A Multivariate Multiple Third-Variable Effect Analysis with an Application to Explore Racial and Ethnic Disparities...

Area of Science:

• Epidemiology
• Biostatistics
• Public Health

Background:

• Racial and ethnic minorities, particularly Black and Hispanic populations, experience disproportionately higher rates of obesity and related chronic diseases compared to non-Hispanic Whites.
• Understanding the complex interplay of factors contributing to these health disparities is crucial for developing targeted interventions.

Purpose of the Study:

• To extend the general third-variable effect analysis (TVEA) method to accommodate multivariate/multicategorical predictors and multivariate response variables.
• To develop and apply novel algorithms and an R package for analyzing multiple mediators/confounders (MCs) simultaneously.
• To identify and quantify the indirect effects of potential MCs in explaining racial and ethnic disparities in obesity and body mass index (BMI) using NHANES data.

Main Methods:

• Extension of the general TVEA method to handle multivariate outcomes and predictors.
• Development of algorithms and an R package for implementing the extended TVEA.
• Application of the method to the National Health and Nutrition Examination Survey (NHANES) dataset.
• Inclusion of socio-demographic, individual, and environmental variables as potential MCs.

Main Results:

• The extended TVEA successfully identified multiple mediators/confounders (MCs) influencing obesity and BMI.
• Quantification of the indirect effects of identified MCs revealed their contribution to racial and ethnic disparities.
• Significant socio-demographic, individual, and environmental factors were found to explain a portion of the ethnic/racial differences in obesity and BMI.

Conclusions:

• The developed methodology provides a robust framework for analyzing complex health disparities involving multiple influencing factors.
• The study successfully identified key variables that mediate racial and ethnic differences in obesity and BMI.
• These findings underscore the importance of considering a comprehensive set of variables to understand and address health inequities.