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Mediation Approach to study Interplay of Poverty, Socioeconomic Status and Treatment on Mortality

Abstract Number:

2749 

Submission Type:

Contributed Abstract 

Contributed Abstract Type:

Poster 

Participants:

Demond Handley (1), Yesung Kweon (1), Samiila Obeng-Gyasi (2), Jesse Plascak (2), Mohamed Elsaid (3)

Institutions:

(1) The Ohio State University, N/A, (2) The Ohio State University Wexner Medical Center, Columbus, OH, (3) N/A, N/A

Co-Author(s):

Yesung Kweon  
The Ohio State University
Samiila Obeng-Gyasi  
The Ohio State University Wexner Medical Center
Jesse Plascak  
The Ohio State University Wexner Medical Center
Mohamed Elsaid  
N/A

First Author:

Demond Handley  
The Ohio State University

Presenting Author:

Demond Handley  
The Ohio State University

Abstract Text:

Prior studies showed Persistent poverty (PP) to have effect on risk of mortality for various cancers. We used a causal path-specific mediation approach to understand how the interplay between census-tract level PP, socioeconomic status (SES), and receipt of cancer treatment affect mortality. Using Cox models, we obtain weighted causal estimates for the natural direct effect (NDE) of PP on mortality, and natural indirect effects (NIE) of PP on mortality through the combined pathways considering an exposure-induced mediator-outcome confounder SES and treatment mediator. We use data on 50,533 stage I-IV hepatocellular carcinoma patients, identified in the SEER program. The analysis showed PP had indirect effect on higher mortality probability. Cox models yielded NDE 1.06 (95% CI: 0.99-1.13) of PP on mortality accounted for 31% of total effect. The NIE 1.03 (95% CI: 1.02-1.05) of PP on mortality, through the combined SES pathway, accounted for 16% of total effect, and the NIE 1.10 (95% CI: 1.04-1.17) of PP on mortality only through treatment mediator, accounted for 53% of total effect. Thus, SES and receiving treatment contribute to understanding the causal effect of PP on mortality.

Keywords:

Causal Analysis|Mediation Analysis|Persistent Poverty|Cancer|Mortality|

Sponsors:

Section on Statistics in Epidemiology

Tracks:

Causal Inference

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