The presence of intermediate confounders, also called recanting witnesses, is a fundamental challenge to the investigation of causal mechanisms in mediation analysis, preventing the identification of natural path-specific effects. Proposed alternative parameters (such as randomizational interventional effects) are problematic because they can be non-null even when there is no mediation for any individual in the population; i.e., they are not an average of underlying individual-level mechanisms. In this paper we develop a novel method for mediation analysis in settings with intermediate confounding, with guarantees that the causal parameters are summaries of the individual-level mechanisms of interest. The method is based on recently proposed ideas that view causality as the transfer of information, and thus replace recanting witnesses by draws from their conditional distribution, what we call "recanting twins". We show that, in the absence of intermediate confounding, recanting twin effects recover natural path-specific effects. We present the assumptions required for identification of recanting twins effects under a standard structural causal model, as well as the assumptions under which the recanting twin identification formulas can be interpreted in the context of the recently proposed separable effects models. To estimate recanting-twin effects, we develop efficient semi-parametric estimators that allow the use of data driven methods in the estimation of the nuisance parameters. We present numerical studies of the methods using synthetic data, as well as an application to evaluate the role of new-onset anxiety and depressive disorder in explaining the relationship between gabapentin/pregabalin prescription and incident opioid use disorder among Medicaid beneficiaries with chronic pain.
On the magnitude, sign and ranking of recanting-twin path-specific effects
EPILOGY, Institut Mondor of Biomedical Research, INSERM U955, University Paris Est Créteil（巴黎东克雷泰伊大学）；Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University（乌得勒支大学）；Hasselt University（哈瑟尔特大学）
Although the exposure can be randomly assigned in studies of mediation effects, any form of direct intervention on the mediator is often infeasible. As a result, unmeasured mediator-outcome confounding can seldom be ruled out. We propose semiparametric identification of natural direct and indirect effects in the presence of unmeasured mediator-outcome confounding by leveraging heteroskedasticity restrictions on the observed data law. For inference, we develop semiparametric estimators that remain consistent under partial misspecifications of the observed data model. We illustrate the proposed …
It is often of interest in the health and social sciences to investigate the joint mediation effects of multiple post-exposure mediating variables. Identification of such joint mediation effects generally require no unmeasured confounding of the outcome with respect to the whole set of mediators. As the number of mediators under consideration grows, this key assumption is likely to be violated as it is often infeasible to intervene on any of the mediators. In this paper, we develop a simple two-step method of moments estimation procedure to assess mediation with multiple mediators simultaneous…
Judea Pearl's insight that, when errors are assumed independent, the Pure (aka Natural) Direct Effect (PDE) is non-parametrically identified via the Mediation Formula was `path-breaking' in more than one sense! In the same paper Pearl described a thought-experiment as a way to motivate the PDE. Analysis of this experiment led Robins \& Richardson to a novel way of conceptualizing direct effects in terms of interventions on an expanded graph in which treatment is decomposed into multiple separable components. We further develop this novel theory here, showing that it provides a self-contained f…
Proximal Mediation Analysis with Unmeasured Treatment-Induced Confounding
Center for Applied Statistics and School of Statistics, Renmin University of China（中国人民大学统计学院与应用统计中心）；Department of Biostatistics & Medical Informatics, University of Wisconsin-Madison（威斯康星大学麦迪逊分校生物统计与医学信息学系）
Semiparametric Mediation Analysis with Separately Observed Mediator and Outcome under Unmeasured Confounding
Department of Biostatistics, University of California, Los Angeles（加州大学洛杉矶分校生物统计系）；Department of Biostatistics, Harvard T.H. Chan School of Public Health（哈佛大学陈曾熙公共卫生学院生物统计系）
Causal effect estimation from observational data is one of the essential problems in causal inference. However, most estimation methods rely on the strong assumption that all confounders are observed, which is impractical and untestable in the real world. We develop a mediation analysis framework inferring the latent confounder for debiasing both direct and indirect causal effects. Specifically, we introduce generalized structural equation modeling that incorporates structured latent factors to improve the goodness-of-fit of the model to observed data, and deconfound the mediators and outcome …
Researchers are often interested in learning not only the effect of treatments on outcomes, but also the pathways through which these effects operate. A mediator is a variable that is affected by treatment and subsequently affects outcome. Existing methods for penalized mediation analyses may lead to ignoring important mediators and either assume that finite-dimensional linear models are sufficient to remove confounding bias, or perform no confounding control at all. In practice, these assumptions may not hold. We propose a method that considers the confounding functions as nuisance parameters…
Mediation analysis is a strategy for understanding the mechanisms by which treatments or interventions affect later outcomes. Mediation analysis is frequently applied in randomized trial settings, but typically assumes: a) that randomized assignment is the exposure of interest as opposed to actual take-up of the intervention, and b) no unobserved confounding of the mediator-outcome relationship. In contrast to the rich literature on instrumental variable (IV) methods to estimate a total effect of a non-randomized exposure, there has been almost no research into using IV as an identification st…
The use of causal mediation analysis to evaluate the pathways by which an exposure affects an outcome is widespread in the social and biomedical sciences. Recent advances in this area have established formal conditions for identification and estimation of natural direct and indirect effects. However, these conditions typically involve stringent no unmeasured confounding assumptions and that the mediator has been measured without error. These assumptions may fail to hold in practice where mediation methods are often applied. The goal of this paper is two-fold. First, we show that the natural in…
In causal mediation studies that decompose an average treatment effect into a natural indirect effect (NIE) and a natural direct effect (NDE), examples of post-treatment confounding are abundant. Past research has generally considered it infeasible to adjust for a post-treatment confounder of the mediator-outcome relationship due to incomplete information: it is observed under the actual treatment condition while missing under the counterfactual treatment condition. This study proposes a new sensitivity analysis strategy for handling post-treatment confounding and incorporates it into weightin…
Experiments often include multiple treatments, with the primary goal to compare the causal effects of those treatments. This study focuses on comparing the causal anatomies of multiple treatments through the use of causal mediation analysis. It proposes a novel set of comparative causal mediation (CCM) estimands that compare the mediation effects of different treatments via a common mediator. Further, it derives the properties of a set of estimators for the CCM estimands and shows these estimators to be consistent (or conservative) under assumptions that do not require the absence of unobserve…
Natural direct and indirect effects are mediational estimands that decompose the average treatment effect and describe how outcomes would be affected by contrasting levels of a treatment through changes induced in mediator values (in the case of the indirect effect) or not through induced changes in the mediator values (in the case of the direct effect). Natural direct and indirect effects are not generally point-identifiable in the presence of a treatment-induced confounder, however they may still be identified if one is willing to assume monotonicity between a treatment and the treatment-ind…
Causal mediation analysis is a useful tool for epidemiological research, but it has been criticized for relying on a "cross-world" independence assumption that is empirically difficult to verify and problematic to justify based on background knowledge. In the present article we aim to assist the applied researcher in understanding this assumption. Synthesizing what is known about the cross-world independence assumption, we discuss the relationship between assumptions for causal mediation analyses, causal models, and non-parametric identification of natural direct and indirect effects. In parti…
When comparing time-varying treatments in a non-randomised setting, one must often correct for time-dependent confounders that influence treatment choice over time and that are themselves influenced by treatment. We present a new two step procedure, based on additive hazard regression and linear increments models, for handling such confounding when estimating average treatment effects on the treated (ATT). The approach can also be used for mediation analysis. The method is applied to data from the Swiss HIV Cohort Study, estimating the effect of antiretroviral treatment on time to AIDS or deat…
The same intervention can produce different effects in different sites. Transport mediation estimators can estimate the extent to which such differences can be explained by differences in compositional factors and the mechanisms by which mediating or intermediate variables are produced; however, they are limited to consider a single, binary mediator. We propose novel nonparametric estimators of transported stochastic (in)direct effects that consider multiple, high-dimensional mediators and intermediate variables. They are multiply robust, efficient, asymptotically normal, and can incorporate d…
A parametric expression for causal natural direct and indirect effects is derived for the setting of a binary outcome with a binary mediator. The proposed effect decomposition does not require the outcome to be rare and generalizes the existing ones, allowing for interactions between both the exposure and the mediator and confounding covariates. Further, it outlines the relationship between the causal effects and the correspondent pathway-specific logistic regression parameters, in parallel with results derived under the rare outcome assumption. Formulae for standard errors, obtained via the d…
Questions concerning mediated causal effects are of great interest in psychology, cognitive science, medicine, social science, public health, and many other disciplines. For instance, about 60% of recent papers published in leading journals in social psychology contain at least one mediation test (Rucker, Preacher, Tormala, & Petty, 2011). Standard parametric approaches to mediation analysis employ regression models, and either the "difference method" (Judd & Kenny, 1981), more common in epidemiology, or the "product method" (Baron & Kenny, 1986), more common in the social sciences. In this pa…
University of Science and Technology of China（中国科学技术大学）；University of HongKong（香港大学）
Path-specific effects in mediation analysis provide a useful tool for fairness analysis, which is mostly based on nested counterfactuals. However, the dictum ``no causation without manipulation'' implies that path-specific effects might be induced by certain interventions. This paper proposes a new path intervention inspired by information accounts of causality, and develops the corresponding intervention diagrams and $π$-formula. Compared with the interventionist approach of Robins et al.(2020) based on nested counterfactuals, our proposed path intervention method explicitly describes the man…
Causal mediation analysis is an important statistical method in social and medical studies, as it can provide insights about why an intervention works and inform the development of future interventions. Currently, most causal mediation methods focus on mediation effects defined on a mean scale. However, in health-risk studies, such as alcohol or risky sex, outcomes are typically count data and heavily skewed. Thus, mediation effects in these setting would be natural on a rate ratio scale, such as in Poisson and negative binomial regression methods. Existing methods also mainly rely on the assu…
Causal mediation analysis aims to estimate the natural direct and indirect effects under clearly specified assumptions. Traditional mediation analysis based on Ordinary Least Squares (OLS) relies on the absence of unmeasured causes of the putative mediator and outcome. When this assumption cannot be justified, Instrumental Variables (IV) estimators can be used in order to produce an asymptotically unbiased estimator of the mediator-outcome link. However, provided that valid instruments exist, bias removal comes at the cost of variance inflation for standard IV procedures such as Two-Stage Leas…
Mediation analysis is concerned with the decomposition of the total effect of an exposure on an outcome into the indirect effect through a given mediator, and the remaining direct effect. This is ideally done using longitudinal measurements of the mediator, as these capture the mediator process more finely. However, longitudinal measurements pose challenges for mediation analysis. This is because the mediators and outcomes measured at a given time-point can act as confounders for the association between mediators and outcomes at a later time-point; these confounders are themselves affected by …
With multiple potential mediators on the causal pathway from a treatment to an outcome, we consider the problem of decomposing the effects along multiple possible causal path(s) through each distinct mediator. Under Pearl's path-specific effects framework (Pearl, 2001; Avin et al., 2005), such fine-grained decompositions necessitate stringent assumptions, such as correctly specifying the causal structure among the mediators, and there being no unobserved confounding among the mediators. In contrast, interventional direct and indirect effects for multiple mediators (Vansteelandt and Daniel, 201…
In causal mediation analysis, nonparametric identification of the pure (natural) direct effect typically relies on, in addition to no unobserved pre-exposure confounding, fundamental assumptions of (i) so-called "cross-world-counterfactuals" independence and (ii) no exposure- induced confounding. When the mediator is binary, bounds for partial identification have been given when neither assumption is made, or alternatively when assuming only (ii). We extend existing bounds to the case of a polytomous mediator, and provide bounds for the case assuming only (i). We apply these bounds to data fro…
Mediation analysis seeks to infer how much of the effect of an exposure on an outcome can be attributed to specific pathways via intermediate variables or mediators. This requires identification of so-called path-specific effects. These express how a change in exposure affects those intermediate variables (along certain pathways), and how the resulting changes in those variables in turn affect the outcome (along subsequent pathways). However, unlike identification of total effects, adjustment for confounding is insufficient for identification of path-specific effects because their magnitude is…
University of Cambridge（剑桥大学）；University of Cagliari（卡利亚里大学）
Given empirical evidence for the dependence of an outcome variable on an exposure variable, we can typically only provide bounds for the "probability of causation" in the case of an individual who has developed the outcome after being exposed. We show how these bounds can be adapted or improved if further information becomes available. In addition to reviewing existing work on this topic, we provide a new analysis for the case where a mediating variable can be observed. In particular we show how the probability of causation can be bounded when there is no direct effect and no confounding. Keyw…
To estimate direct and indirect effects of an exposure on an outcome from observed data strong assumptions about unconfoundedness are required. Since these assumptions cannot be tested using the observed data, a mediation analysis should always be accompanied by a sensitivity analysis of the resulting estimates. In this article we propose a sensitivity analysis method for parametric estimation of direct and indirect effects when the exposure, mediator and outcome are all binary. The sensitivity parameters consist of the correlation between the error terms of the mediator and outcome models, th…
Causally Interpretable Meta-Mediation Analysis With Missing At Random Mediator and Outcome Data
EPILOGY, Institut Mondor of Biomedical Research, INSERM U955（INSERM U955 蒙多尔生物医学研究所 EPILOGY）；Université Paris-Est Créteil（巴黎东克雷泰伊大学）；Mines Paris, Université Paris Sciences Lettres（巴黎矿业学院，巴黎文理研究大学）；Department of Mathematics, Université du Québec à Montréal（蒙特利尔大学数学系）
Inverse Probability Weighting-based Mediation Analysis for Microbiome Data
The University of Texas at San Antonio（德克萨斯大学圣安东尼奥分校）；The University of Texas MD Anderson Cancer Center（德克萨斯大学安德森癌症中心）；BeOne Medicines（博生医药）；Texas A&M University（德克萨斯农工大学）；University of Toronto（多伦多大学）；Columbia University（哥伦比亚大学）
Causal mediation analysis usually requires strong assumptions, such as ignorability of the mediator, which may not hold in many social and scientific studies. Motivated by a multilevel randomized treatment experiment using functional magnetic resonance imaging (fMRI), this paper proposes a multilevel causal mediation framework for data with hierarchically nested structure, and this framework provides valid inference even if structured unmeasured confounding for the mediator and outcome is present. For the first-level data, we propose a linear structural equation model for a continuous mediator…
While estimation of the marginal (total) causal effect of a point exposure on an outcome is arguably the most common objective of experimental and observational studies in the health and social sciences, in recent years, investigators have also become increasingly interested in mediation analysis. Specifically, upon evaluating the total effect of the exposure, investigators routinely wish to make inferences about the direct or indirect pathways of the effect of the exposure, through a mediator variable or not, that occurs subsequently to the exposure and prior to the outcome. Although powerful…
Mediation analysis is appealing for its ability to improve understanding of the mechanistic drivers of causal effects, but real-world data complexities challenge its successful implementation, including: 1) the existence of post-exposure variables that also affect mediators and outcomes (thus, confounding the mediator-outcome relationship), that may also be 2) multivariate, and 3) the existence of multivariate mediators. Interventional direct and indirect effects (IDE/IIE) accommodate post-exposure variables that confound the mediator-outcome relationship, but currently, no estimator for IDE/I…
Since the early 2000s, evidence has accumulated for a significant differential effect of first-line antiretroviral therapy (ART) regimens on human immunodeficiency virus (HIV) viral load suppression. This finding was replicated in our data from the Harvard President's Emergency Plan for AIDS Relief (PEPFAR) program in Nigeria. Investigators were interested in finding the source of these differences, i.e., understanding the mechanisms through which one regimen outperforms another, particularly via adherence. This question can be naturally formulated via mediation analysis with adherence playing…
It is often of interest to decompose a total effect of an exposure into the component that acts on the outcome through some mediator and the component that acts independently through other pathways. Said another way, we are interested in the direct and indirect effects of the exposure on the outcome. Even if the exposure is randomly assigned, it is often infeasible to randomize the mediator, leaving the mediator-outcome confounding not fully controlled. We develop a sensitivity analysis technique that can bound the direct and indirect effects without parametric assumptions about the unmeasured…
