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arXiv 2007.03288stat.ME
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存在竞争风险时至事件发生时间终点的纵向中介分析

Longitudinal mediation analysis of time-to-event endpoints in the presence of competing risks

Tat-Thang Vo, Hilary Davies-Kershaw, Ruth Hackett, Stijn Vansteelandt

摘要:

这项建议的动机是对英国老龄化纵向研究(ELSA)的分析,该研究旨在调查孤独在解释听力损失对痴呆症的负面影响方面的作用。使这种中介分析复杂化的方法学挑战包括使用受竞争风险影响的事件发生时间终点,以及中介和混杂因素之间存在反馈关系,这些关系都是随着时间的推移而重复测量的。为了应对这些挑战,我们引入了自然效应比例(原因特异性)风险模型。这些扩展了边际结构比例(原因特定)风险模型,使效果分解。我们表明,在一定的因果假设下,路径特定的直接和间接影响索引这个模型是可识别的观察数据。接下来,我们提出了一个逆概率加权的方法来估计这些影响。在ELSA数据中,这种方法几乎没有证据表明听力损失对痴呆的总影响是通过孤独感介导的,非统计学显著的间接影响等于1.012(风险比(HR)量表; 95%置信区间(CI)0.986至1.053)。

英文摘要:

This proposal is motivated by an analysis of the English Longitudinal Study of Ageing (ELSA), which aims to investigate the role of loneliness in explaining the negative impact of hearing loss on dementia. The methodological challenges that complicate this mediation analysis include the use of a time-to-event endpoint subject to competing risks, as well as the presence of feedback relationships between the mediator and confounders that are both repeatedly measured over time. To account for these challenges, we introduce natural effect proportional (cause-specific) hazard models. These extend marginal structural proportional (cause-specific) hazard models to enable effect decomposition. We show that under certain causal assumptions, the path-specific direct and indirect effects indexing this model are identifiable from the observed data. We next propose an inverse probability weighting approach to estimate these effects. On the ELSA data, this approach reveals little evidence that the total efect of hearing loss on dementia is mediated through the feeling of loneliness, with a non-statistically significant indirect effect equal to 1.012 (hazard ratio (HR) scale; 95% confidence interval (CI) 0.986 to 1.053).

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