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Causal mediation analysis examines the mechanism by which exposure affects outcome via mediators. In contrast to single-mediator scenarios, the presence of multiple ordered mediators introduces complex pathways and corresponding path-specific effects, which are difficult to interpret due to the cross-world counterfactual definition. Path-specific effects also require convoluted and unverifiable assumptions for identification. This article proposes a framework of separable path-specific effects as an extension of the separable effect method to the case of multiple ordered mediators. Compared to the traditional approach, separable path-specific effects can be interpreted as the causal effects of several separated components on the outcome, facilitating a more intuitive understanding of underlying mechanisms. We elucidate the relationship between separable and traditional path-specific effects by demonstrating their equivalence under the individual-level isolation assumptions and identifying both effects under the finest fully randomized causally interpretable structured tree graph (FFRCISTG) model, which inherently makes individual-level isolation assumptions. Moreover, weakening the individual-level isolation assumptions to their population-level counterparts, separable path-specific effects remain identifiable under the FFRCISTG model. Under this causal model, the assumptions for identifying separable path-specific effects can be verified in future experiments, thereby addressing the problem of relying on unverifiable cross-world assumptions in the traditional method. We also discuss how this framework can detect violations of assumptions such as the presence of intermediate confounders and the misspecification of causal order among mediators. In summary, compared with the traditional path-specific effects method, the proposed separable method provides a more verifiable and interpretable approach for causal multiple mediation analysis.
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http://dx.doi.org/10.1097/EDE.0000000000001887 | DOI Listing |
Background: Metals are associated with cardiovascular disease (CVD), but the underlying pathways remain largely unclear. We evaluated the potential intermediate role of coronary artery calcification (CAC) trajectory on the association between urinary metals and incident CVD, accounting for competing risks by death from other causes.
Methods: We used data from 6,527 participants of the Multi-Ethnic Study of Atherosclerosis (MESA).
Pharm Stat
July 2025
Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium.
Questions about the mode of action (MoA) of a drug have interest to scientific communities as well as regulatory authorities. In the absence of an already established MoA such questions may be enlightened by causal mediation analysis in clinical trials. In this paper, we present a general framework that facilitates causal mediation analysis in a setting of a clinical trial where both the outcome of interest, one or more mediators and additional potential post-baseline confounders are measured repeatedly at planned visits.
View Article and Find Full Text PDFEpidemiology
September 2025
From the Institute of Statistics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
Causal mediation analysis examines the mechanism by which exposure affects outcome via mediators. In contrast to single-mediator scenarios, the presence of multiple ordered mediators introduces complex pathways and corresponding path-specific effects, which are difficult to interpret due to the cross-world counterfactual definition. Path-specific effects also require convoluted and unverifiable assumptions for identification.
View Article and Find Full Text PDFBiometrics
April 2025
Univ. Bordeaux, Inserm, Bordeaux Population Health, U1219, F-33000 Bordeaux, France.
Mediation analysis aims to decipher the underlying causal mechanisms between an exposure, an outcome, and intermediate variables called mediators. Initially developed for fixed-time mediator and outcome, it has been extended to the framework of longitudinal data by discretizing the assessment times of mediator and outcome. Yet, processes in play in longitudinal studies are usually defined in continuous time and measured at irregular and subject-specific visits.
View Article and Find Full Text PDFStat Med
February 2025
Department of Statistics, University of California, Davis, California, USA.
A causal mediation model with multiple time-to-event mediators is exemplified by the natural course of human disease marked by sequential milestones with a time-to-event nature. For example, from hepatitis B infection to death, patients may experience intermediate events such as liver cirrhosis and liver cancer. The sequential events of hepatitis, cirrhosis, cancer, and death are susceptible to right censoring; moreover, the latter events may preclude the former events.
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