The role of multiple mediation with contextual neighborhood measures in ovarian cancer survival

IF 4.3 3区材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC

ACS Applied Electronic Materials Pub Date : 2024-10-09 DOI:10.1016/j.annepidem.2024.10.002

Andrew B. Lawson , Yao Xin , Edward S. Peters , Courtney Johnson , Theresa Hastert , Elisa V. Bandera , Anthony J. Alberg , Lindsay Collin , Paul Terry , Maxwell Akonde , Hannah Mandle , Michele L. Cote , Melissa Bondy , Jeffrey Marks , Lauren C. Peres , Kendra L. Ratnapradipa , Joellen M. Schildkraut

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引用次数: 0

Abstract

Background

Mediation by multiple agents can affect the relation between neighborhood deprivation and segregation indices and ovarian cancer survival. In this paper, we examine a variety of potential clinical mediators in the association between deprivation indices (DIs) and segregation indices (SIs) with all-cause survival among women with ovarian cancer in the African American Cancer Epidemiology Study (AACES).

Methods

We use novel Bayesian multiple mediation structural models to assess the joint role of mediators (stage at diagnosis, histology, diagnostic delay) combined with the DIs and SIs (Yost, ADI, Kolak’s URB, ICE-income) and a set of confounders with survival. The confounder set is selected in a preliminary step, and each DI or SI is included in separate model fits.

Results

When multiple mediators are included, the total impact of DIs and SIs on survival is much reduced. Unlike the single mediator examples previously reported, the Yost, ADI and ICE-income indices do not display significant direct effects. This suggests that when important clinical mediators are included, the impact of neighborhood SES indices is significantly attenuated. It is also clear that certain behavioral and demographic measures such as physical activity, smoking, or adjusted family income do not have a significant role in survival when mediated by clinical factors.

Conclusion

Multiple mediation via clinical and diagnostic-related measures reduces the contextual effects of neighborhood measures on ovarian cancer survival. The robust association of the Kolak URB index on survival may be due to its relevance to access to care, unlike SES-based indices whose impact was significantly reduced when important clinical mediators were included.

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卵巢癌存活率与邻近环境因素的多重中介作用......

背景：多种因素的中介作用可能会影响邻里贫困指数和隔离指数与卵巢癌生存率之间的关系。在本文中，我们研究了非裔美国人癌症流行病学研究（AACES）中卵巢癌女性患者的贫困指数（DIs）和隔离指数（SIs）与全因生存之间关系的各种潜在临床中介因素：我们使用新型贝叶斯多重中介结构模型来评估中介因素（诊断分期、组织学、诊断延迟）、DIs 和 SIs（Yost、ADI、Kolak's URB、ICE-income）以及一组混杂因素对生存的共同作用。混杂因素集在初步步骤中选定，每个 DI 或 SI 都包含在单独的模型拟合中：结果：当包括多个中介因素时，直接诱因和间接诱因对生存的总影响大大降低。与之前报道的单一中介因子的例子不同，约斯特指数、ADI 指数和 ICE-income 指数没有显示出显著的直接影响。这表明，如果将重要的临床中介因素包括在内，邻里社会经济地位指数的影响就会明显减弱。同样明显的是，某些行为和人口统计指标，如体育锻炼、吸烟或调整后的家庭收入，在临床因素的中介作用下，对生存率的影响并不明显：结论：通过临床和诊断相关因素的多重中介作用降低了邻里因素对卵巢癌生存率的影响。科拉克URB指数与生存率的紧密联系可能是由于其与获得医疗服务的相关性，这与基于社会经济地位的指数不同，后者的影响在纳入重要的临床中介因素后显著降低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ACS Applied Electronic Materials Multiple-

CiteScore

7.20

自引率

4.30%

发文量

567