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

Yesung Kweon Co-Author
The Ohio State University
 
Samiila Obeng-Gyasi Co-Author
The Ohio State University Wexner Medical Center
 
Jesse Plascak Co-Author
The Ohio State University Wexner Medical Center
 
Mohamed Elsaid Co-Author
 
Demond Handley First Author
The Ohio State University
 
Demond Handley Presenting Author
The Ohio State University
 
Monday, Aug 4: 2:00 PM - 3:50 PM
2749 
Contributed Posters 
Music City Center 
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 

Abstracts


Main Sponsor

Section on Statistics in Epidemiology