health. 2013. PMID: 23386673
-
G-computation demonstration in causal mediation analysis.Eur J Epidemiol. 2015 Oct;30(10):1119-27. doi: 10.1007/s10654-015-0100-z. Epub 2015 Nov 4. Eur J Epidemiol. 2015. PMID: 26537707 Free PMC article.
-
Flexible Mediation Analysis With Multiple Mediators.Am J Epidemiol. 2017 Jul 15;186(2):184-193. doi: 10.1093/aje/kwx051. Am J Epidemiol. 2017. PMID: 28472328
-
Confounding in health research.Annu Rev Public Health. 2001;22:189-212. doi: 10.1146/annurev.publhealth.22.1.189. Annu Rev Public Health. 2001. PMID: 11274518 Review.
-
Sources of confounding in life course epidemiology.J Dev Orig Health Dis. 2019 Jun;10(3):299-305. doi: 10.1017/S2040174418000582. Epub 2018 Aug 16. J Dev Orig Health Dis. 2019. PMID: 30111382 Review.
Cited by
-
Indirect Effects of Neighbourhood Socioeconomic Status on Preterm Birth Risk in an Argentine Population.Matern Child Health J. 2024 Jun 3. doi: 10.1007/s10995-024-03951-1. Online ahead of print. Matern Child Health J. 2024. PMID: 38831170
-
Cognition as mediator of pulmonary function and risk of sarcopenia among older adults.BMC Public Health. 2024 May 18;24(1):1347. doi: 10.1186/s12889-024-18848-5. BMC Public Health. 2024. PMID: 38762539 Free PMC article.
-
Causal association between rheumatoid arthritis and an increased risk of age-related macular degeneration: A Mendelian randomization study.Medicine (Baltimore). 2024 Apr 12;103(15):e37753. doi: 10.1097/MD.0000000000037753. Medicine (Baltimore). 2024. PMID: 38608102 Free PMC article.
-
Exploring the Mediating Role of Sleep Deficit-Related Functional Status in Subacute Stroke Survivors.Medicina (Kaunas). 2024 Feb 29;60(3):422. doi: 10.3390/medicina60030422. Medicina (Kaunas). 2024. PMID: 38541148 Free PMC article.
-
Can psychosocial risk factors mediate the association between precarious employment and mental health problems in Sweden? Results from a register-based study.Scand J Work Environ Health. 2024 May 1;50(4):268-278. doi: 10.5271/sjweh.4151. Epub 2024 Mar 24. Scand J Work Environ Health. 2024. PMID: 38522097 Free PMC article.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources