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Robust inference for causal mediation analysis of recurrent event data.

Yan-Lin Chen1, Yan-Hong Chen2, Pei-Fang Su3

  • 1Institute of Statistics, National Yang Ming Chiao Tung University, Hsin-Chu, Taiwan.

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|May 21, 2024
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Summary

This study introduces a new causal mediation analysis method for recurrent events, like cardiovascular disease. The method helps understand how treatments affect event frequency and the role of mediators, such as kidney function.

Keywords:
causal inferenceinverse probability weightingmediation analysisrecurrent eventsrobust inferencetriply robust estimation

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Area of Science:

  • Biostatistics
  • Epidemiology
  • Causal Inference

Background:

  • Recurrent events, such as cardiovascular events, are common in biomedical research.
  • Understanding treatment effects and mediation mechanisms is crucial for managing recurrent conditions.
  • Existing causal inference methods do not adequately address mediation for recurrent event data.

Purpose of the Study:

  • To propose a novel methodology for causal mediation analysis tailored to recurrent event data.
  • To formally define causal direct and indirect effects for recurrent outcomes within a counterfactual framework.
  • To develop a robust statistical approach for estimating these effects.

Main Methods:

  • Developed a novel causal mediation analysis framework for recurrent outcomes.
  • Defined causal estimands (direct and indirect effects) using counterfactual definitions.
  • Created a semiparametric estimator with triple robustness against model misspecification.

Main Results:

  • Successfully applied the novel methodology to a real-world dataset.
  • Quantified the effects of two diabetes drugs on cardiovascular disease recurrence.
  • Examined the mediating role of kidney function in the relationship between diabetes drugs and cardiovascular events.

Conclusions:

  • The proposed causal mediation analysis methodology effectively accommodates recurrent event data.
  • This approach provides a robust tool for understanding treatment effects and mediation in recurrent event settings.
  • The findings offer insights into managing cardiovascular disease recurrence in diabetes patients by considering kidney function.