Nonlinear Predictive Models for Multiple Mediation Analysis: With an Application to Explore Ethnic Disparities in Anxiety and Depression Among Cancer Survivors
Nonlinear Predictive Models for Multiple Mediation Analysis: With an Application to Explore Ethnic Disparities in Anxiety and Depression Among Cancer Survivors
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DOI：
10.1007/s11336-018-9612-2
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发表时间：
2018-12-01
期刊：
影响因子：
3
通讯作者：
Jensen, Roxanne E.
中科院分区：
文献类型：
--
作者：
Yu, Qingzhao;Medeiros, Kaelen L.;Jensen, Roxanne E.
中介分析允许检查第三个变量（中介/混杂因素）在暴露和结果之间因果路径中的影响。 Yu等人提出的通用多重中介分析方法（MMA）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。此前的研究发现，与非西班牙裔癌症幸存者相比，西班牙裔癌症幸存者在癌症诊断后更有可能忍受焦虑和抑郁。在本文中，我们在 MY-Health 研究中应用 MMA 来识别中介因素/混杂因素，并量化每个已识别的中介因素/混杂因素在解释参加该研究的癌症幸存者焦虑和抑郁方面的种族差异时的间接影响。我们考虑了一些社会人口统计学变量、肿瘤特征和治疗因素作为潜在的中介因素/混杂因素，发现西班牙裔和非西班牙裔白人癌症幸存者之间焦虑或抑郁的大多数种族差异可以用西班牙裔患者诊断年龄较小、教育水平较低、就业比例较低、在美国出生的可能性较小、保险较少和社会支持较少来解释。
Mediation analysis allows the examination of effects of a third variable (mediator/confounder) in the causal pathway between an exposure and an outcome. The general multiple mediation analysis method (MMA), proposed by Yu et al., improves traditional methods (e.g., 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. Previous studies find that compared with non-Hispanic cancer survivors, Hispanic survivors are more likely to endure anxiety and depression after cancer diagnoses. In this paper, we applied MMA on MY-Health study to identify mediators/confounders and quantify the indirect effect of each identified mediator/confounder in explaining ethnic disparities in anxiety and depression among cancer survivors who enrolled in the study. We considered a number of socio-demographic variables, tumor characteristics, and treatment factors as potential mediators/confounders and found that most of the ethnic differences in anxiety or depression between Hispanic and non-Hispanic white cancer survivors were explained by younger diagnosis age, lower education level, lower proportions of employment, less likely of being born in the USA, less insurance, and less social support among Hispanic patients.