Multiple mediation analysis with survival outcomes: With an application to explore racial disparity in breast cancer survival.
Multiple mediation analysis with survival outcomes: With an application to explore racial disparity in breast cancer survival.
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DOI：
10.1002/sim.7977
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发表时间：
2019-02-10
影响因子：
2
通讯作者：
Scribner RA
中科院分区：
文献类型：
--
作者：
Yu Q;Wu X;Li B;Scribner RA
中介分析允许检查暴露和结果之间路径中第三个变量的影响。 Yu等人提出的通用多重中介分析方法改进了传统方法（例如，自然和受控直接效应的估计），以能够同时考虑多个中介/混杂因素，并使用线性和非线性预测模型来估计中介/混杂效应。在本文中，我们扩展了事件时间结果的方法，并应用该方法来探索乳腺癌生存率的种族差异。乳腺癌是所有种族女性中最常见的癌症，也是癌症死亡的第二大原因。尽管美国乳腺癌的生存率有所提高，但白人和黑人女性之间的显着差异仍然存在。先前的研究发现，与白人女性相比，黑人女性的生存率较低，原因可能在于更晚期和更具侵袭性的肿瘤以及不够理想的治疗。由于当前分析方法的局限性和缺乏全面的数据集，研究人员无法区分每个因素对总体种族差异的相对影响。我们利用疾病预防控制中心资助的护理模式研究，通过一种新颖的多重中介分析来检查乳腺癌生存中种族差异的决定因素。使用所提出的方法，我们应用 Cox 风险模型和多重加性回归树作为预测模型，发现路易斯安那州乳腺癌患者的所有种族生存差异都可以通过研究中包含的因素来解释。
Mediation analysis allows the examination of effects of a third variable in the pathway between an exposure and an outcome. The general multiple mediation analysis method, proposed by Yu et al, improves traditional methods (eg, estimation of natural and controlled direct effects) to enable consideration of multiple mediators/confounders simultaneously and the use of linear and nonlinear predictive models for estimating mediation/confounding effects. In this paper, we extend the method for time-to-event outcomes and apply the method to explore the racial disparity in breast cancer survivals. Breast cancer is the most common cancer and the second leading cause of cancer death among women of all races. Despite improvement of survival rates of breast cancer in the US, a significant difference between white and black women remains. Previous studies have found that more advanced and aggressive tumors and less than optimal treatment may explain the lower survival rates for black women as compared to white women. Due to limitations of current analytic methods and the lack of comprehensive data sets, researchers have not been able to differentiate the relative effect each factor contributes to the overall racial disparity. We use the CDC-funded Patterns of Care study to examine the determinants of racial disparities in breast cancer survival using a novel multiple mediation analysis. Using the proposed method, we applied the Cox hazard model and multiple additive regression trees as predictive models and found that all racial disparity in survival among Louisiana breast cancer patients were explained by factors included in the study.
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影响因子：
7.6
作者：
BARON, RM;KENNY, DA
通讯作者：
KENNY, DA
DOI：
10.1023/a:1026595011371
发表时间：
2000-12-01
期刊：
Prevention science : the official journal of the Society for Prevention Research
影响因子：
--
作者：
MacKinnon, D P;Krull, J L;Lockwood, C M
通讯作者：
Lockwood, C M
影响因子：
5.4
作者：
VanderWeele, Tyler J.;Robinson, Whitney R.
通讯作者：
Robinson, Whitney R.
影响因子：
9.1
作者：
ALWIN, DF;HAUSER, RM
通讯作者：
HAUSER, RM
影响因子：
120.7
作者：
ELEY, JW;HILL, HA;EDWARDS, BK
通讯作者：
EDWARDS, BK