论文标题
在存在竞争风险的情况下对事件终点的纵向调解分析
Longitudinal mediation analysis of time-to-event endpoints in the presence of competing risks
论文作者
论文摘要
该提案是由对英国衰老纵向研究（ELSA）的分析进行的，该研究旨在调查孤独感在解释听力损失对痴呆症的负面影响中的作用。使这种调解分析复杂化的方法论挑战包括使用遇到竞争风险的时间端点，以及调解人与混杂因素之间的反馈关系，这些终点随着时间的推移反复测量。为了解决这些挑战，我们引入了自然效应比例（特定原因）危害模型。这些扩展了边际结构比例（特定原因）危害模型以实现效应分解。我们表明，在某些因果假设下，可以从观察到的数据中识别该模型的路径特异性直接和间接效应。接下来，我们提出了一种估计这些效果的反概率加权方法。在ELSA数据上，这种方法几乎没有证据表明，听力损失的总效率是通过孤独感来介导的，其非统计学上的显着间接效应等于1.012（危险比（HR）量表； 95％置信区间； 95％置信区间（CI）0.986至1.053）。
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).
