Multiple mediators approach to study environmental chemicals as determinants of health disparities.
Multiple mediators approach to study environmental chemicals as determinants of health disparities.
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DOI：
10.1097/ee9.0000000000000015
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发表时间：
2018-06-01
期刊：
影响因子：
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通讯作者：
James-Todd, Tamarra
中科院分区：
文献类型：
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作者：
Bellavia, Andrea;Zota, Ami R;James-Todd, Tamarra
健康差异研究的一个主要目标是识别和干预可改变的风险因素，这些因素有助于解释观察到的社会因素与不良健康结果之间的关联。为此，结合中介分析的统计方法显示出了希望，因为它们量化了暴露-结果关联中中间变量的贡献。越来越多的文献表明，环境中的化学物质会导致健康差异。然而，将环境化学品作为健康差异的一个重要组成部分进行评价，会带来方法上的复杂性，可能使标准的调解方法不充分。具体到环境健康，是评估环境毒物的来源和生物标志物的问题，以便计算如果我们对可改变的因素进行干预，仍然存在的差距的比例。最近关于多种介质的方法学发展，有助于将暴露源和生物标志物纳入健康差异的流行病学研究。我们阐述了一个概念框架，并介绍了如何使用调解技术来解决环境健康差异问题。因此，我们提供了一种方法工具，有可能推动这一不断发展的领域，同时为围绕环境因素对健康差异的影响的公共卫生预防和政策提供信息。
A major goal of health disparities research is to identify and intervene upon modifiable risk factors that help explain the observed associations between social factors and adverse health outcomes. To this end, statistical methods incorporating mediation analysis have shown promise, as they quantify the contribution of an intermediate variable in an exposure-outcome association. A growing body of literature suggests that environmental chemicals can contribute to health disparities. However, evaluating environmental chemicals as an important component of health disparities introduces methodological complexities that may make standard mediation approaches inadequate. Specific to environmental health is the issue of evaluating both the source and biomarker of the environmental toxicant in order to calculate the proportion of the disparity that would remain had we intervened on the modifiable factors. Recent methodological developments on multiple mediators can improve efforts to integrate both source and biomarker of exposure into epidemiological studies of health disparities. We illustrate a conceptual framework and present how mediation techniques can be used to address environmental health disparities questions. With this, we provide a methodological tool that has the potential to advance this growing field, while simultaneously informing public health prevention and policy surrounding the impact of environmental factors on health disparities.